The only place to prepare radioactive drugs for cancer diagnosis in Vietnam

Before Vietnam could prepare these two drugs, cancer patients had to go abroad if they needed to use them .

Currently, the Nuclear Research Institute is the only unit in the country using the Da Lat Nuclear Reactor to produce radioactive drugs. Radiopharmaceuticals being prepared here include I-131 solutions and capsules used in diagnosing and treating thyroid diseases (basedow, thyroid cancer.); P-32 solution is used to treat cancer pain caused by bone metastasis; P-32 is a pressure plate used to treat hemangiomas in children; Tc-99m is attached to specific marker compounds (MDP: bone scintigraphy; DTPA: kidney scintigraphy; Phytec: liver scintigraphy) for 25 nuclear medicine departments nationwide in cancer diagnosis and treatment. Some products are also exported to Cambodia.

Dr. Pham Thanh Minh, Director of the Center for Research and Preparation of Radioactive Isotopes, Institute of Nuclear Research, said that the production process is carried out by irradiating non-radioactive materials on the reactor. The nucleus will become radioactive material. Technicians will then perform extraction to obtain the radionuclide of interest, check its quality and distribute it to hospitals.

There are two types of radioactive drugs: short and long half-lives. In Vietnam, there is the Hanoi Irradiation Center (HIC) and a number of hospitals that use accelerators to actively produce radiopharmaceuticals with short half-lives to serve cancer diagnosis. Particularly, the Nuclear Research Institute mainly produces radiopharmaceuticals with long half-lives.

Pharmaceutical preparation room I-131. (Photo: Nuclear Research Institute).

Dr. Minh said that diagnosing and treating diseases with radioactive drugs is an irreplaceable method for some cancers today. Currently, radioactive drugs used at the Da Lat nuclear reactor are meeting about 60% of demand. "Proactively producing radioactive drugs domestically helps product prices be 1/3 cheaper than imported ones and contributes to the formation and development of the domestic nuclear medicine network," Dr. Minh said. However, the Da Lat nuclear reactor has a low capacity (500 kW) so it does not meet domestic demand. In addition, importing raw materials to produce drugs also faces difficulties due to regulations of the Ministry of Health.

The Department of Nuclear Medicine, Cho Ray Hospital (HCMC) is one of 25 units in the country that uses radioactive drugs to treat about 200 patients each month. The hospital is currently using radioactive drug I-131 from Da Lat Nuclear Research Institute and from abroad to treat thyroid cancer, hyperthyroidism such as Basedow.

This is an image of a patient being taken into the scanning chamber of a PET/CT machine, a device that provides very detailed images of cancerous tissues with high accuracy, used at Cho Ray Hospital. Before the PET/CT scan, the patient is injected intravenously with a radioactive marker, which is an important active ingredient that helps experts assess the location and extent of inflammation or cancer cells.

Recently, the hospital's Nuclear Medicine Department has just prepared and successfully used two new types of radioactive markers named Ga-68 PSMA in prostate cancer and Ga-68 Dotatate in neuroendocrine tumors. Preparing radioactive drugs for PET/CT scans is not a simple job, the space is extremely closed to ensure absolute radiation safety.

Nuclear physics engineer Nguyen Tan Chau and radiochemistry engineer Nguyen Thi Phuong Nam are in charge of preparing these two drugs. From 2021, this unit will begin importing machinery and testing modulation. Before that, they spent many years diligently studying and exchanging experiences. On November 7, nearly 3 years after many efforts, the drug was officially put into use.

Drug preparation is a series of chemical reactions consisting of 3 stages, 28 steps and takes more than 30 minutes. Engineers must continuously monitor the reaction process, collect information and operate in the correct order. Each day, the preparation room only produces 2-4 doses.

The result after each preparation is about 15 ml. The medicine will be immediately transferred to the PET/CT scanning room so that it can be injected into the patient one hour before going into the scanner. The advantage of these two drugs in PET/CT scans is that images of cancer cells will show more biological and metabolic detail, making it easier to evaluate and monitor cancer treatment.

The two types of drugs have a very short half-life, just over 60 minutes . After half-life, the drug's effectiveness is reduced, so the drug cannot be imported from abroad. Therefore, patients must go abroad on their own if needed . "This is also the reason why the department is determined to produce Ga-68 PSMA and Ga-68 Dotatate on its own to serve patients right at the hospital ," Dr. Nguyen Xuan Canh, Head of the Department of Nuclear Medicine, shared.

Engineer Nguyen Tan Chau is checking the radiation level around the modulator. This is work that takes place continuously in a high radiation environment.

This is a model that simulates the reaction process. Engineers of the Department of Nuclear Medicine research based on this model to test drug preparation.

When radioactive drugs are injected into a patient's veins, PET/CT can provide very detailed images of cancerous tissues with high accuracy. Above is the diagnosis of recurrent prostate cancer in a 47-year-old patient who had previously undergone surgery. The red light spots are cancer cells that appear after reacting with the drug Ga-68 PSMA.

Right from the time the drug was used, Cho Ray Hospital performed PET/CT scans to evaluate and monitor treatment for 12 patients diagnosed with neuroendocrine tumors and 13 patients with prostate cancer. This is considered a big step forward for Vietnam to help patients easily access advanced imaging diagnostic technology, without having to go abroad like before.

Dr. Canh commented that the current trend is targeted treatment with radioactive drugs for some prostate cancers, bone metastases, hepatocellular carcinoma, and neuroendocrine tumors. . He hopes that domestic scientists will research the binding of radioactive isotopes on targeted drugs to record images and evaluate the drug's ability to absorb cancer lesions, as a basis to help doctors make decisions. intended treatment. "Targeted drugs can be supplied to hospitals, helping to reduce treatment costs by more than 50%," said Dr. Canh.

With forecasts of increased demand for radiopharmaceuticals in the near future, the Nuclear Research Institute is planning to add low-enrichment U-235 fuel rods (19.75%) to increase furnace production of radioactive substances. radiopharmaceuticals in the next 10 years to supply about 80% of the needs for domestic and foreign hospitals. The Vietnam Atomic Energy Institute is promoting the implementation of the Center for Nuclear Science and Technology Research (CNST) project with a nuclear reactor with a large capacity of 10 MWt, which uses the furnace to produce isotopes. Radiation serving socio-economic development will be a top priority task.

The Institute also plans to build a strong, leading research team in the radiopharmaceutical industry (at least 10 people), to research and develop products for practical application.