ACR-ACNM-ARS-ASTRO-SNMMI Practice Parameter for the Performance of Therapy With Radiopharmaceuticals

OBJECTIVES

This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine, the American Radium Society, the American Society for Radiation Oncology, and the Society of Nuclear Medicine and Molecular Imaging. The document is intended to serve as a resource for appropriately trained and licensed physicians who perform therapeutic procedures with unsealed sources, referred to in the document using the more inclusive terminology of radiopharmaceuticals, for which a written directive is required for authorized users under NRC 10 CFR 35.300.

METHODS

This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the American Radium Society.

RESULTS

This practice parameter addresses the overall role of the applicable physician-authorized user, Qualified Medical Physicist, and other specialized personnel involved in the delivery of radiopharmaceutical therapy. Therapeutic radiopharmaceuticals include those administered as elemental radioactive isotopes (radionuclides) or the radioactive element incorporated into a targeting molecule (ligand) by one or more chemical bonds. This document provides guidance regarding general principles of radionuclide therapies and indications of various alpha, beta, gamma, and mixed emission agents with references to several recent practice parameters on new and commonly performed radiopharmaceutical therapies.

CONCLUSION

This document addresses clinical circumstances, elements of available agents, and the qualifications and responsibilities of various members of the radiation care team, specifications of consultation and other clinical documentation, post-therapy follow-up, radiation safety precautions, elements of quality control and improvement programs, infection control, and patient education to ensure optimal patient care and safety when utilizing radiopharmaceuticals.

Principal component analysis identifies patterns of cytokine expression in non-small cell lung cancer patients undergoing definitive radiation therapy

Background/Purpose

Radiation treatment (RT) stimulates the release of many immunohumoral factors, complicating the identification of clinically significant cytokine expression patterns. This study used principal component analysis (PCA) to analyze cytokines in non-small cell lung cancer (NSCLC) patients undergoing RT and explore differences in changes after hypofractionated stereotactic body radiation therapy (SBRT) and conventionally fractionated RT (CFRT) without or with chemotherapy.

Methods

The dataset included 141 NSCLC patients treated on prospective clinical protocols; PCA was based on the 128 patients who had complete CK values at baseline and during treatment. Patients underwent SBRT (n = 16), CFRT (n = 18), or CFRT (n = 107) with concurrent chemotherapy (ChRT). Levels of 30 cytokines were measured from prospectively collected platelet-poor plasma samples at baseline, during RT, and after RT. PCA was used to study variations in cytokine levels in patients at each time point.

Results

Median patient age was 66, and 22.7% of patients were female. PCA showed that sCD40l, fractalkine/C3, IP10, VEGF, IL-1a, IL-10, and GMCSF were responsible for most variability in baseline cytokine levels. During treatment, sCD40l, IP10, MIP-1b, fractalkine, IFN-r, and VEGF accounted for most changes in cytokine levels. In SBRT patients, the most important players were sCD40l, IP10, and MIP-1b, whereas fractalkine exhibited greater variability in CFRT alone patients. ChRT patients exhibited variability in IFN-γ and VEGF in addition to IP10, MIP-1b, and sCD40l.

Conclusions

PCA can identify potentially significant patterns of cytokine expression after fractionated RT. Our PCA showed that inflammatory cytokines dominate post-treatment cytokine profiles, and the changes differ after SBRT versus CFRT, with vs without chemotherapy. Further studies are planned to validate these findings and determine the clinical significance of the cytokine profiles identified by PCA.

Pros: concurrent chemo-radiotherapy remains the ideal treatment in fit patients with large volume unresectable stage III non-small cell lung cancer

The debate of treating stage III, large volume non-small cell lung cancer (NSCLC) with definitive chemo-radiotherapy continues to be waged. A physically fit patient, having large volume and unresectable disease is the ideal candidate for this treatment approach. The ability of this patient population to successfully complete, and thereby benefit from an aggressive, combined treatment to improve local control and survival, drives the recommendation of treating oncologists for this approach. Until a phase III trial proves otherwise, concurrent chemo-radiotherapy will remain the ideal treatment for fit patients having large volume unresectable stage III NSCLC.

Uptake and distribution of ultrasmall anatase TiO2 Alizarin red S nanoconjugates in Arabidopsis thaliana

While few publications have documented the uptake of nanoparticles in plants, this is the first study describing uptake and distribution of the ultrasmall anatase TiO(2) in the plant model system Arabidopsis. We modified the nanoparticle surface with Alizarin red S and sucrose and demonstrated that nanoconjugates traversed cell walls, entered into plant cells, and accumulated in specific subcellular locations. Optical and X-ray fluorescence microscopy coregistered the nanoconjugates in cell vacuoles and nuclei.

Assembly and Charge Transfer in Hybrid TiO2Architectures Using Biotin−Avidin as a Connector

Exploiting the presence of undercoordinated surface Ti atoms at the tips of TiO2 nanorods and the dopamine selectivity for these Ti surface states, biotin was conjugated to TiO2 nanocrystallites using dopamine as a bridging linker. Using abiotin-avidin complex as a connector the "tip-to-tip" assembly of 400 nm elongated TiO2 rods was obtained. The photoexcitation of avidin-TiO2 hybrids resulted in the transfer of holes from nanocrystallites to protein and consequent oxidation of avidin, most probably at tyrosine 33.

Aqueous self-assembly of unsymmetric Peptide bolaamphiphiles into nanofibers with hydrophilic cores and surfaces

Unsymmetric peptide bolaamphiphiles that incorporate (l-glutamyl)3glycine at one terminus and either tetraethylene glycol or aspartic acid at the other were found to form hydrogels at low wt %, presumably by self-assembling into nanofibers presenting (l-glutamyl)3glycine at their surfaces and burying the second headgroup at their cores. Transmission electron microscopy measurements on 1 wt % gels negatively stained with phosphotungstic acid and positively stained with uranyl acetate show one-dimensional objects with diameters of 5 nm and lengths in excess of 1 mum. Circular dichroism and solid-state FTIR spectra indicate the adoption of beta-sheet structure within the nanofibers.

Assembling a lasing hybrid material with supramolecular polymers and nanocrystals

The combination of bottom-up and top-down processes to organize nanophases in hybrid materials is a key strategy to create functional materials. We found that oxide and sulphide nanocrystals become spontaneously dispersed in organic media during the self-assembly of nanoribbon supramolecular polymers. These nanoribbon polymers form by self-assembly of dendron rodcoil molecules, which contain three molecular blocks with dendritic, rod-like, and coil-like architectures. In an electric field these supramolecular assemblies carrying bound nanocrystals migrate to the positive electrode in an etched channel and align in the field. In the system containing ZnO nanocrystals as the inorganic component, both phases are oriented in the hybrid material forming an ultraviolet lasing medium with a lower threshold relative to pure ZnO nanocrystals.