It's hard to put into words what you feel when you find out that you or someone you love has cancer. It's normal to feel scared and curious when your doctor tells you about a new treatment, such as PRRT, which is an unfamiliar term. But don't worry. Although this is a somewhat complex topic, today we'll talk about what PRRT is, what it does, and what its advantages and disadvantages are, in a very simple way that you can understand.
What does PRRT simply mean?
Simply put, PRRT is a highly advanced treatment that targets, seeks out, and destroys cancer cells, much like a 'guided missile' . It is specifically used to treat a type of cancer called `Neuroendocrine Tumors (NETs).'
The specialty of this treatment is that the radioactive material (radioactivity) released by it goes directly into the cancer cells and destroys them. Therefore, the damage to healthy cells is much less than with regular radiation therapy.
How does this treatment work inside the body?
To understand this, let's use a simple example. Imagine that your cancer cells are doors with lots of special 'keyholes' (`receptors`). Each door only fits a key with a specific shape.
This drug, called PRRT, is made by combining two components:
1. The Key: This is a protein. This key can only fit into the 'keyhole' of cancer cells. It does not fit into healthy cells.
2. The Radioactive Passenger: This key has a very small radioactive element (`radionuclide`) attached to it.
So, when you give this drug to your body, this 'key' travels throughout the body, finds the 'keyholes' in the cancer cells, and attaches itself to them. Then, the 'radioactive passenger' on the key goes inside the cancer cell, damages the DNA of that cell, and destroys the cell from the inside.
This method allows for the selective destruction of only cancer cells, without causing significant damage to healthy cells. This is the biggest advantage of this treatment.
The most commonly used PRRT drug today is `lutetium Lu 177 dotatate (LUTATHERA®)`.
Who is PRRT treatment recommended for?
This treatment is not suitable for all cancer patients. Currently, it is mainly recommended for cancers called `gastroenteropancreatic NETs`, which are cancers of the digestive tract (intestines, stomach, rectum) and pancreas. There are several situations in which this treatment may be suitable for you.
| Status | Explanation |
|---|---|
| Not suitable for surgery | If the cancer has spread ( metastasized ) to multiple parts of the body, surgery alone is unlikely to provide a complete cure. Many people with NETs may have already spread the cancer when they are diagnosed. |
| Other treatments have not been successful | In cases where surgery is not possible, things like hormone therapy are given. But sometimes, those treatments cause the cancer cells to continue to grow uncontrollably. For those people, PRRT is a good option. |
| Cancer cells have that 'keyhole' | This is the most important thing. In order for the PRRT drug to reach the 'key' and connect, there must be 'keyholes' called somatostatin receptors on the surface of the cancer cells. Your doctor will do a special scan, such as an octreotide scan or a PET scan , to see if your cancer cells have these. |
What happens before and during treatment?
Before treatment
If you are taking other medications for NETs (especially somatostatin analogs), your doctor will likely advise you to stop taking them a few weeks before PRRT. Your doctor will also likely do blood tests about a week before your treatment to check your kidney function and blood cell counts to make sure your body is in a good state to receive the treatment.
On the day of treatment
This treatment is usually given every two months for 4 sessions over a period of 8 months. This is an outpatient procedure, without having to stay in the hospital. The entire procedure takes about 5-6 hours.
- First, a small tube (cannula) is inserted into a vein in your arm and a saline line is created.
- About an hour before the treatment begins, medication is given to prevent nausea and vomiting.
- Then, you will be given a saline solution containing amino acids to protect your kidneys for about 4 hours. This is very important.
- About 30 minutes after the amino acids start being administered, the PRRT drug is administered to the body through the saline over a period of 30-45 minutes.
- Once all the saline has been administered, the tube in the arm is removed.
The day after treatment, you will have another scan to check where the radioactive medicine has gone in your body, especially where the cancerous tumors are.
What are the side effects and risks?
As with any treatment, there may be some side effects.
Most common side effects:
The most common side effects are nausea and vomiting , but these can be largely controlled by early treatment.
Other possible complications:
- Any effect on kidney or liver function.
- Decreased number of blood cells (white blood cells, red blood cells, platelets). This can cause difficulty breathing, increased susceptibility to infections, and an increased risk of bleeding or bruising.
- Very rarely, there is a very small risk of developing other blood cancers such as myelodysplastic syndrome or leukemia.
Your doctor will monitor your blood levels regularly throughout your treatment. If any problems arise, they may decide to change the dose or stop your treatment.
A very serious situation that requires immediate attention!
Carcinoid crisis is a rare but potentially life-threatening condition that can occur during this treatment. It is caused by the sudden release of large amounts of hormones from the cancer cells into the bloodstream. Symptoms can appear within the first 48 hours of receiving treatment.
If you have any of these symptoms, go to the nearest hospital Emergency Department (ETU) immediately or call 1990:
* Difficulty breathing
* Redness of the face or neck, feeling hot or burning in the body (Flushing)
* Sudden drop in blood pressure (feeling dizzy)
* Heart palpitations
* Severe diarrhea
Daily life after treatment
Most people tolerate this treatment well and recover quickly.
Radioactivity and safety:
The treatment uses a very small amount of radiation. This will be passed out of your body in your urine and stool over the next few days. During this time, your doctor will give you instructions to prevent others from being exposed to radiation.
- It is especially important to stay away from pregnant women and young children for a few days.
- Wash your hands thoroughly with soap after using the toilet.
Traveling:
There may be a very small amount of radiation in your body for up to 3 months after your treatment. This may set off radiation detectors at airports or borders. Therefore, always keep the special card you receive from the hospital and your treatment details with you. This is very important to avoid any inconveniences when traveling.
Take-Home Message
- PRRT is an advanced treatment that delivers radiation that is specifically targeted to cancer cells. It is used specifically for Neuroendocrine Tumors (NETs).
- Although this is not a treatment that completely cures cancer, it helps shrink or stop the growth of tumors, control symptoms, and improve quality of life by increasing survival time.
- For a few days after treatment, follow the instructions given to protect others from radiation (especially staying away from young children and pregnant women).
- Be aware of the symptoms of carcinoid crisis (difficulty breathing, flushing, severe diarrhea, increased heart rate). If you experience any of these symptoms, go to a hospital's ETU immediately.
- Don't hesitate to talk to your doctor about any side effects or problems you may experience.
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