Dear patient,
benign thyroid disease can be treated in several ways. Firstly, there is the option of taking medication; surgery and radioiodine therapy are also available.
Medication for hyperthyroidism can have severe side effects and lead to further growth of the thyroid gland. If the disease persists, a definitive therapy, i.e. either surgery or radioiodine therapy, often has to be carried out even after the start of drug treatment. The success of these two methods appears to be largely equivalent.
The patient must be given an anaesthetic for the operation, as the patient must lie absolutely still during the procedure and particular attention must be paid to the vocal cord nerves. Under certain circumstances, an injury could lead to permanent paralysis of one or both vocal cords. Swelling and pain may occur after the operation and a scar will remain.
The side effects of radioiodine therapy are significantly less severe. This has been an established and extremely effective treatment for more than 40 years. A radioactive form of iodine, iodine-131, has a radiation range of only a few millimetres in the tissue. This elegantly and selectively treats only the areas of the thyroid gland that are actually causing the hyperthyroidism and spares the other, healthy tissue. Even the smallest areas can be treated, which appear to be inconspicuous on ultrasound, but nevertheless contain cells that cause the faulty hyperfunction independently of regulatory mechanisms.
A small proportion of the iodine-131 radiation escapes from the body and is used to check the effect of the therapy. This is also the reason why radioiodine therapy may only be carried out in Germany during an inpatient stay of at least 48 hours.
The iodine-131 is administered in the form of a small capsule and reaches the overproducing areas of the thyroid gland via the bloodstream and irradiates them precisely. The iodine that is not absorbed by the thyroid gland is excreted in the urine within the next few hours. In most cases, a single treatment is sufficient to achieve the full effect; a second treatment is rarely necessary. Sometimes it may be necessary to take thyroid tablets after the therapy, as well as after an operation. They serve to prevent further growth. In rare cases, a sore throat, similar to a cold, may occur after therapy. If this occurs, the throat can be cooled and by taking anti-inflammatory substances, the patient will experience relief and freedom from symptoms after a short time. Unfortunately, for reasons of radiation protection, no visitors may be received during the inpatient stay and the ward area may not be left from the ward corridor and rooms. The bright and spacious rooms on the ward are equipped with a window, free TV and radio as well as a bathroom. Special features of these rooms include specially shielded walls and windows as well as a so-called drainage system to collect waste water. The length of stay depends on the type of illness, the dose and the individual excretion and is usually between 2 and 5 days. After discharge, depending on the patient, we recommend keeping a distance of a few days from small children and pregnant women, after which no further precautionary measures are necessary.
Would you like to find out more or make an appointment for treatment? We will be happy to advise you!
(see contact above)
PRRT
Neuroendocrine tumour cells have special receptors on their surface that serve as a "docking site" for the hormone somatostatin. These so-called somatostatin receptors also occur naturally in other body tissues, but their density is particularly high in the cells of certain neuroendocrine tumours.
Nuclear medicine uses a special substance (DOTAiTATE) that can bind to somatostatin receptors. The substance is coupled with radioactive elements in the laboratory and can be introduced into the body in the form of an injection or infusion. In this way, the radioactive molecules reach those cells that have somatostatin receptors. Depending on the type of radioactive labelling, precise, sensitive diagnostics (DOTAiTATE - PET/CT) or systemic treatment (radiopeptide therapy, PRRT) are possible.
For therapy, DOTAiTATE is chemically combined with radioactive lutetium-177(177Lu). The substance labelled in this way accumulates in the body in exactly the same way as previously determined on the PET/CT images and is retained in the respective cells for a longer period of time. The lutetium emits high-energy beta rays, which only have a short range of a few millimetres in the body, but transfer high doses of energy into the diseased tissue. This results in precise, targeted "internal irradiation" of these tissues.
This means that metastasised neuroendocrine tumours can be treated in a targeted manner. In many cases, it is possible to reduce the tumour mass, slow down the progression of the disease and improve any existing neuroendocrine symptoms. The therapy has been used in many places for many years and is generally well tolerated with few side effects.
The indication for the treatment of a neuroendocrine tumour is typically determined on an interdisciplinary basis by internal oncology, endocrinology, surgery and nuclear medicine. The actual treatment then takes place on the nuclear medicine therapy ward and involves a stay of around three days. The therapeutic substance is administered on the first day of the stay in the form of an intravenous infusion, whereby additional medication is usually also administered to improve tolerance. For certain indications in certain neuroendocrine tumours, we have also been offering the approved therapeutic agent Lutathera® (lutetium-177 oxodotreotide) for therapy since mid-2022.
The treatment consists of several therapy cycles, which are carried out several months apart. Depending on the response and tolerability, two to four or even more such cycles can be administered.
Would you like to find out more or make an appointment for treatment? We will be happy to advise you!
(see contact above)
PSMA - Therapy
Radionuclide therapy with lutetium-177-PSMA ("PSMA therapy" for short) is a modern, innovative therapeutic procedure that is becoming increasingly popular in the treatment of certain stages of metastasised prostate cancer. The therapy is usually very well tolerated and provides promising initial results.
