E4833. Theranostics: Past, Present, and Future
  1. Michael Kavanaugh; Brigham and Women's Hospital; Dana Farber Cancer Institute
  2. Nusrat Shaikh; Jaslok Hospital and Research Centre
  3. Miguel Almeida; Brigham and Women's Hospital; Dana Farber Cancer Institute
  4. Vikram Lele; Jaslok Hospital and Research Centre
  5. Harshita Gupta; Jaslok Hospital and Research Centre
  6. Benjamin Auer; Brigham and Women's Hospital; Dana Farber Cancer Institute
  7. Hina Shah; Brigham and Women's Hospital; Dana Farber Cancer Institute
Theranostics employs molecular tracers targeted to specific tissues or tumor types to produce diagnostic images of tumor burden and provide localized therapeutic radiation to tumor with minimal effect on healthy tissue. While the field has been around since the early 1900s, with the advent of radioactive iodine for thyroid cancer, new developments in radiopharmaceuticals has led to an increase in the types of tumors that can be targeted and the radionuclides that can be delivered. Research in theranostics is providing new tools in the treatment of otherwise refractory cancers, and these treatments are prolonging survival and improving quality of life. Currently prostate, neuroendocrine, thyroid, lymphoma, and neuroblastoma have targeted therapeutic and diagnostic pairs available, and multiple new targets are on the horizon. Diagnostic tracers utilize gamma and positrons emissions, while the therapeutic pair utilizes beta particles, alpha particles, and auger electrons. Standard treatment protocols are often employed, however, pretreatment and on-treatment dosimetry can be performed to ensure optimal therapeutic dose for each patient. This exhibit reviews the history of theranostics, the current state, and the anticipated future directions, and how our institution has established our theranostics practice.

Educational Goals / Teaching Points
Provide a brief history of the field of theranostics. Overview of the current treatments available. - Delineate the strengths and weaknesses of different radionuclides. Describe dosimetry with pretreatment imaging and on-treatment imaging. Review tumor phenotype characterization via multiple tracers. Explain how on-treatment monitoring can be performed after therapies. Guide to setting up a theranostics practice. Upcoming and potential avenues for the future of theranostics.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Prostate cancer, neuroendocrine cancer, thyroid cancer, neuroblastoma, PSMA, DOTATATE, FAPI, MIBG, 123Ra, 177Lu, 131I, and PET/CT.

Theranostics provides new treatment avenues for patients in whom standard therapies have failed. Appropriately selected diagnostic and therapeutic pairs can provide accurate tumor burden and phenotype characterization, allowing for subsequent delivery of targeted radiation directly to the tumor sites with minimal damage to healthy tissue. Currently available radiopharmaceuticals are increasingly gaining a role in clinical practice. As research progresses, the types of tumors that can be targeted and the patients that can be treated will continue to expand.