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What to Expect: Lutetium-177 Octreotate Therapy

Lutetium-177 Octreotate Therapy, Neuroendocrine Tumours, What to Expect, Patient Journey, Theranostics, Theranostics Singapore, Cancer Treatment, Dr Andrew Tan

What Is Lutetium-177 Octreotate Therapy? 

One of the therapies used to treat neuroendocrine tumours is Lutetium-177 Octreotate Therapy. It is a targeted radioligand therapy that specially targets tumours that express somatostatin receptors (i.e. neuroendocrine tumours). 

Its method of action consists of using peptide molecules such as artificial octreotate – transport – linked to a carrier agent for radioisotopes such as Lu-177 that destroy cancer cells.

What Are Neuroendocrine Tumours (NETs)?

Neuroendocrine tumours are cancers that arise from very specialised cells in the body (neuroendocrine cells). These cells have similar traits to nerve cells and hormone-producing cells. They are rare tumours and can appear in the lungs, pancreas, appendix, small intestine, and rectum.

Some produce hormones excessively (functional neuroendocrine tumours), while others produce little to no hormones (non-functional neuroendocrine tumours).

What to Expect Before Treatment With Lutetium-177 Octreotate Therapy?

If you have been diagnosed with a neuroendocrine tumour, our doctor shall do the pertinent assessment to corroborate the disease and determine the exact stage of the disease.  

Among the laboratory tests, you can expect to require a complete blood count, 24h creatinine clearance, chromogranin A, kidney, and liver function test.

In addition – before starting the treatment – a PET scan with gallium octreotate shall be carried out. This will determine the extent of the disease as well as the somatostatin receptor density on the tumours. 

Then, our doctor will explain the procedure as well as the possible side effects, together with all the recommendations that you should know after applying the treatment.

What to Expect During Treatment With Lutetium-177 Octreotate Therapy?

This type of therapy can be performed on an outpatient basis in the nuclear medicine department. Before starting, the patient will be asked to consume an average of 1.5L of fluids.

A peripheral intravenous line is placed in the patient for the administration of the treatment, in conjunction with an antiemetic before the infusion of amino acid compounds.

Administration of amino acids will be 30 minutes before lutetium-177 octreotate accompanied by intravenous fluids. This stage of the procedure takes a couple of hours.

Lutetium-177 octreotate is then given as a slow, controlled infusion, which will last for approximately 20 minutes. After that, you must wait a couple of hours while the radioactivity decreases.

The entire treatment lasts approximately 4 to 6 hours, ranging from the preparation phase and the time spent waiting for the manifestation of side effects if any.

What to Expect After Treatment With Lutetium-177 Octreotate Therapy?

After the treatment, you may experience a series of varied symptoms, for which you will spend a couple of hours in the nuclear medicine department. The most common immediate side effect is nausea. 

The medical staff will be attentive to any manifestation outside of what is expected and will treat these side effects accordingly. 

Lutetium-177 octreotate therapy has been shown to increase progression-free survival and an increase in overall survival, with excellent safety profiles.

How Long Before I Can Be Discharged After Lutetium-177 Octreotate Therapy? 

Discharge from the nuclear medicine department will be after 6 to 8 hours on average after starting treatment. The reason behind this is to wait for radioactivity levels to decrease and for the side effects to subside.

The patient must go back to the nuclear medicine department for a full body scan and check on the progress of the treatment after 24 hours.

How Will I Feel After Lutetium-177 Octreotate Therapy? 

It is normal to experience several side effects since it is a radioactive treatment. 

Some possible side effects of Lutetium-177 Octreotate Therapy include: 

  • Nausea (usually counteracted with prophylactic treatment)
  • General fatigue and tiredness
  • Marrow suppression, leading to decreased platelet and red cell counts. This is usually transient and mild, but some patients may require a blood transfusion. 
  • Renal impairment 
  • Diarrhoea

Many of these symptoms are transitory. In the face of uncertainty, please consult our doctor.

Radiation Precautions of Lutetium-177 Octreotate Therapy

In general, the patients must follow a series of recommendations that we will mention below to avoid contamination to third parties:

  • The patient must keep well hydrated for two days after treatment. In other words, he must increase his fluid intake.
  • The radiotracer will be expelled in the urine in the next few days, so you must flush the toilet twice.
  • Avoid contact with pregnant women and children under five years of age – at least 6 feet apart – for at least a week after treatment. 
  • Normal activities can be resumed after a complete post-treatment body scan.

