Well-differentiated thyroid cancer is the most common endocrine malignancy with an increasing incidence. Most patients with well-differentiated thyroid caner have a favorable prognosis with high survival rate. While surgery and radioiodine therapy is sufficient treatment for the majority of patients with differentiated thyroid cancer, a minority of these patients experiences progressive, life-threatening growth and metastatic spread of the disease. Because there is no prospective controlled study to evaluate the differences of management of thyroid cancer, it is hard to choose the best treatment option. And there are still lots of controversies about the management of this disease, such as surgical extent, proper use of radioiodine for remnant ablation and therapy, use of rhTSH instead of withdrawal of thyroid hormone, long-term follow-up strategy, thyroglobulin as a tumor marker, etc. In this review, recent data related to these conflicting issues and recent advances in diagnosis, radioiodine therapy and long-term monitoring of well-differentiated thyroid cancer are summarized.
Carcinoma, Papillary ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Prognosis ; Survival Rate ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin Alfa

Radiosynovectomy has been used as an effective treatment in patients with resistant synovitis after failure of long-term medication and intraarticular steroid injection. Although 90Y silicate/citrate, 186Re sulfide, and 169Er citrate were approved in Europe for the appropriate radiopharmaceuticals for radiosynovectomy, other radionuclides such as 32P-chromic phosphate, 165Dy-ferric hydroxide macroaggregate, 188Rh-microspheres, 153Sm-particulate, and 166Ho-ferric hydroxide macroaggregate have been used in many countries. Reported success rates range from 40% to 90% for the different joints and underlying disease. In Korea, 188Re-tin-colloid and 166Ho-chitosan complex are now using as the major radionuclides in radiosynovectomy with good clinical results. A study on radiation synovectomy using 188Re-tin-colloid for patients with Korean rheumatoid arthritis shows the treatment resulted in the improvement of arthritis and well tolerated. In our study, the radiosynovectomy with 166Ho-chitosan complex in 53 hemophilic patients markedly decreased intra-articular bleeding frequency and need for coagulation factor. This review inculdes general priciples in the application of radiosynovectomy and the clinical experience in Korea.
Arthritis ; Arthritis, Rheumatoid ; Blood Coagulation Factors ; Citric Acid ; Europe ; Hemophilia A ; Hemorrhage ; Humans ; Joints ; Korea ; Radioisotopes ; Radiopharmaceuticals ; Synovitis

Radionuclide therapy has been continued for treatment of incurable diseases for past decades. Relevant evaluation of absorbed dose in radionuclide therapy is important to predict treatment output and essential for making treatment planning to prevent unexpected radiation toxicity. Many scientists in the field related with nuclear medicine have made effort to evolve concept and technique for internal radiation dosimetry. In this review, basic concept of internal radiation dosimetry is described and recent progress in method for dosimetry is introduced.
Nuclear Medicine ; Radiometry*

Coronary artery disease is a leading cause of morbidity and mortality across the world. Percutaneous coronary intervention has become the major technique of revascularization. However, restenosis remains a major limitation of this procedure. Recently the need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction of two major advances, intracoronary brachytherapy and the drug-eluting stents. Intracoronary brachytherapy has been employed in recent years to prevent restenosis lesions with effective results, principally in in-stent restenosis. Restenosis is generally considered as an excessive form of normal wound healing divided up in processes: elastic recoil, neointimal hyperplasia, and negative vascular remodeling. Restenosis has previously been regarded as a proliferative process in which neointimal thickening, mediated by a cascade of inflammatory mediators and other factors, is the key factor. Ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. Subsequently, several randomized, double-blind trials have demonstrated that intracoronary brachytherapy can reduce the rates of both angiographic restenosis and clinical event rates in patients undergoing percutaneous coronary intervention for in-stent restenosis. Some problems, such as late thrombosis and edge restenosis, have been identified as limiting factors of this technique. Brachytherapy is a promising method of preventing and treating coronary artery restenosis.
Brachytherapy* ; Coronary Artery Disease* ; Coronary Vessels* ; Drug-Eluting Stents ; Humans ; Hyperplasia ; Models, Animal ; Mortality ; Percutaneous Coronary Intervention ; Radiation, Ionizing ; Thrombosis ; Wound Healing

Tissue hyperplasia is one of the most frequently encountered complications when self-expanding metallic stents are placed in benign non-vascular luminal organ strictures, thus causing restenosis of the lumen. The investigators postulated that ionizing irradiation could be applied to prevent restenosis caused by tissue hyperplasia in non-vascular luminal organs as it reduced coronary or peripheral arterial narrowing successfully. The authors combined beta-irradiation using 188Re-MAG3 solution with balloon dilation for animal and clinical studies because this new treatment approach had the advantages such as low penetration depth of beta-ray, self-centering irradiation, and mechanical effect of balloon dilation over using gamma-irradiation with afterloading devices. In this article, the concept and mechanism of radioisotope balloon dilation, and animal and clinical studies using radioisotope balloon dilation are reviewed.
Animals ; Constriction, Pathologic* ; Humans ; Hyperplasia ; Phenobarbital* ; Research Personnel ; Stents

Molecular imaging has its root in nuclear medicine and gene therapy monitoring. Therefore, recent progress in the development of non-invasive imaging technologies, particularly nuclear medicine, should allow molecular imaging to play a major role in the field of gene therapy. These tools have recently been validated in gene therapy models for continuous quantitative monitoring of the location, magnitude, and time-variation of gene delivery and/or expression. This article reviews the use of radionuclide imaging technologies as they have been used in imaging gene delivery and gene expression for gene therapy applications. The studies published to date lend support that noninvasive imaging tools will help to accelerate pre-clinical model validation as well as allow for clinical monitoring of human gene therapy.
Gene Expression ; Genetic Therapy* ; Humans ; Molecular Imaging ; Nuclear Medicine ; Radionuclide Imaging

