Investigation of the effects of tumor size and type of radionuclide on tumor curability in targeted radiotherapy

Background: Targeted radiotherapy is one of the important methods of radiotherapy that involves the use of beta-emitting radionuclides to deliver a dose of radiation to tumor cells. An important feature of this method is the tumor size and the finite range of beta particles emitted as a result of radionuclide disintegration those have significant effects for the curability of tumors. Material and Methods: Monte Carlo simulations and mathematical models have been used to investigate the relationship of curability to tumors size for tumors treated with targeted 131I and 90Y. The model assumed that radionuclides are distributed uniformly throughout tumors. Results: The results show that there is an optimal tumor size for cure. For any given cumulated activity, cure probability is greatest for tumors whose diameter is close to the optimum value. There is a maximum value of curability that occurs at a diameter of approximately 3.5 mm for 131I. For 90Y maximum curability occurs at a tumor diameter of approximately 3.5 cm. Tumors smaller than the optimal size are less vulnerable to irradiation from radionuclides because a significant proportion of the disintegration energy escapes and is deposited outside the tumor volume. Tumors larger than the optimal size are less curable because of greater clonogenic cell number. Conclusion: With single radionuclide targeted radiotherapy, there is an optimal tumor size for tumor cure. It is suggested that single agent targeted radiotherapy should not be used for treatment of disseminated disease when multiple tumors of differing size may be present. The use of several radionuclides concurrently would be more effective than reliance on single radionuclide. This approach of using combination of radionuclides with complementary properties could hopefully prepare new measures and improve the efficiency of tumor therapy