What Questions Should I Ask My Doctor?

Most individuals feel many fears when diagnosed with some type of cancer, so it is important to clarify each of your concerns. 

Below is a summary of questions (although there may be more):

  • What are my treatment options if I have a neuroendocrine tumour?
  • How many tests do I need to know if I am a candidate for Lutetium-177 Octreotate Therapy?
  • How long is the total duration of Treatment With Lutetium-117 Octreotate Therapy?
  • Is it really necessary to do a scan 24 hours after the infusion?
  • Will my overall survival increase after therapy?
  • What recommendations should you follow after treatment?
  • How long should I wait to be intimate with my partner?

In case of presenting discomfort or not feeling in a more optimal state of mind, always remember to call or go to our specialist. They will help you mitigate any discomfort through symptomatic treatments if necessary.

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What to Expect: Yttrium-90 Selective Internal Radiation Therapy (SIRT)

Yttrium-90 Selective Internal Radiation Therapy, SIRT, Theranostics, Theranostics Singapore, Cancer Treatment, Liver Cancer, Dr Andrew Tan

What Is Yttrium-90 Selective Internal Radiation Therapy (SIRT)

Yttrium-90 Selective Internal Radiation Therapy (SIRT) is known as radioembolisation, and its purpose is to eliminate tumours located in the liver. It works as small radioactive beads that migrate to the tumour through one’s arteries. These beads emit short-range radiation, which targets the tumour but minimises damage to the surrounding tissues.

What Is Liver Cancer?

Liver (Hepatic) cancer occurs when there is an abnormal and uncontrolled growth of liver cells. Although there are many different types, the most common is hepatocellular carcinoma.

Various risk factors can lead to this type of cancer. Among them, we have episodes of hepatitis, liver cirrhosis, excessive alcohol consumption, obesity, and diabetes, among others.

Typically, there is pain in the right abdominal region and yellowing of the skin (pathological jaundice). Although it is usually asymptomatic at the beginning, it tends to generate symptoms after the disease has advanced significantly.

What Is A Mapping Arteriogram Procedure / Liver Lung Shunt Study & Why Do I Need It?

Mapping Arteriogram Procedure / Liver Lung shunt study must be performed a week before starting the SIRT treatment. Mapping will allow the identification of the blood vessels (arteries) that are directed to the tumour, as well as blocking the  passage to other organs such as the intestines. This is necessary to prevent the radiation from affecting healthy organs.

The procedure requires a series of preparations and steps before, during, and after. Everything related to mapping arteriography will be explained in detail by your treating physician.

What to Expect Before Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)?

Aside from the angiography, there will be a series of blood tests to assess the baseline liver, kidney and bone marrow function. 

The patient is required to fast for 6 hours before the angiogram, and there will be a clinical examination prior to the procedure. 

The angiogram will be performed with a liver lung shunt study. This involves injecting a diagnostic radiotracer into the hepatic artery catheters, which will allow the doctors to fully understand the distribution of particles into the tumour and normal tissue. The doctors will then be able to determine if the patient is a suitable candidate for Y90 SIRT and, if so, to calculate a proper dose of the radioactive microspheres.

  • Speak to Our Doctor About Other Prescribed Medications

A series of medications will most likely need to be discontinued on the day of treatment to ensure successful therapy and even mapping, so make a list of your medications and consult with our doctor.

Among them, we have anticoagulants – such as aspirin, AINES, vitamin E, oral hypoglycemic agents, and insulin – and diuretics, among others. In the case of diabetes treatment, your dose may be adjusted.

  • Reactions to Contrast 

These types of procedures generally make use of contrast media, allowing the doctor to see the arteries that communicate with the tumour. If you have previously had allergic reactions to contrast media, you should notify your medical care team to avoid complications. This will allow our doctor to look for an alternative to be used as a contrast medium.

What to Expect During Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)?

The actual Y90 SIRT procedure is almost entirely like the pre-treatment angiographic mapping and liver lung shunt. The only difference is the radioactive particles used. While in the assessment phase, a diagnostic tracer is used, in the treatment phase, the Y90 microspheres are injected.

