Nuclear Medicine and Theranostics Clinic

 

Our Team

The Theranostics Center at Banner - University Medical Center and The University of Arizona - Tucson is designated as a Comprehensive Radiopharmaceutical Therapy Center of Excellence. We are the first team to achieve this prestigious status in the state of Arizona. Our multidisciplinary care team consists of board-certified physicians specializing in Nuclear Medicine, Hematology Oncology, Endocrinology, Interventional Radiology, Radiation Oncology, Surgery, certified technologists, nurses, nurse practitioners, a radiation safety team and medical physicists. Delivering excellent patient care is our number one priority. 

Our center offers a complete range of diagnostic Nuclear Medicine imaging and therapeutic procedures using I131, Y90, Lu177, Ra223, perform clinical trials, and is the first in Southern Arizona to offer 177Lu PSMA-617 (Pluvicto) Therapy for patients with metastatic prostate cancer. 

What is Theranostics?

Nuclear medicine and molecular imaging use small and safe amounts of radioactive material inside the body to see how organs or tissue are functioning (for diagnosis) or to target and destroy damaged or diseased organs or tissue (for treatment). 

Theranostics is a combination of the terms therapeutics and diagnostics. Theranostics describes the combination of using one radioactive drug to identify (diagnose) and a second radioactive drug to deliver therapy to treat the tumor/disease. 

Our Clinic

Directions to our clinic located at 3838 N. Campbell Avenue, Tucson, AZ 85719

Before Your Procedure

Your appointment is unique to you, and you will meet with our nuclear medicine physicians to review your medical history and the indication for the therapy. As part of your therapy preparation, blood tests will be performed to ensure it is safe to proceed. The tests will depend on your therapy type and may include tests for your tumor markers, red cells, white cells, platelets, liver, and kidney function. 

You should notify your physician or the technologist if you are allergic and/or sensitive to medications, contrast dyes, or iodine and/or if you are pregnant or suspect you may be pregnant.

What Should I Expect During My Visit?

Consultation

You will meet with our Nuclear Medicine Physicians for a consultation that will take between 60-90 minutes. In the meeting you will review:

  • The purpose of the meeting and possible therapy
  • An evaluation of the patient's home situation and review of radiation safety precautions
  • A review of the side effects commonly seen with the proposed therapy
  • Ways to diminish radiation and enhance excretion
  • If applicable, dietary restrictions prior to therapy
  • Post therapy instructions

Therapy Appointment

  • The duration of your therapy appointment is dependent upon therapy type and can take between 30 minutes to five hours.
  • Comfortable clothing is recommended.
  • Treatment will be administered while sitting in a recliner chair.
  • For most therapies, it is recommended you drink a bottle or two of water before receiving treatment.

After the Procedure

For most therapies, you will be instructed to drink plenty of fluids and empty your bladder frequently for 24 to 48 hours to help flush the remaining radionuclide from your body. 

For questions regarding your appointment, please call (520) 694-0111 and ask for the Front Desk. 

Types of Therapies Offered at Our Clinic

 

Thyroid Ablation for Thyroid Cancer After Thyroidectomy

After thyroid surgery, in most cases, a small microscopical thyroid tissue was left behind. In other cases, the thyroid cancer may spread to other areas. Therefore, your physician may refer you to Nuclear Medicine to remove what is left of your thyroid using a radiation treatment called Iodine-131 Radioablation Therapy (RAI).

There are diagnostic and therapeutic parts to your care with this agent:

1. The first part (diagnostic) will consist of you getting several pills that contain a small amount of radioactive iodine. You should take these on an empty stomach (no food for at least 4 hours) and not eat for one-two hours afterwards. The following day you will return, and a total body scan will be performed while you are laying down. The scan will take about 30 - 45 minutes. Some additional measurements of your thyroid area will also be taken. The images will be shown to one of the doctors in Nuclear Medicine and they will meet with you for a few minutes and show you your scan. This scan is to determine the dose for the ablation and to check if the thyroid cancer has spread.

2. The second part (therapeutic) is the treatment with the higher dose of radioactive iodine. The Nuclear Physician will determine the dose needed and if you can be treated at home or be required to be hospitalized for radiation safety purposes. If you are treated as an outpatient, you will receive your radioactive iodine and be asked to return to the department several days later for a final scan. If you are treated as an inpatient, you will be admitted to the hospital and stay in an isolated room for about two days. A repeat scan will be performed before you are discharged.

  • For the therapy, your stomach should be empty prior to getting the dose and for two hours afterward. After that, we will ask you to significantly increase your fluid intake for the next 48 hours. Drink a variety of any liquids. Drinking only water might wash out a lot of salts from your body and make you feel sick. Coffee, juice, tea, soda, sport drinks and others will all work. The purpose is to flush out the extra unneeded iodine from your body.
  • You will need to be in isolation from others.

 

177Lu PSMA-617 (Pluvicto) Therapy

Prostate cancers often are initially very responsive to treatment by blocking the male hormones (androgens), but sometimes become resistant to that type of therapy. When that happens, doctors will often use other chemotherapy agents to try and treat the prostate cancer. When patients become resistant to androgen blocking treatment and a group of chemotherapy agents known as taxanes (paclitaxel, docetaxel or cabazitaxel) no longer work, then treatment with Pluvicto becomes an option.

Prostate cancer cells often have receptors on their surface that certain molecules can attach to. Think of them as a “lock and key” combination with the lock being the receptor on the cell surface and the key being the radioligand. In this case, we are planning on using a ligand (PSMA 617) that has a radioactive material (Lutetium-177) attached to it and together they are called Pluvicto. There are more of these receptors present in prostate cancer cells than on normal cells. When the Pluvicto binds to the prostate cancer cells, it brings along the radiation directly to the tumor cells no matter where they are located in the body. The goal of the treatment is to deliver enough radiation to the tumor cells to significantly decrease their growth and kill as many of them as possible.

