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Medullary thyroid carcinoma; Somatostatin receptor scintigraphy; Targeted radionuclide therapy; Radiation therapy

Introduction

Medullary thyroid carcinoma (MTC) is a rare form of thyroid cancer that arises from the parafollicular cells, also known as C cells, of the thyroid gland [1]. It accounts for approximately 5-10% of all thyroid malignancies. The management of MTC requires a multidisciplinary approach, and nuclear medicine plays a pivotal role in various aspects of its diagnosis, staging, and treatment. This article provides an updated perspective on the applications of nuclear medicine approaches in the management of MTC .Accurate diagnosis and staging of MTC are essential for appropriate treatment planning [2]. Nuclear medicine imaging techniques such as thyroid scintigraphy with technetium- 99m pertechnetate or iodine-123 can assess the functional status of the thyroid gland and help distinguish MTC from other thyroid nodules. Additionally, positron emission tomography (PET) using radiotracers like fluorine-18 fluorodeoxyglucose (FDG) or gallium-68 doctorate can provide valuable information on the extent of MTC, detecting local and distant metastases [3]. MTC cells often express somatostatin receptors, which can be exploited for imaging using somatostatin receptor scintigraphy (SRS) [4]. Radiolabeled somatostatin analogs such as indium-111 pentetreotide or gallium-68 dotatate can be administered to visualize the somatostatin receptor-positive MTC lesions [5]. SRS has demonstrated high sensitivity in detecting both primary tumors and metastatic lesions, aiding in accurate staging, treatment planning, and monitoring of MTC patients [6].

Discussion

Calcitonin and carcinoembryonic antigen (CEA) are biomarkers that are frequently elevated in MTC [7]. Nuclear medicine techniques such as radioimmunoassay and immuno-PET can measure the levels of these markers in blood or tissue samples, providing important prognostic information and aiding in the assessment of treatment response. MTC can be resistant to conventional therapies, necessitating the exploration of alternative treatment options. Targeted radionuclide therapy (TRT) offers a promising approach in the management of MTC [8]. TRT involves the administration of radiolabeled compounds that specifically target MTC cells, delivering localized radiation therapy. Radiolabeled somatostatin analogs, such as lutetium-177 octreotate or yttrium-90 dotatate, have shown promising results in MTC patients with somatostatin receptor-positive tumors [9]. Nuclear medicine techniques also play a vital role in prognostication and post-treatment monitoring of MTC. Serial calcitonin and CEA measurements, along with imaging modalities like SRS and PET, can assess treatment response, detect recurrence or metastases, and guide subsequent management decisions [10].

Conclusion

Nuclear medicine approaches have revolutionized the management of MTC by providing valuable diagnostic, staging, therapeutic, and monitoring tools. Techniques such as SRS, molecular imaging, and targeted radionuclide therapy have improved the accuracy of diagnosis, localization of metastases, and treatment outcomes. With ongoing advancements in nuclear medicine imaging and targeted therapies, the future holds promise for further enhancing the precision and efficacy of MTC management. Collaborative efforts among clinicians, nuclear medicine specialists, and researchers are crucial in optimizing the role of nuclear medicine in MTC and improving patient outcomes in this challenging malignancy. Several investigational nuclear medicine therapeutic options are currently under evaluation in metastatic MTC. More data are needed to evaluate the efficacy, toxicity, and role of these therapeutic options in the management of MTC patients.

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