How Long Does Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT) Take?

The angiographic procedure and implantation of the microspheres depend on the complexity of the patient. Usually, the procedure will take about 90 minutes.

What to Expect After Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)?

After treatment, the patient will be transferred to a recovery area where they will remain for approximately 1 to 4 hours. During this period, the catheter is removed from the bladder. 

Yttrium-90 Selective Internal Radiation Therapy (SIRT) treatment has several reported side effects. These include: 

  • A fever of more than 38 ° C
  • Abdominal pain
  • Nausea and vomiting

Our specialist will indicate if antipyretic, analgesic and antiemetic medications are necessary.

How Long Before I Can Be Discharged After Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)? 

You are typically required to rest in bed for a minimum of 6 hours post-treatment. If everything goes well with no complications, you should be able to be discharged the next morning.

You Should Arrange For Someone to Take You Home Following Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)

As it is a radiation treatment that causes fatigue in patients, our doctor will recommend that someone take care of bringing you home safely. You should arrange for an accompanying adult after your treatment. 

What Questions Should I Ask My Doctor?

It is normal to experience fear or doubts when diagnosed with liver cancer, so we have prepared a shortlist of questions that you can ask your doctor. 

  • How do I know if I am a candidate for Selective Internal Radiation Therapy (SIRT)?
  • Is it mandatory to perform mapping arteriography before starting SRIT?
  • Should I stop my medication if I am diabetic?
  • What if I am allergic to contrast and am not aware?
  • If I have a device on my skin, what should I do?
  • Can I have sex?
  • What to do with my clothes in case they get stained with body fluids?
  • Is it mandatory to have a companion when I go home?
  • If I follow another treatment such as chemotherapy, should I stop it?

In case of not feeling well, you should notify your companion of your discomfort. Your companion should inform your treating physician. Side effects after therapy are generally few and short-lived.

It is essential that if your companion notices something out of the ordinary after the treatment, they should immediately notify your doctor so that they can carry out the corresponding corrections.

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What to Expect: Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy

Lutetium-177, Prostate Specific Membrane Antigen, PSMA, Cancer Treatment, What to Expect, Theranostics, Theranostics Singapore, Dr Andrew Tan

What Is Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Prostate-Specific Membrane Antigen (PSMA) is a type of receptor found on cell membranes throughout the body and is particularly increased on the cell surfaces of prostate cancer. 

Lutetium-177 PSMA Therapy uses two components. One of them is a PSMA molecule that binds to the PSMA receptor in cancer cells. The other is a radioactive drug known as Lutetium-177 (Lu 177), which, when transported to the cancer cell by the PSMA molecule, is able to kill the cancer through radioactivity. 

The purpose of the treatment with Lu-177 is to destroy cancer cells, preserving healthy tissue – and – although it is not a cure – it can minimise the cancer’s symptoms, slow tumour growth, and prolong the patient’s quality of life.

What Is Prostate Cancer?

Prostate cancer is one of the most common cancers among men. Approximately 1 in 9 men will be diagnosed with prostate cancer in their lifetime, and it is the second leading cause of cancer-related death in men in the United States. While the majority of prostate cancers are early stage at diagnosis, a significant portion will have regional or distant metastases. 

As men get older, the prostate increases in size. This abnormal growth often does not produce any symptoms, so prevention is key. However, this abnormal growth of the prostate gland usually oppresses the bladder and urethra, which can thus manifest the first symptoms. 

In turn, a man may present difficulties with his erection. Sterility is also a possibility.

If you suspect that you are suffering from some of the symptoms of prostate cancer, make an appointment with your doctor.

What to Expect Before Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Our doctor will conduct a series of tests – from blood tests to more specialised studies to evaluate the state of the kidney and salivary glands – that will determine if you are the right candidate for treatment with Lutetium-177 PSMA.

This will typically include a PET scan (Positron Emission Tomography) using PSMA as the ligand. This will allow us to stage the disease. Our doctor will explain the possible side effects of the treatment and clarify any concerns you may have. 

What to Expect During Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

This type of therapy is typically used for men with castrate-resistant metastatic prostate cancer who have undergone previous hormonal treatments and chemotherapy and are now progressing.

