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Luke Nordquist, MD, FACP, CEO
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tromero@gucancer.comWhat to Expect
as a Theranostic Patient
Theranostic treatments combine diagnostic imaging with targeted therapy using radiopharmaceuticals — drugs that deliver radiation directly to cancer cells while minimizing harm to healthy tissue.
Theranostic treatments combine diagnostic imaging with targeted therapy using radiopharmaceuticals. These are drugs that deliver radiation directly to cancer cells to image or treat a cancer while minimizing harm to healthy tissue. This personalized approach has been most often used for cancers like prostate cancer and neuroendocrine tumors in the past but is currently being investigated in most other types of cancer.
Important Note
The information below provides a general overview of what you might experience. This is not a substitute for personalized advice from your healthcare team. Always discuss your specific treatment plan, risks, benefits, and instructions with your Theranostics providers.
Your Theranostics Care Team
Your treatment will be overseen by a multidisciplinary team, typically including:
Authorized User (AU)
A specially trained and licensed physician, usually a nuclear medicine physician or radiation oncologist, who is authorized to prescribe and supervise the administration of radiopharmaceuticals.
Nuclear Medicine Technologists
Trained professionals who are licensed to prepare and administer the radiopharmaceutical and perform imaging scans.
Primary Oncologist
Your primary oncologist or referring physician, who coordinates overall cancer care.
Together, this team will educate you about the specific radiopharmaceutical being used, the reason for your treatment, how it targets your cancer, expected benefits, and potential side effects (such as dry mouth, fatigue, nausea, or effects on blood counts). They will also provide guidance on managing side effects and any necessary precautions after treatment.
Theranostic Imaging
Before therapy (and sometimes during or after), imaging helps confirm that the radiopharmaceutical targets your cancer effectively.
PET/CT
Positron Emission Tomography / Computed Tomography
Commonly used for initial diagnostic scans in Theranostics (e.g., with gallium-68, fluorine-18, copper-64 tracers). It provides high-resolution images, excellent sensitivity for detecting small tumors, and precise localization by combining functional (PET) and anatomical (CT) information. PET imaging identifies the locations of the cancer that later the therapeutic Theranostic agent will seek out to treat.
SPECT/CT
Single Photon Emission Computed Tomography / CT
Often used for post-therapy imaging (e.g., with lutetium-177 or other beta-emitters that emit gamma rays). It has slightly lower resolution than PET/CT but is widely available and effective for monitoring radiation distribution after treatment.
Your team will explain which type of scan you need and why.
Types of Treatment Theranostics
Theranostic treatments typically use two types of radiation: beta emitters or alpha emitters.
Beta Emitters
e.g., lutetium-177
These release electrons that travel several millimeters in tissue, damaging cancer cells and some surrounding areas (cross-fire effect). They may be more effective for larger tumors or clusters.
Alpha Emitters
e.g., actinium-225
These release high-energy alpha particles that travel only a very short distance (a few cell widths). They deliver intense, highly targeted damage to cancer cells with minimal impact on nearby healthy tissue, potentially making them useful for microscopic disease or resistant tumors.
Side effects and radiation precautions can differ between alpha and beta therapies — your team will provide details specific to your treatment. Treatment with a beta emitter may require a patient to limit their time and distance around other people for a period of time. Alpha emitters on the other hand don't have such precautions given the extremely short distance they can travel.
After Treatment
Release Criteria & Safety Precautions
After receiving a therapeutic radiopharmaceutical for imaging or treatment, you may be monitored briefly in the clinic. Discharge decisions are based on radiation safety guidelines to protect family members, caregivers, and the public. These criteria will vary depending on what radiation was administered and what facility and country it was administered in.
Release criteria vary by the isotope used, amount administered, your body's uptake and clearance rate, and regulations in your country. They are generally designed to keep radiation exposure to others well below safe limits (often equivalent to natural background radiation).
Many patients are released the same day (outpatient basis), especially for common beta-emitter therapies.
You will receive written instructions, which may include temporary precautions like limiting close contact with children or pregnant individuals, hygiene measures, or travel restrictions.
Alpha therapies often require fewer external precautions due to their extremely short radiation range.
Your team will tailor these instructions to your situation and provide contact information for questions.
Theranostic treatments offer promising, targeted options for many patients. Open communication with your care team is key to feeling prepared and supported throughout the process. If you have concerns, don't hesitate to ask — they are there to guide you every step of the way.
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