There are both diagnostic and therapeutic parts to your care with this agent:

1. The diagnostic part uses an imaging agent version of the PSMA ligand that is labelled with either Ga-68 (Locametz) or F-18 (Pylarify). Both of these agents work in a similar fashion and can be imaged using a PET/CT scanner. This allows us to see where the tumor is and how well the PSMA ligand attaches to it. This procedure involves an injection into an arm vein, waiting some time to allow it to circulate, and then performing the scan. The scan itself takes about 30 minutes and we do not expect you to have any side effects from it. After the scan is performed, your doctor will arrange a time to consult with a Nuclear Medicine physician. The Nuclear Medicine physician will review the images and this information with you and then set up a schedule for your therapy.

2. The treatment part consists of six treatments of 177Lu PSMA-617 (Pluvicto), given every six weeks. Each treatment will take approximately 1-2 hours (the administration of the radioactive material only takes about 20-30 minutes). The rest of the time is to monitor for any side effects and to provide some additional fluids to help flush out the extra medication. Your blood values will be monitored very closely while on this treatment.

PSMA Pluvicto Therapy National Shortage Information

 

Radium-223 Chloride

Radium-223 (Xofigo) is a radioactive material for patients with prostate cancer that has spread to the bones and is not responsive to medical or surgical treatments that lower the levels of testosterone in the body.

Radium-223 deposits in the bones wherever your cancer has spread delivering radiation directly to the tumor. The amount of radiation is insufficient to cure the cancer, but has been found to help prolong life and decrease bone pain. A typical course of treatment is a dose injected into a vein once every four weeks for six doses. 

Not everyone will experience a decrease in pain following Radium-223 therapy, and there is no way to predict who will benefit and who will not. The treatment will deliver radiation to the bone and bone marrow and, as a result, can decrease white cells, platelets and red cells. Your blood values will be monitored very closely while on this treatment.

 

Y90 Therasphere

The Y90 Therasphere ablation therapy is for patients who have a specific type of liver cancer that cannot be managed with surgery.

There are diagnostic and therapeutic parts to your care with this agent:

  1. The diagnostic part uses Tc99m-MAA.The MAA is composed of small particles that will be inserted into your liver artery to trace the vascularization of the tumor.  This type of radioactive material allows us to obtain a scan (SPET/CT) to show us where the tumor is and how well the tracer accumulates within it. This part of the treatment takes place in the Interventional Radiology (IR) procedure room. Once the scan is performed, the IR physician will arrange a time to meet with you, review the images, and then set up a schedule for your therapy.

  2. The therapy part consists of Y90 Therasphere.  Therasphere consists of millions of microscopic glass spheres attached to Yttrium-90. The therapy is similar to the diagnostics part and involves an injection of the radiotherapy into a selected branch of the hepatic artery that supplies the liver tumor. The procedure is performed as an outpatient procedure in the Interventional Radiology (IR) procedure room by board-certified Interventional Radiologists specialty trained to deliver unsealed radioactive material as part of their Nuclear Medicine training. Each treatment will require recovery time in the observation unit and you will be under the supervision of the Interventional Radiology and Radiation Safety teams.

 

177Lu DOTATATE (Lutathera) Therapy

Neuroendocrine tumors are a group of cancers that develop from cells that have nerves and glands that produce hormones.  In many cases, these tumors produce hormones that cause you to have symptoms.  There are several options for treating these tumors that your oncologist has already discussed.  PRRT is one of these treatments.

Neuroendocrine tumors often have receptors on their surface that can attach to certain molecules called peptides.  Think of them as a "lock and key" combination with the lock being the receptor on the cell surface and the key being the peptide.  In this case, we are planning on using a peptide (DOTATATE) that has a radioactive material attached to it.  There are more of these receptors present on neuroendocrine tumor cells than on normal cells.  When the radioactive peptide binds to the neuroendocrine tumor cells, it brings the radiation directly to the tumor cells no matter where they are located in the body.  The goal of the treatment is to deliver enough radiation to the tumor cells to significantly decrease their growth and kill as many of them as possible. 

There are diagnostic and therapeutic parts to your care with this agent:

  1. The diagnostic part uses 68Ga DOTATATE (NETSpot).  The peptide is the same one that is used for therapy but uses a different type of radioactive material that allows us to obtain a scan (PET/CT) to show us where the tumor is and how well the peptide attaches to it. This procedure involves an injection into an arm vein, waiting 45 minutes to allow it to circulate, and then performing the scan.  The scan takes about 30 minutes and we do not expect you to have any side effects.  Once the scan is performed, the Nuclear Medicine doctor will talk to your oncologist, arrange a time to meet with you, review the images with you, and then set up a schedule for your therapy.

  2. The therapy part consists of four treatments of 177Lu DOTATATE (Lutathera) every eight weeks.  Each treatment will last between 4-6 hours.  During the treatment, you will be given an infusion of amino acids to help your body get rid of the extra radioactive peptide.  Some people may feel sick from the amino acid infusion.  To help prevent that from happening, you will receive some medication (Zofran) prior to starting the treatment.  You will also be asked to empty your bladder every hour.  This is done because the main way that your body gets rid of the extra radioactive peptide is through your urine.  The administration of the radioactive material only takes about 30 minutes.  The rest of the time is to allow the amino acids to help flush out the extra peptide. Your blood values will be monitored very closely while on this treatment.

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