Typically, this type of treatment is done in a nuclear medicine department. Treatment with Lutetium-177 PSMA Therapy minimises the effects of prostate cancer and prevents its spread to neighbouring tissues and organs. 

How Long Does Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy Take?

Once you are in the treatment area, our doctor will briefly explain the procedure: a peripheral catheter will be placed in your arm to start treatment.

Generally, each treatment will take approximately 30 minutes. It consists of 2 – 4 doses with 4 – 8 weeks apart between each dose.

What to Expect After Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Our doctor may recommend the additional use of an antiemetic (for nausea) and a diuretic to help clear the lutetium from your body. 

After the administration, you must wait a few hours in the hospital while the effects of the radiation diminish. Approximately 1- 2 days after treatment, our doctor will request an imaging study, specifically a Single-Photon Emission Computed Tomography (SPECT) scan.

How Long Do I Have to Wait to Be Discharged After Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

Once the first treatment session is over, the patient must stay in the nuclear medicine centre for roughly two hours. Patients must wait for the radioactivity to diminish in intensity before being allowed to go home.

How Am I Going to Feel After Treatment With Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy? 

In general, the infusion of the Lutetium 177 PSMA is usually fast and painless, with no complications encountered. 

As expected, any treatment brings with it potential side effects, which may or may not occur. Some of the more common side effects include

  • Tiredness or fatigue
  • Xerostomia (dry mouth). In some cases, this may be fairly severe, usually in patients undergoing multiple rounds of treatment. 
  • Nausea, not always accompanied by vomiting.
  • Effects on the bone marrow, resulting in reduced blood counts (platelets, red blood cells). This is usually transient and mild, but blood transfusion may be needed in some patients. 
  • Dry eyes

There may be radiation exposure to other organs such as the kidneys and small intestine, but reported side effects are rare. 

However, you should feel free to speak to our doctor if you have any concerns about how you feel post-treatment. 

What Questions Should I Ask My Doctor?

If you are feeling overwhelmed by your diagnosis, here are some questions that you can ask your doctor. 

  • How do I know if I am qualified to receive PSMA treatment with Lutetium-177?
  • Is Positron Emission Tomography (PET Scan) necessary?
  • How long does Lutetium-177 Prostate-Specific Membrane Antigen (PSMA) Therapy last?
  • Should I stay long after the first therapy session is completed?
  • Will I have all the side effects, and for how long?
  • Will I have sexual dysfunction-related issues?
  • Will the therapy cure my cancer?

After treatment, it is normal for the body to experience different symptoms. The type and severity of symptoms vary between patients, and the more common side effects have been outlined. 

If you have any symptoms, consult your doctor immediately, especially if prolonged or increasing in severity. Our doctors are available to clarify any doubts or concerns you have and help you minimise the side effects.

Finally, it can be concluded that therapy with Lutetium 177 Prostate-Specific Membrane Antigen (PSMA) is often a satisfactory therapy option to reduce pain and other symptoms associated with mCRPC (castration-resistant metastatic cancer) – notably if other treatments have failed. Remember to consult with your doctor for any questions you may have.

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What to Expect: Radium-223 Therapy (Xofigo) 

Radium-223 Therapy, Xofigo, What to Expect, Theranostics, Theranostics Singapore, Cancer Treatment, Patient Information, Dr Andrew Tan

What Is Radium-223 Therapy (Xofigo)? 

Radium-223 Therapy (Xofigo) is a form of targeted radioactive therapy. It is a type of radioactive treatment that targets sclerotic bony metastases.

What Is Prostate Cancer?

Prostate cancer is one of the most common cancers among men. Approximately 1 in 9 men will be diagnosed with prostate cancer in their lifetime, and it is the second leading cause of cancer-related death in men in the United States. 

While most prostate cancers are early stage at diagnosis, a significant portion will have regional or distant metastases.

What to Expect Before Treatment With Radium-223 Therapy (Xofigo)?

Our doctor must confirm that you have prostate cancer through existing studies and tests. Once this is confirmed, our doctor typically requests a series of tests to assess your general health.

You will need a bone scan that demonstrates bony metastases. 

You may also be asked to stop taking calcium before the treatment session. Our doctor will sit down with you to look at your medical history, explain the severity of the disease and everything related to the treatment. Take advantage of this moment to clarify any possible concerns you may have.

What Will My Radium-223 Therapy (Xofigo) Treatment Schedule Look Like?

