ABSTRACT
Patients receiving therapy with radiopharmaceuticals currently are receiving poor-quality medical care. Instead of tailoring the therapy to each individual patient, based on his or her specific biochemistry and metabolism, physicians generally prescribe dosages of radiopharmaceuticals to treat cancer and other diseases in a one-size-fits-all approach. Some administrations are adjusted for patient body weight, but this does not account for each subject's specific uptake of the compounds in tumors and normal tissues, and this may be inappropriate for obese patients, as organ sizes and radionuclide uptakes and clearance rates in their organs and tissues may be the same as a normal-weight individual. In external beam radiotherapy, every single patient receives an individualized radiation dose evaluation before therapy begins, based on computed tomography (CT) images of the subject and testing of computer-simulated therapy treatments. Thus, patients receive individualized treatment plans, which have the best chance of success with their disease. Giving 100 nuclear medicine therapy patients the same activity to treat their disease results in a broad distribution of effectiveness in the therapy and the outcomes, as much as a factor of 5 or more, as measured for one nuclear medicine therapy agent (Wahl 2005). As this is known, the tendency is to err on the side of caution and give too little, rather than too much radiation, to avoid normal tissue complications. Hence, if the distribution of effectiveness can be assumed to be Gaussian, the average of the distribution will be suboptimal, a large proportion of the population receives therapy that is decidedly suboptimal, and only a fraction of this population can expect a favorable therapeutic effect.
