As we continue our conversation on Precision Medicine for cancer, a popular therapy used to treat NET tumours or Neuro Endocrine Tumours is PRRT or Peptide Receptor Radionuclide therapy.
Neuroendocrine tumours are a rare form of cancer and originate from Neuro endocrine cells in the body and hence the name.They are different from adenocarcinoma’s and often do not do not respond well to chemotherapy, the 1st line of treatment for most cancers.
By administering radioactive protein lutetium octreotate, it is possible to treat NET tumours or neuro endocrine carcinoma with precision and offset progression of disease.
In PRRT a peptide or a cell targeting protein is combined with a small amount of radio active nuclide creating what is called as a radio peptide. The radio peptide when injected into the patients blood stream travels and binds to a neuro endocrine tumour, delivering a high dose of radiation to the tumours. This also limits damage to the nearby healthy tissue and hence lesser and milder side effects than chemotherapy.
What kind of cancers can be treated by PRRT?
Along with Neuroendocrine tumours, carcinoids, islet cell carcinoma of the pancreas, small cell carcinoma of the lung a form of lung cancer, pheochromocytoma (a rare tumor that forms in the adrenal glands), gastro-enteropancreatic (stomach cancer , intestine cancer and pancreas) neuroendocrine tumors, and rare thyroid cancers that are unresponsive to treatment with radio iodine are often treated with PRRT.
Role of PRRT is also being explored for treatment of prostate cancer.
When is a patient a candidate for PRRT ?
Patients with following conditions are often proposed for PRRT
- When neuro endocrine tumours are not responsive to other lines of cancer treatment
- When surgical removal of tumours is not possible at current stage, PRRT may be used to reduce size of the tumours.
- PRRT is also a treatment option for last stage inoperable cancers when metastasis has set in.
The main aim of PRRT is then to slow down progression of disease, offer relief and prolong life.
However, not all neuroendocrine tumours respond to PRRT. First an OctreoScan is done. If the patient is found to have a positive OctreoScan and meets other requirements, PRRT is proposed.
What happens during PRRT ?
For patients having a positive octreoscan, to start with an amino acid solution is delivered to protect the kidneys.
As most net tumours have a lot of a specific type of surface receptor, a protein called somatostatin. Octreotide, is a lab version of somastostatin. During PRRT, a dose of radio nuclides such as Lutetium, Yttrium are often combined with octreotide and injected into the blood stream.
Molecular imaging and scans follow to see whether the radio peptide has latched on of the tumour sites correctly.
The entire session usually lasts for about 4 hrs and is often done as an out patient procedure.
The main goals of PRRT hence are to provide symptom relief, to stop or slow tumor progression and to improve overall survival.
Advantages of PRRT ?
PRRT along with other molecular therapies or targeted therapies offer excellent results as they are tailor made keeping in mind molecular properties of the tumour and also biologic characteristics of the patient.
PRRT is offered in Germany , USA, UK and other developed countries at a significant cost, In India, a single session of PRRT costs approx USD 6300.
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We often get queries on CyberKnife and what is CyberKnife used for ?
CyberKnife is an excellent treatment option for treating cancer’s such as prostate cancer, gliomas ,brain cancer, kidney cancer, lung cancer, spine cancer, cancer of the pancreas, head and neck cancer, liver cancer, early stage -localised breast cancer and several types of malignant tumours, benign tumours and several other medical conditions.
CyberKnife delivers stereostatic radiation( SBRT) with extreme precision and a tissue margin of 1-5mm
Cyber knife is totally non invasive and offers hope for inoperable localised cancers such as small cell lung cancer,for inoperable lesions where there is no other alternative for the patient to be treated.
CyberKnife can spot the exact size, shape and location of the tumor and delivers highly concentrated beams of radiation with precision ranging from 1 to 5 mm and this leads to minimal damage and bleeding.
Since CyberKnife treatment is totally non invasive, it is used for treatment of inoperable cancers as an alternate to surgery or as an alternative to surgery to minimise trauma, avoid complications and reduce risk.
Most patients can be treated several times with the CyberKnife and even treated again or retreated with minimal side effects leading to a better quality of life.For example for prostate cancer, even for a repeat surgery, CyberKnife can be used very successfully.
CyberKnife treatment is FDA approved and can spot patient movement even while breathing. The radiation beams can be aimed from several directions, thereby never losing the precision which is hall mark of a CyberKnife treatment.
CyberKnife treatment usually gets completed in 3 to 5 sessions spread over a week. Most patients can lead normal lives post CyberKnife treatment Most CyberKnife treatments are covered by insurance providers all over the world.
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Since the treatment involves a high degree of expertise, CyberKnife treatment is not offered by most hospitals.
The stage, location and size of the tumour or the cancer plays an important role, hence multiple teams of doctors and oncologists need to be involved before a decision on use of CyberKnife as treatment option can be arrived.
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What is Lung Cancer?
Lung cancer refers to molvolent tumours in the lung which can further spread throughout the body, if not treated at once.
It is highly fatal and the main reason responsible is tobacco smoking and air pollution. The developed tumor could be splenetic or benign.
Lung Cancer Causes:
Exposure to asbestos is also a cause of lung cancer and workplace is quite a common place where a person could be exposed to such fibre.
Maximum of the cancer in lungs is harmonize with consumption of tobacco in different forms such as cigarette smoking. Tobacco contains various harmful chemical compounds such as nitrosamines and polycyclic aromatic hydrocarbons and the consumption of these injurious chemicals increases risks of cancer.
Lung Cancer Treatment:
The treatment of lung cancer begins by performing several tests on the patient to understand the sophistication and severeness of the defect.
- CT Scan
- Bone scan
Several imaging tests are also done to detect disease spread.
The tests also include lung cancer tests, biopsy, sputum cytology, PET, bronchoscopy and mediastinoscopy.
After these tests the doctor decide the best treatment on the basis of the tests results.
- Surgery is an option, which is suitable for treating early stage cancer, but not appropriate for NSCLC .
- Chemotherapy is the most successful method of treating small cell lung cancer (SCLC).
Complications to be Faced:
There are several complications that can occur.
- Surgery: Coughing, tightness in chest, deep breathing, pain, weakness and excessive air and fluid in the chest are common side effects that can occur.
- Chemotherapy: Complications like Hair loss, vomiting, nausea, etc. are some of other side effects you may experience.
- Radiation therapy: Side effects are sore and dry throat, changes in skin .
Post operative care
The patient will need to visit the doctor within 2 to 6 weeks after the treatment and then regular follow ups must be made at regular intervals.