Unsealed source therapy or radionuclide therapy uses the same principles as diagnostic nuclear medicine procedures (see Chapter c20). There will be a vector (a pharmaceutical that will recognize the tumour or target organ) and an isotope (see Table 24.1). Depending on the half‐life of the radiopharmaceutical, the therapy can be given in both outpatient and inpatient settings.
Table 24.1 Therapeutic treatments
Radioactive material
In/outpatient
Condition
Route of administration
Notes
Iodine‐131 sodium iodide
Outpatient treatment
Thyrotoxicosis
Oral (capsule or drink)
Most of the radioactive iodine is concentrated in the thyroid, but a substantial amount will be present in the urine and blood. Lesser quantities will be found in the patient's faeces, sweat, saliva and seminal fluid. The patient should receive an instruction document listing the precautions necessary to safeguard others. The patient may be infirm or incontinent and therefore admitted for treatment
Iodine‐131 sodium iodide
Inpatient treatment
Thyroid cancer
Oral (capsule or drink)
Large administered dose therefore more significant risks. The patient is usually isolated in a special suite
Iodine‐131 mIBG
Inpatient treatment
Neuroblastoma
IV via infusion pump
As above
Strontium‐89
Outpatient treatment
Bone metastases
IV
The patient may be admitted to a ward within a short period of time following treatment, for example upon deterioration of their condition
Samarium‐153
Outpatient treatment
Bone metastases
IV
Patients should be advised to drink plenty of fluids prior to treatment, and urine should be collected for at least 6 hours post treatment
Indium‐111 octreotide
Inpatient treatment
GI cancer and neuroendocrine cancer
IV
Patients are always isolated following treatment, often in specially shielded rooms
Rhenium‐186
Outpatient treatment
Prostate cancer
IV bolus
Radiation protection guidance is given to patients post procedure as per local policies
Radium‐223
Outpatient treatment
Prostate cancer
IV bolus
Radiation protection guidance is given to patients post procedure as per local policies
GI, gastrointestinal; IV, intravenous; mIBG, iodine‐123‐metaiodobenzylguanidine.
