Department of Nuclear Medicine

Location: Royal Marsden

Section: NHS Clinical Research Programme

Consultants: Dr G J R Cook MSc MD FRCP FRCR, Dr V J Lewington MSc FRCP

Introduction

• The Department of Nuclear Medicine is based at Sutton and provides a regional service for surrounding hospitals as well as Royal Marsden patients. At Chelsea, a nuclear medicine service is provided by the Royal Brompton Hospital. Nuclear medicine is closely linked to the Department of and the Thyroid and Isotope Therapy Unit and forms part of the Department of Diagnostic Imaging with which it has close clinical and research collaborations.
• The Nuclear Medicine Department focuses on the use of radiopharmaceuticals for diagnosis, therapy and research in oncology. Unique information is provided through the ability to investigate tumour biology and metabolism. The Department also collaborates with many clinical units providing data for a number of research projects.

Relevance to the NHS Research and Development Programme

Our research programmes involving positron emission tomography (PET) and single photon emission computed tomography (SPECT) to measure different aspects of tumour biology and function are of very high or high importance in the NHS R&D programme in cancer. Our dosimetric therapy planning approaches should optimise efficacy and minimise toxicity of targeted radionuclide therapies. The use of radionuclide investigations in patients on drug trials and under routine treatment will provide early markers for disease response and methods to monitor toxicity. When fully developed, these studies will assist the NHS by reducing costs and by avoiding unnecessary or inappropriate therapy.

Recent Highlights

• Dr Val Lewington has increased the number of novel targeted radionuclide therapies carried out. These include radiolabelled peptides to treat neuroendocrine tumours (Figure 1), including thyroid cancer and radioimmunotherapy for refractory non-Hodgkin’s lymphoma. We are also participating in research trials, investigating the therapeutic potential of new bone seeking radiopharmaceuticals for skeletal metastases
• A Gemini PET-CT scanner is installed and is being used for both clinical and research applications (Figure 2)
• It is anticipated that a cyclotron/radiochemistry facility will be shortly commissioned
• We have maintained a number of new research collaborations with units from within The Royal Marsden and The Institute, as well as outside institutions. A number of clinical FDG PET studies have been initiated
• We have been involved in a study of a novel SPECT angiogenesis targeting radiopharmaceutical and plan to extend this project to PET
• We have been represented at national and international meetings, presenting research findings and invited lectures and have also contributed to the European PET learning facility in Vienna at technical and clinical levels
• Members of the team have been instrumental in establishing a radionuclide therapy and dosimetry course at the European Association of Nuclear Medicine centre in Vienna
• We are one of the leading UK trial centres for a new research study combining radioisotope therapy with radiosensitisers for refractory childhood neuroblastoma
• In collaboration with colleagues in the Radioisotope Physics Team, The Royal Marsden continues to coordinate the central review of mIBG scans in the European-wide ESIOP neuroblastoma study which is nearing completion

Future Aims

• Functional imaging using radiopharmaceuticals is playing an increasing role in drug development and in the monitoring of tumour response to therapy at a very early stage. With the arrival of a cyclotron and radiochemistry facility, we will play a more active role in this field with new and existing PET and SPECT tracers. We are contributing to two national PET; The Department has become involved with the development of techniques to use PET-CT data in radiotherapy planning for a number of cancers.
• The range of radionuclide therapies offered is increasing. In addition to current treatments, the therapeutic potential of new techniques will be assessed. Participation in an international trial using a new radioactive peptide to treat neuroendocrine tumours is planned for 2006. A cross specialty, quantitative trial of a new anti-melanoma drug, will commence in Q3/2006.
• The combination of clinical, technical and scientific expertise in radioisotope medicine is unique in the UK and will lead to increasing clinical and research demand. A significant infrastructure investment will be necessary to meet rising expectation and to establish The Royal Marsden as the leading UK centre for nuclear medicine oncology, innovation and therapy.