Our treating doctor will explain the damage to your body caused by prostate cancer and the consequences of not being treated. They will also explain the program you must follow to achieve the best possible treatment outcome with Radium-223 Therapy (Xofigo). 

Other information that will be provided to you will be regarding possible adverse effects and the therapeutic measures that you can take to minimise these effects. 

What happens after treatment and the prevention measures to keep in mind will be explained in detail. 

Finally, you may be advised to stop any other radiotherapy or chemotherapy treatments that you are undergoing before starting Radium-223 Therapy (Xofigo).

What to Expect During Treatment With Radium-223 Therapy (Xofigo)?

The treatment program for Radium-223 Therapy (Xofigo) consists of intravenous administration (peripheral route in one arm) of the drug. 

Treatment typically comprises 4-6 sessions, with a period of 4 weeks between each one.

The drug will be administered directly in the vein, and the procedure is typically fast and painless. 

Before each session, a blood sample will be drawn to evaluate health parameters and haematological conditions.

How Long Does Treatment With Radium-223 (Xofigo) Take?

Radium-223 Therapy (Xofigo) is a relatively quick procedure, which will take no more than half an hour. The application of the intravenous drug takes no more than a minute.

As mentioned, additional time will be required while the nurse places the catheter for the intravenous line and its subsequent removal.

What to Expect After Treatment With Radium-223 Therapy (Xofigo)?

After Radium-223 Therapy (Xofigo) treatment, there will be low-grade radioactivity from the patient. Small amounts of radioactivity may be present in the urine and stools. 

One of the advantages of this type of treatment is that it will not be necessary to avoid contact with family and friends since the radiation levels received is very low. Still, the doctor will give you a card stating that you have received such treatment.

How Long Before I Can Be Discharged After Treatment With Radium-223 (Xofigo) Therapy? 

As it is an outpatient procedure, discharge after intravenous application will be quick – it will not take more than a couple of hours for the first side effects to subside. Generally speaking, within 1-2 hours, you may be on your way home.

How Will I Feel After Treatment With Radium-223 (Xofigo) Therapy? 

Once the treatment is complete, you may feel somewhat dizzy or, in some cases, fatigued. It is normal to have some discomfort since you have received radiation treatment. However, try not to worry as these symptoms should disappear relatively quickly. In case of persistence, consult our doctor.

This type of therapy for prostate cancer is one of the few that generates minimal side effects. Among them, we have:

  • Nausea
  • Diarrhoea
  • Anaemia
  • Oedema in the ankles and wrist 

If you have had a therapy session and you have persistent side effects, feel dizzy, confused, and weaker than normal, or have any other symptoms that are not expected, notify our doctor immediately.

Any prolongation of the symptoms may be a cause for alarm, so you must notify your medical care immediately. Our doctor will take the necessary therapeutic measures to correct any discomfort as your body responds to the treatment.

Radiation Safety Precautions

As mentioned above, there will be small traces of radiation particles in the urine, blood, and faeces. Therefore, you must comply with the following radiological safety conditions:

  • Flush the toilet twice and wash your hands properly.
  • Wash clothes and sheets stained with vomit, blood, urine, and faeces separately. Handle with gloves.
  • Stay well hydrated before and after therapy.
  • Use a condom when having sex to prevent your partner from becoming pregnant (it is dangerous because of the effects of radiation) – this recommendation is valid for six months.
  • Do not expose your partner to pre-seminal fluid and semen, as it may contain radioactive particles.

What Questions Should I Ask My Doctor?

If you are feeling overwhelmed by your diagnosis, here are some questions that you can ask your doctor. 

  • How do I know if I am a candidate for Radium-223 Therapy (Xofigo)?
  • Is it an outpatient procedure? Why?
  • How many therapy sessions with Radium-223 Therapy (Xofigo) do I need?
  • What happens if I don’t follow through with all the Radium-223 Therapy (Xofigo) sessions?
  • Is it mandatory to stop other methods of therapy like chemotherapy?
  • Should I stop taking dietary supplements that contain calcium?
  • Should I take any security measures with my family and partner?
  • Can I have sex?
  • What do I do if I have blood in my urine?
  • Is it mandatory to have blood tests before each session?
  • Could I end up being sterile?
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