Nuclear medicine in the treatment of endocrine and neuroendocrine tumors

Radionuclide therapy plays an important role in the treatment of endocrine and neuroendocrine tumors. Therapy with 131I is used in patients with papillary and follicular thyroid carcinoma for ablation of thyroid remnants and for treatment of distant metastases. In neck recurrence, 131I may be used as monotherapy or in combination with surgery. Both radioimmunotherapy and 90Y-DOTATOC are being applied in non-131I-avid thyroid malignancies such as medullary thyroid carcinoma. 131I-MIBG is currently used in various treatment schedules for recurrences and metastases of neuroblastoma, pheochromocytoma, paraganglioma and carcinoid. In neuroblastoma 131I-MIBG can be given upfront to reduce large and bulky tumors for subsequent surgery, chemotherapy and autologus bone marrow infusion. In carcinoid and other neuroendocrine tumors therapy with radiolabelled somatostatin analogues appears to be a promising modality. Radiopharmaceutical quality requirements, patient preparation, radiation protection and hospital isolation facilities are important supportive factors to enable adequate radionuclide therapy