The first presentation reviews current indications for ¹⁷⁷Lu-PSMA-617 and practical considerations related to PSMA-directed RPTs including practice building and multidisciplinary patient management. Applications of pre-treatment molecular imaging with PSMA PET as part of the Theragnostic treatment paradigm will be discussed along with post-treatment imaging including SPECT. The presentation also explores topics related to further improving on prostate cancer clinical outcomes with PSMA-directed RPTs including ongoing clinical trials, dosimetry, and combination therapy including with external beam radiotherapy. A discussion of challenging clinical scenarios related to applying ¹⁷⁷Lu-PSMA-617 in the clinic is also included.

In the second presentation, the role of RA-233 and its applications are discussed.

The third presentation reviews the therapy-specific considerations for RAI toward the treatment of thyroid cancer. Discussion includes the basic mechanism, indications and toxicities of RAI therapy.

Hepatic brachytherapy using intra-arterial Y90 microspheres is a maturing therapy that often is delivered without the concomitant application of personalized dosimetry planning and post-treatment confirmatory dosimetry, multidisciplinary consultation, and collaborative management prior to and post liver-directed RPT. The fourth presentation reviews the eligibility criteria for liver-directed radiotherapy using Y90 and the estimated absorbed does in tumor and normal live prior to and after implementation.

This last presentation covers NET classification, incidence, survival; mechanism of action, renal protection; Lu-177-DOTATATE; NCCN guidelines on PRRT; clinical indications, sequencing; COMPETE Trial; other considerations such as dosimetry, delivery alphas, radioresistance); and community perspective.

Topics

• Advancing Radiation Oncology Leadership in PSMA-Targeted Radiopharmaceutical Therapy ‒ Mallika Marar, MD, MBA
• Ra-223 for mCRPC ‒ Richard G. Stock, MD
• Therapy Specific Considerations for Radioactive Iodine ‒ Stephanie Markovina, MD, PhD and Nikhil Rammohan, MD, PhD
• Therapy-Specific Considerations for Liver-Directed Radiopharmaceutical Therapy/Selective Internal Radiation Therapy (⁹⁰Y) ‒ Andrew Kennedy, MD
• Radioligand Therapy NET ‒ Ravi Shridhar, MD, PhD