title: Radioimmunotherapy in non-Hodgkin lymphoma: opinions of nuclear medicine physicians and radiation oncologists.
abstract: Despite approval by the Food and Drug Administration and consistent reports of the efficacy and safety of (90)Y-ibritumomab tiuxetan and (131)I-tositumomab, these therapies are infrequently used. This study investigates the opinions and patterns of the use of radioimmunotherapy by nuclear physicians, affiliated researchers, nuclear medicine technologists, and radiation oncologists and aims to identify possible barriers to the use of this promising therapy.
  
  
  METHODS
  An e-mail-based survey with 13 broad questions related to radioimmunotherapy was sent electronically to 13,221 Society of Nuclear Medicine members and radiation oncologists throughout the United States.
  
  
  RESULTS
  Six hundred thirteen individuals (4.6%) responded to the electronic survey. Two hundred fifty-one responders (40.9%) had treated patients with non-Hodgkin lymphoma (NHL) with radioimmunotherapy in the last 24 mo. Of the responders, 29.5% used only (90)Y-ibritumomab tiuxetan, 7.6% used only (131)I-tositumomab, and 24.9% used both radiopharmaceuticals; 37.9% did not treat NHL with radioimmunotherapy. Most responders said their patients came from university hospitals (33.9%) or private offices (25.6%), and they mainly treated in a second-line (42.9%), third-line (35.6%), or consolidation (23.5%) setting. Major concerns were that referring oncologists and hematologists wanted to treat by themselves with nonradioactive compounds (mean ± SD, 3.418 ± 1.49) and that (90)Y-ibritumomab tiuxetan and (131)I-tositumomab were expensive (mean ± SD, 3.413 ± 1.35). Of the responders and involved physicians, 40.4% and 35.2%, respectively, did not know if their institution accepted Medicare patients for radioimmunotherapy. Almost 30% (29.6%) of the responders thought radioimmunotherapy would probably grow and 38.0% thought it would grow in importance in the future. Responders who did not administer radioimmunotherapy for NHL thought it took too much time to administer radioimmunotherapy (P < 0.01) and had concerns about the dosimetry procedure (P < 0.01) and radiation safety (P < 0.01). Individuals who perceived a negative future for radioimmunotherapy had significantly more concerns about the time-consuming administration process (P < 0.05) and the high cost of radioimmunotherapy (P < 0.05). Responders from academic centers had significantly fewer concerns about payment (P < 0.01), dosimetry (P < 0.01), and radiation safety (P < 0.01).
  
  
  CONCLUSIONS
  Radioimmunotherapy was generally viewed positively by the surveyed population. However, limited referrals due to alternative nonradioactive therapies and logistic, educational, and economic concerns played an important role for subgroups in the perception of radioimmunotherapy for NHL.
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0817, USA.
authors.forename: Niklaus G
authors.initials: NG
authors.lastname: Schaefer
authors.forename: Peng
authors.initials: P
authors.lastname: Huang
authors.forename: Julia W
authors.initials: JW
authors.lastname: Buchanan
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
mesh_terms: D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D003625:Data Collection; D003710:Demography; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D006405:Hematology / Q000706:statistics & numerical data; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy*; D009683:Nuclear Medicine / Q000706:statistics & numerical data*; D010465:Perception; D010820:Physicians / Q000706:statistics & numerical data*; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D016499:Radioimmunotherapy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data
chemical_list: D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D019275:Radiopharmaceuticals; C422802:ibritumomab tiuxetan; C119496:tositumomab I-131