Extravasation, as distinct from infiltration, is when a potentially toxic agent (e.g., radiographic contrast, chemotherapy, anesthesia or radionuclide) is unintentionally administered to the surrounding tissue instead of directly into the vein. There is an expectation for vascular access in interventional medicine across nearly all specialties that this high frequency, study/treatment critical procedure needs to occur with rare failure and that this failure rate should be characterized in quality assurance. This opinion piece, written by a family practitioner who has served as the chief medical officer for a not-for-profit payer, reflects on our responsibility to be aware as clinicians of known potential harm and disclose to patients before a risk has occurred and if harm has occurred. In this paper, clinical obligations of reporting will be reviewed, which are necessary to maintain and enhance our trust with our patients. In the second half, the perspectives of a not-for-profit payer chief medical officer will be considered.
Introduction: Breast cancer is a complex disease and constitutes the leading cause of cancer in women globally. Conventional treatment modalities include surgery, chemotherapy, radiation therapy, and hormonal therapy; all of these have their limitations and often result in significant side effects or toxicity. Targeted radionuclide therapy based on a theranostic approach has been successfully applied in several malignancies, such as prostate cancer, thyroid cancer, and neuro-endocrine tumours. Several studies have also highlighted the potential of theranostic applications in breast cancer.
Aim: This review aims to provide an overview of the most promising current and future theranostic approaches in breast cancer.
Discussion: The discussion includes pre-clinical as well as clinical data on some of the most successful targets used to date. Examples of potential theranostic approaches include those targeting the Human epidermal growth factor receptor 2 (HER2) expression, angiogenesis, aspects of the tumour microenvironment, Gastrin-releasing peptide receptor (GRPR), Prostate-specific membrane antigen (PSMA) and Chemokine receptor 4 (CXCR-4) expression. Several challenges to widespread clinical implementation remain, which include regulatory approval, access to the various radiopharmaceuticals and imaging technology, cost-effectiveness, and the absence of robust clinical data.
Conclusion: Theranostic approaches have the potential to greatly improve diagnosis, treatment, and outcomes for patients with breast cancer. More research is needed to fully explore the potential of such approaches and to identify the best potential targets, considering feasibility, costs, efficacy, side effects and outcomes.
Neuroendocrine tumors (NETs) are not commonly diagnosed in children. Metastatic NETs tend to have poor outcomes, and this is seen in adult and pediatric populations. The role of somatostatin receptor imaging using [68Ga]Ga-DOTA-TATE for imaging and peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-TATE in children is currently not well established. The guidelines for treating pediatric neuroendocrine tumors are still lacking. Extensive trials have been conducted in adult patients and have demonstrated improved survival in metastatic NETs with PRRT using [177Lu]Lu-DOTA-TATE. We present two pediatric patients with metastatic NETs who were imaged with [68Ga]Ga-DOTA-TATE PET/CT and treated with [177Lu]Lu-DOTA-TATE therapy.