World Journal of Nuclear Medicine

LETTER TO EDITOR
Year
: 2020  |  Volume : 19  |  Issue : 4  |  Page : 447--451

Case work-up and monitoring of systemic radionuclide therapies: A proposed 3-sheet excel format with integrated graph for implementation in a busy treatment set-up


Sarvesh Loharkar, Sandip Basu 
 Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe; Homi Bhabha National Institute, Mumbai, Maharashtra, India

Correspondence Address:
Prof. Sandip Basu
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, JerbaiWadia Road, Parel, 400 012; Homi Bhabha National Institute, Mumbai, Maharashtra
India




How to cite this article:
Loharkar S, Basu S. Case work-up and monitoring of systemic radionuclide therapies: A proposed 3-sheet excel format with integrated graph for implementation in a busy treatment set-up.World J Nucl Med 2020;19:447-451


How to cite this URL:
Loharkar S, Basu S. Case work-up and monitoring of systemic radionuclide therapies: A proposed 3-sheet excel format with integrated graph for implementation in a busy treatment set-up. World J Nucl Med [serial online] 2020 [cited 2022 Aug 11 ];19:447-451
Available from: http://www.wjnm.org/text.asp?2020/19/4/447/302443


Full Text

Therapeutic nuclear medicine using targeted systemic radionuclides (RN) has seen rapid development over the last decade as a popular and preferred treatment modality in clinical oncology practice in view of its excellent tolerability and minimal adverse effects as compared to systemic chemotherapies. As a consequence, there has been an increasing routine therapeutic work burden in the centers with RN therapy facilities. The domain and practice of therapeutic nuclear medicine esp. Newer systemic RN therapies is way different than pure diagnostic work this fraternity is used to. Monitoring of single patient during multiple therapy cycles with multiple investigations at every cycle (both in-house and outside) and also long follow-up need huge amount of clinical data to be handled for each patient.[1],[2],[3] In a standard government/university center in a developing country, the expanding numbers of treatment procedures while in private setups working with at most 1–2 physicians, the enhanced burden of therapeutic work adds up in hardship and increase in the chance of error or negligence. In a major treatment center in India like ours, the standing average weekly systemic RNT statistics include 15–20 radioiodine therapy for thyroid carcinoma, 20–25 (177Lu) Lu-DOTA-TATE PRRT, 5–8 (177Lu) Lu-PSMA PRLT, in addition to131I-MIBG therapy for neuroblastoma, pheochromocytoma, or paraganglioma and pain palliation therapies that vary as per the patient referral. A user-friendly generalized protocol framework is thus the need of the hour, which can be easily modified depending on need of each patient individually.

We herein present a 3-sheet Excel format with integrated graph for case work-up and follow-up of the systemic RN therapies that could be conveniently employed in a busy treatment setup. The format primarily has three main sheets:

Sheet 1 [Table 1]a: Case summary that includes four subheadings (i) baseline information of the patient (including name, age, sex, institutional Id, and final tissue diagnosis; presenting symptoms; treatment history), (ii) details of RN therapies administered previously (dose, date, cumulative dose), (iii) any untoward event or new symptom during/after the therapy, and (iv) special remarksSheet 2: [Table 1]b: Response assessment summary in three scales symptomatic response (and health-related quality of life assessment); biochemical tumor marker response; imaging response (both anatomical and functional imaging-based RECIST 1.1 and PERCIST assessment)Sheet 3 [Table 1]c. Adverse effect assessment: Hematological and renal parameters and also liver function tests or some specific values such as thyroid function test monitoring in case of131I-MIBG therapy.{Table 1}

A dummy case example with graphical representation is illustrated from the 177Lu-DOTATATE PRRT employing the aforementioned format [Table 1]a,[Table 1]b,[Table 1]c.

We believe adoption of such format would greatly aid management and monitoring of all aforementioned data conveniently (salient history, dose records, three-dimensional response assessment, adverse effects, and survival records over time) including the trend of the parameters at the same time and also be a convenient mode of digital record keeping over long time, thus could play pivotal role in better global monitoring of the patient and decision-making by the treating physician.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Giammarile F, Chiti A, Lassmann M, Brans B, Flux G, EANM. EANM procedure guidelines for 131I-meta-iodobenzylguanidine (131I-mIBG) therapy. Eur J Nucl Med Mol Imaging 2008;35:1039-47.
2Bodei L, Mueller-Brand J, Baum RP, Horsch D, O'Dorisio MS, et al. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours [published correction appears in Eur J Nucl Med Mol Imaging 2014;41:584.
3Kratochwil C, Fendler WP, Eiber M, Baum R, Bozkurt MF, Czernin J, et al. EANM procedure guidelines for radionuclide therapy with 177 Lu-labelled PSMA-ligands (177 Lu-PSMA-RLT). Eur J Nucl Med Mol Imaging 2019;46:2536-44.