EANM position paper on the role of radiobiology in nuclear medicine

An Aerts,Fijs W.B Van Leeuwen,Sören Holm,Roland Hustinx,Michael Lassmann,Gerhard Glatting,Uta Eberlein,Lidia Strigari,Mark Konijnenberg

doi:10.1007/s00259-021-05345-9

Abstract

Executive SummaryWith an increasing variety of radiopharmaceuticals for diagnostic or therapeutic nuclear medicine as valuable diagnostic or treatment option, radiobiology plays an important role in supporting optimizations. This comprises particularly safety and efficacy of radionuclide therapies, specifically tailored to each patient. As absorbed dose rates and absorbed dose distributions in space and time are very different between external irradiation and systemic radionuclide exposure, distinct radiation-induced biological responses are expected in nuclear medicine, which need to be explored. This calls for a dedicated nuclear medicine radiobiology. Radiobiology findings and absorbed dose measurements will enable an improved estimation and prediction of efficacy and adverse effects. Moreover, a better understanding on the fundamental biological mechanisms underlying tumor and normal tissue responses will help to identify predictive and prognostic biomarkers as well as biomarkers for treatment follow-up. In addition, radiobiology can form the basis for the development of radiosensitizing strategies and radioprotectant agents. Thus, EANM believes that, beyond in vitro and preclinical evaluations, radiobiology will bring important added value to clinical studies and to clinical teams. Therefore, EANM strongly supports active collaboration between radiochemists, radiopharmacists, radiobiologists, medical physicists, and physicians to foster research toward precision nuclear medicine.

Highlights

In recent years, the number of radiopharmaceuticals for diagnostic and therapeutic applications has increased considerably
Radiobiology studies the interactions of ionizing radiation on atomic and molecular structures and their induced effects on cells, tissues, and organs, both normal and diseased
Research in radiobiology can rely on the newest techniques and insights in biology in general and is exploitinggenomics, proteomics, metabolomics, high-throughput screening, and exploring new models like stem cells, organoids, in vivo orthotopic and subcutaneous patient-derived xenograft models, or siRNA- or CRISPR/Cas9-derived models

Summary

Introduction

The number of radiopharmaceuticals for diagnostic and therapeutic applications has increased considerably. Radiobiology studies the interactions of ionizing radiation on atomic and molecular structures and their induced effects on cells, tissues, and organs, both normal and diseased. Research in radiobiology can rely on the newest techniques and insights in biology in general and is exploiting (epi)genomics, proteomics, metabolomics, high-throughput screening, and exploring new models like stem cells, organoids, in vivo orthotopic and subcutaneous patient-derived xenograft models, or siRNA- or CRISPR/Cas9-derived models These are anticipated to lead to new hypotheses to understand the effects generated from ionizing radiation on biological systems and to improve therapies based on ionizing radiation [78, 83]. Today, improved insights into the dose-response effects caused by ionizing radiation on tumor cell killing as well as on acute and long-term normal tissue collateral damage are impacting greatly treatment planning in external beam radiation therapy (EBRT) [83, 84].

40 Gy BED

Discussion