The prostate-specific membrane antigen (PSMA) occurs naturally in many body tissues, but is found to a particularly high degree on prostate carcinoma cells. This makes it a suitable target structure for the diagnosis and treatment of prostate carcinoma and its metastases.
In nuclear medicine, special substances are used that can bind to PSMA. These so-called ligands are coupled with radioactive substances in the laboratory and injected into the body. In this way, the radioactive molecules enter the cells that carry the PSMA. Depending on the type of radioactive labelling, precise, sensitive diagnostics (PET/CT) or treatment (PSMA therapy) are possible.
For therapy, the ligands are chemically combined with radioactive lutetium-177(177Lu). The substance accumulates in the body in exactly the same way as was previously determined on the PET/CT images and is retained in the respective cells for a longer period of time. The lutetium emits high-energy beta rays, which only have a short range of a few millimetres in the body, but transfer high doses of energy into the diseased tissue. This enables precise, targeted "internal irradiation" of these tissues.
The decision as to when PSMA therapy is appropriate in the course of treatment is typically made on an interdisciplinary basis by oncologists, urologists and nuclear medicine specialists. The actual treatment takes place on the nuclear medicine therapy ward and usually involves a three-day inpatient stay. Since 05/2023, it has also been possible to use the approved therapeutic agent Pluvicto® (lutetium-177-vipivotide tetraxetane), which, according to studies, may also be indicated and used earlier in the treatment cascade.
Would you like to find out more or make an appointment for treatment? We will be happy to advise you!
(see contact above)
Case study PSMA therapy
mCRPC (73 y), GS: 3+4 =7; ED 02/2007.
Histology from liver metastases: Metastasis of a poorly differentiated, partly neuroendocrine de-differentiated prostate adenocarcinoma, G3.
Condition after ADT including abiraterone, 9x docetaxel, 28x cabazitaxel
SIRT
Selective internal radiotherapy (SIRT) is a minimally invasive therapy for the treatment of tumour tissue in the liver (primary liver tumours and possibly also liver metastases from other diseases).
As part of the treatment, small radioactively loaded spheres (so-called microspheres) are introduced into the liver. These microspheres remain trapped in the smallest blood vessels in the well-perfused tumour tissue. The radioactive substance yttrium-90 contained in the spheres emits therapeutically effective beta radiation over a period of several days. The radiation transmits high local energy doses, although its range in the body is only about one centimetre.
This achieves a high radiation effect in the tumour tissue while sparing the surrounding healthy parts of the liver. The tumour tissue is substantially damaged in this way, preventing further growth and spread. The tumour foci can thus be reduced in size or, under certain circumstances, removed completely.
SIRT utilises a special feature of the liver's blood vessel supply. While healthy liver tissue receives its blood supply mainly from the hepatic vein (portal vein), tumour tissue is usually supplied with blood mainly from the hepatic artery. The microspheres are therefore introduced into the hepatic artery via the groin using a special catheter (angiography) in collaboration with doctors from the radiology clinic.
The treatment can halt further progression of the disease for some time and maintain quality of life as long and as well as possible.
The decision as to whether SIRT can be used sensibly is typically made in an interdisciplinary tumour conference with colleagues from all medical disciplines involved.
The necessary preliminary examinations and the actual treatment are carried out by doctors from the Nuclear Medicine and Radiology clinics (combined in the Centre for Imaging) and in cooperation with the Internal Medicine I department. In order to minimise side effects or complications, the entire liver is not usually treated at the same time, but instead parts of the liver are usually treated in stages in two treatment cycles, several weeks apart. The individual treatment cycles each take place during a stay of around three days on an internal medicine ward.
Would you like to find out more or make an appointment for treatment? We will be happy to advise you!
(see contact above)
Xofigo - Therapy
Treatment with radium-223 (Xofigo®) is suitable for patients with painful bone metastases from a prostate carcinoma that no longer responds to hormonal treatment (so-called castration-resistant stage) if there are no known distant metastases in other organs.
Where there are metastases in the skeletal system, there is typically a significantly increased bone metabolism. Radium accumulates in the bones in a similar way to calcium from food and, depending on the bone metabolism, to a particularly high degree where there are bone metastases. Radium emits high-energy alpha radiation, which, however, only has a very short range in the body. In this way, targeted internal irradiation of the bone metastases is possible, whereby surrounding, non-affected body tissue is largely spared. This can improve pain symptoms and prolong survival time.
The decision as to whether treatment with Xofigo® is appropriate is typically made on an interdisciplinary basis by urologists, oncologists and nuclear medicine specialists. As the therapeutically effective radiation does not leave the body, treatment is possible on an outpatient basis. It is offered and carried out in the Nuclear Medicine Clinic.
Patients typically receive six injections of Xofigo® at one-month intervals. If necessary, the intervals between injections can also be extended. Similarly, in individual cases, more or less than six injections of Xofigo® can be administered.
Would you like to find out more or make an appointment for treatment? We will be happy to advise you!
(see contact above)