title: Radiopharmaceuticals in the elderly cancer patient: Practical considerations, with a focus on prostate cancer therapy: A position paper from the International Society of Geriatric Oncology Task Force.
abstract: Molecular imaging using radiopharmaceuticals has a clear role in visualising the presence and extent of tumour at diagnosis and monitoring response to therapy. Such imaging provides prognostic and predictive information relevant to management, e.g. by quantifying active tumour mass using positron emission tomography/computed tomography (PET/CT). As these techniques require only pharmacologically inactive doses, age and potential frailty are generally not important. However, this may be different for therapy involving radionuclides because the radiation can impact normal bodily function (e.g. myelosuppression). Since the introduction of Iodine-131 as a targeted therapy in thyroid cancer, several radiopharmaceuticals have been widely used. These include antibodies and peptides targeting specific epitopes on cancer cells. Among therapeutic bone seeking agents, radium-223 (223Ra) stands out as it results in survival gains in patients with castration-resistant prostate cancer and symptomatic bone metastases. The therapeutic use of radiopharmaceuticals in elderly cancer patients specifically has received little attention. In elderly prostate cancer patients, there may be advantages in radionuclides' ease of use and relative lack of toxicity compared with cytotoxic and cytostatic drugs. When using radionuclide therapies, close coordination between oncology and nuclear medicine is needed to ensure safe and effective use. Bone marrow reserve has to be considered. As most radiopharmaceuticals are cleared renally, dose adjustment may be required in the elderly. However, compared with younger patients there is less, if any, concern about adverse long-term radiation effects such as radiation-induced second cancers. Issues regarding the safety of medical staff, care givers and the wider environment can be managed by current precautions.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: john.prior@chuv.ch.
authors.forename: John O
authors.initials: JO
authors.lastname: Prior
authors.affiliation: Department of Oncology/Hematology, Kantonsspital, St Gallen, Switzerland.
authors.forename: Silke
authors.initials: S
authors.lastname: Gillessen
authors.affiliation: Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.affiliation: Section of Geriatrics and Palliative Medicine, University of Chicago, USA.
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.affiliation: Clinique de Genolier, Geneva, Switzerland.
authors.forename: Matti
authors.initials: M
authors.lastname: Aapro
authors.affiliation: The Institute of Cancer Research, Division of Radiotherapy and Imaging, The Royal Marsden Hospital, Department of Nuclear Medicine, London, UK.
authors.forename: Wim J G
authors.initials: WJG
authors.lastname: Oyen
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D011868:Radioisotopes / Q000627:therapeutic use*; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals
chemical_list: D011868:Radioisotopes; D019275:Radiopharmaceuticals
keywords: Comorbidities; Elderly; Molecular imaging; Prostate cancer; Radionuclide imaging; Radionuclide therapy; Radium-223