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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2021 Dec 09

DOI: 10.23736/S1824-4785.21.03407-5


language: English

Theranostics in primary and secondary liver tumors: the need for a personalized approach

Luca FILIPPI 1 , Arthur J. BRAAT 2

1 Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy; 2 Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands


Primary and secondary hepatic tumors have a dramatic impact in oncology. Despite many advances in diagnosis and therapy, the management of hepatic malignancies is still challenging, ranging from various locoregional approaches to system therapies. In this scenario, theranostic approaches, based on the administration of a radiopharmaceuticals’ pair, the first labeled with a radionuclide suitable for the diagnostic phase and the second one bound to radionuclide emitting particles for therapy, is gaining more and more importance. Selective internal radiation therapy (SIRT) with microspheres labeled with 90Y or 166Ho is widely used as a loco-regional treatment for primary and secondary hepatic tumors. While 166Ho presents both gamma and beta emission and can be therefore considered a real “theranostic” agent, for 90Y-microspheres theranostic approach is realized at the diagnostic phase through the utilization of macroaggregates of human albumin, labeled with 99mTc as “biosimilar” agent respect to microspheres. The aim of the present review is to cover theranostic applications of 90Y/166Ho-labeled microspheres in clinical practice. Furthermore, we report the preliminary data concerning the potential role of some emerging theranostic biomarkers for hepatocellular carcinoma, such as glypican-3 (GPC3) and prostate specific membrane antigen (PSMA).

KEY WORDS: Radioembolization; Microspheres; Yttrium-90; Holmium-166; Hepatocellular carcinoma; Cholangiocarcinoma; Precision medicine; Neuroendocrine tumors; Theranostics

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