but in experienced hands the technique can improve patient management (sensitivity and specificity of 50-75%).

Radioisotope Therapy

The ability of nuclear medicine to design radiolabeled molecules that will target specific cancers for diagnostic use raises the intriguing possibility that the same

Figure 25. Delayed 99mTc-sestamibi images showing uptake in a parathyroid adenoma involving the right superior gland (arrow).

targeting strategy can be used to systemically deliver therapeutic doses of radioisotopes to patients with metastatic cancer. The archetypal radioisotope therapy is iodine-131 for the treatment of benign and malignant thyroid disease (discussed in Chapter 14). Table 5 outlines those radiopharmaceuticals that are currently in routine clinical use or which are in late Phase III trials.

131I-mIBG is used extensively in Europe to treat neuroblastoma, pheochromocytoma and carcinoid. Characteristically, most radioisotope therapies are systemically administered, will treat all metastatic lesions, may be given on multiple occasions, have low toxicity and are probably underutilized. Another common application of radioisotope therapy is the use of bone seeking radiopharmaceuticals for pain palliation.

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