Neuroendocrine tumors (NETs) consist of a heterogeneous group of tumors that are able to uptake neuroamine and/or specific receptors, such as somatostatin receptors, which can play important roles of the localization and treatment of these tumors. When considering therapy with radionuclides, the best radioligand should be carefully investigated. 131I-MIBG and beta-particle emitter labeled somatostatin analogs are well established radionuclide therapy modalities for NETs. 111In, 90Y and 177Lu radiolabeled somatostatin analogues have been used for treatment of NETs. Further, radionuclide therapy modalities, for example, radioimmunotherapy, radiolabeled peptides such as minigastrin are currently under development and in different phases of clinical investigation. For all radionuclides used for therapy, long-term and survival statistics are not yet available and only partial tumour responses have been obtained using 131I-MIBG and 111In-octreotide. Experimental results using 90Y-DOTA-lanreotide as well as 90Y-DOTA-D-Phe1-Tyr3-octreotide and/or 177Lu-DOTA-Tyr3-octreotate have indicated the possible clinical potential of radionuclides receptor-targeted radiotherapy. It may be hoped that the efficacy of radionuclide therapy will be improved by co-administration of chemotherapeutic drugs whose antitumoral properties may be synergistic with that of irradiation.
3-Iodobenzylguanidine ; Hope ; Neuroendocrine Tumors* ; Peptides ; Radioimmunotherapy ; Radioisotopes ; Radiotherapy ; Receptors, Somatostatin ; Somatostatin

Bone metastasis is a common sequelae of solid malignant tumors such as prostate, breast, lung, and renal cancers, which can lead to various complications, including fractures, hypercalcemia, and bone pain, as well as reduced performance status and quality of life. It occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. Several sequelae occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. A multidisciplinary approach is usually required not only to address the etiology of the pain and its complicating factors but also to treat the patient appropriately. Pharmaceutical therapy of bone pain, includes non-steroidal analgesics, opiates, steroids, hormones, bisphosphonates, and chemotherapy. While external beam radiation therapy remains the mainstay of pain palliation of a solitary lesions, bone seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesions. 32P, 89SrCl, 153Sm-EDTMP, 188Re/186Re-HEDP, and 177Lu-EDTMP can be used to treat painful osseous metastases. These various radiopharmaceuticals have shown good efficacy in relieving bone pain secondary to bone metastasis. This systemic form of metabolic radiotherapy is simple to administer and complements other treatment options. This has been associated with improved mobility in many patients, reduced dependence on narcotic and non-narcotic analgesics, improved performance status and quality of life, and, in some studies, improved survival. All of these agents, although comprising different physical and chemical characteristics, offer certain advantages in that they are simple to administer, are well tolerated by the patient if used appropriately, and can be used alone or in combination with the other forms of treatment. This article illustrates the salient features of these radiopharmaceuticals, including the usual therapuetic dose, method of administration, and indications for use and also describe about the pre-management checklists, and indication/contraindication and follow-up protocol.
Analgesics ; Analgesics, Non-Narcotic ; Breast ; Checklist ; Complement System Proteins ; Diphosphonates ; Drug Therapy ; Follow-Up Studies ; Humans ; Hypercalcemia ; Kidney Neoplasms ; Lung ; Neoplasm Metastasis ; Osteoblasts ; Osteoclasts ; Prostate ; Quality of Life ; Radiopharmaceuticals* ; Radiotherapy ; Steroids

Molecular targeting may be defined as the specific concentration of a diagnostic or therapeutic tracer by its interaction with a molecular species that is distinctly present or absent in a disease state. Monoclonal antibody (mAb) is one of the successful agents for targeted therapy in cancer. To enhance the therapeutic effect, the concept of targeting radionuclides to tumors using radiolabeled mAbs against tumor-associated antigens, radioimmunotherapy, was proposed. The efficacy of radioimmunotherapy, however, has to be further optimized. Several strategies to improve targeting of tumors with radiolabeled mAbs have been developed, such as the use of mAb fragments, the use of high-affinity mAbs, the use of labeling techniques that are stable in vivo, active removal of the radiolabeled mAb from the circulation, and pretargeting strategies. Until now, however, there are many kinds of obstacles to be solved in the use of mAb for the targeted therapy. Major technical challenges to molecular targeting are related to the rapid and specific delivery of tracers to the target, the elimination of unwanted background activity, and the development of more specific targets to create a cytocidal effect. Further development of this field will be determined by success in solving these challenges.
Radioimmunotherapy* ; Radioisotopes

Monoclonal antibodies are designed to bind specifically to certain antigen, give therapeutic effect to the target and to be produced in large scale with homogeneity. The monoclonal antibodies conjugated with radionuclide can deliver therapeutic irradiation to the target, and showed successful results in certain malignancies, which is known as radioimmunotherapy. The target-to-background ratio depends on the antigen expression in the target and normal tissues, which is related to the therapeutic efficacy and toxicity in radioimmunotherapy. For the solid tumor beta-ray energy should be high, but lower beta energy is better for the hematological malignancies. I-131 is widely used in thyroid cancer with low cost and high availability. Labeling monoclonal antibody with I-131 is relatively simple and reproducible. Some preclinical data for the I-131 labeled monoclonal antibodies including acute toxicity and efficacy are available from already published literatures. In KIRAMS, physician sponsored clinical trial protocols using Rituximab, KFDA approved anti-CD20 chimeric monoclonal antibody and I-131 were approved by KFDA and currently are ongoing.
Antibodies, Monoclonal ; Hematologic Neoplasms ; Immunoconjugates* ; Radioimmunotherapy* ; Thyroid Neoplasms ; Rituximab