It is really hard to see the weakening of your beloved one. It is also very painful to hear that he is suffering from cancer and if left untreated, he will die soon.
However, today's saving angels do not allow cancer to kill your patient as it did in the past. They are those experts, who taking the advantage of their knowledge and also modern equipment have changed your cancer patients' disappointment into hope.
Flag carrier of this hope creation in the country's east is the Razavi Hospital. Enjoying constructive supports of Astan Quds Razavi, the Health Ministry, Atomic Energy Organization, and Mashhad's University of Medical Sciences, this hospital has succeeded to attain another achievement in the arena of production of medicines and its nuclear medicine ward has been successful to produce two new radiopharmaceuticals. Also, it has started the clinical use of these two radiopharmaceuticals in the country, a success which will soon extend our country's reputation to beyond its boundaries.
Producing and researching on these radiopharmaceuticals are done in a few European countries only. It is a very precise method and is considered as one of the newest topics in the world's area of nuclear medicine. Conducting this method by the Razavi Hospital must be considered as an example of national self-sufficiency case.
For this reason, we talked to Dr.Farshad Emami, nuclear medicine specialist and head of the department of nuclear medicine at the Razavi Hospital, about the center's success.
Dr. Emami! Please explain the beginning of nuclear medicine at the Razavi Hospital
Movement toward nuclear medicine to establish a center for diagnosis of cancer patients at the Razavi Hospital was started in 1386/ 2007. Launching this huge project was postponed as result of imposed sanctions, however. In addition, a project of this big size and grandeur had not been conducted, until that time, in Iran and this issue led to the long time of this project's operation.
Establishing nuclear medicine ward at the Razavi Hospital became a spark for the diagnosis and treatment of Iranian patients. At the present time, there are only three active nuclear medical centers in the country which are giving service in the area of diagnosis and treatment of cancer. All these three nuclear centers are working by taking the advantage of PET imaging and also producing radiopharmaceuticals by using cyclotrons.
Which radiopharmaceuticals help the diagnosis of cancer using this imaging and diagnostic method?
To have a comprehensive cover on all kinds of cancer at this center, production of other radiopharmaceuticals useful in both diagnosis and treatment were also attended to in addition to producing FDG which is used in all centers. This route moved forward to the extent that the advanced cyclotron installed at the Razavi Hospital produced FDG radiopharmaceuticals for the first time in Isfand, 1394/ February, 2016 and its injection was started then. It should also be said that all the 1000 patients who took the advantage of this method to diagnose their diseases were fully satisfied about the diagnosis process.
What kind of substances these radiopharmaceuticals include?
This radiopharmaceutical is a kind of glucose (used by all the cells of the body) which is marked by the radioactive atom of fluorine produced cyclotron.
You mean glucoses are useful in this method?
In general, glucose metabolism increase in cancerous cells and this phenomenon means that glucose accumulation is seen in most cancers. So, this feature can be used and imaging can be done from the accumulation points.
All kinds of cancers include the same process?
The point is that not all the cancers include this process and that’s why Razavi Hospital has strived to increase its activity in imaging cancerous cells and to cover cases which could not be imaged by this radiopharmaceutical. Therefore, in the first phase of this comprehensive approach, we could produce GA-PSMA68 and GA-DOTA60 radiopharmaceuticals which are very useful in diagnosis of prostate and neuroendocrine cancers.
Yes, neuroendocrine cancer is often found in digestive system and prostate cancer which is familiar to all and affect a wide range of old male people. Prostate cancer is one of the most common cancers among men. Actually, all the neuroendocrine cancers take the advantage of this method but these cancers are not very prevalent and number of Iranians suffering from these cancers reach to seven or eight thousand people. Prostate cancer has got a very different story, however. The diagnosis of this cancer includes a wide range meaning that whoever suffers from prostate cancer and his cancerous tumor is supposed to influence other organs can enjoy this method.
You mean this kind of cancer cannot be diagnosed by other ways of imaging?
It is not possible to image the neuroendocrine tumors by using FDG radiopharmaceutical because of their slow pace of growth and metabolism. And a special kind of material is needed to image them. Even in many case of bone influence by the cancerous tumor this method is used.
Has this method come into clinical operation at the Razavi Hospital's nuclear medicine ward?
Yes, after becoming certain about the quality of radiopharmaceutical two and a half months ago, about fifteen patients were imaged by using this method and they are all passing their treatment process now.
What are the advantages of this method over the previous ones?
One of the advantages of this method is that in many cases even when the patient's PSA level is low, influence of cancerous cells on other organs can be diagnosed.
This method is really useful for those whose cancerous tumors are very likely to influence other organs of the body. This method is also applicable for the purpose of diagnosis. However, cooperating with the atomic energy organization, nuclear medicine section of the Razavi Hospital tries to produce the treating substance of this radiopharmaceutical in addition to the diagnosing one.
Comparing to the positions of other countries, how do you evaluate Iran's position in production of radiopharmaceutical?
Producing GA-PSMA 68 is one of the newest issues in the world and many research studies have been done on it. It is so new that lots of articles in the medical journals of the world are authored on this topic. These researches investigate some issues such as which group of patients this radiopharmaceutical is applicable for and to what extent it can change the fate of the patients.
Did you enjoy foreign experience in the production of these radiopharmaceuticals?
Yes; To produce these radiopharmaceuticals, a certainty on the quality of the method was needed. For this purpose, some foreign advisors from Germany, Austria, and Italy were consulted and the final production was formed through cooperation with atomic energy organization and Pars Isotope Co.
Regarding this issue I have to say that one thing was very interesting for these foreign advisors and that was high efficiency of the gallium generator of this company. Some talks were done to export these generators to the European countries, therefore.
What you talked about is effective in diagnosis. Can this method be used for treatment?
Treating patients by this method is completely new. Regarding this method's treating substance, it should be said that there only three or four active centers in Europe which are giving services in this area and some memorandum of understanding have been signed with some of them for future interaction.
What about prevention?
Imaging methods by using rays are usually done after the early diagnosis of the diseases. In other words, a proof for the existence of the disease is required. After receiving this proof, patient is exposed to rays.
Dr. Emami, does this method have any side effect?
No harmful effect has ever been proved scientifically and with respect to the method's assistance to the treatment process of the patients, the benefits will outweighs the possible harms.
You talked about the expenses. How much each patient has to pay for using this method?
Although the total costs of the center are very high, the expense paid by each patient is equivalent to a usual PET-CT scan. In fact, according to the ministry's announcement, the expense of diagnosis by radiopharmaceutical imaging is over fifty million Rials, but the amount has been decreased to that of state centers with the endeavor of Astan Quds Razavi. Patients are paying around thirty million Rials, therefore.
And insurance companies' role?
Special insurances pay the expenses of these imaging methods but other insurances which are used by most of the people don't do that. We hope insurance coverage of this method be done so that all the people can have easier access to this useful method. Unfortunately, insurance companies pay attention to the issue of treatment only, while the diagnosis is a very important issue as lots of expenses of chemotherapy must be avoided.
How many times of imaging is needed for each patient?
What happens in each patient's disease determines the use of the method. For the people who want to influence their other organs by this method, this kind of imaging is done once and then patients' treatment process is formed. After this, progression of the disease is cleared by other methods; however, future return of the disease is possible for some cancer patients. In general, repetitive return of the disease is not expected a lot. Therefore, imaging method is done just once or twice, but even these low times can change the fate of the patient and the disease.
Do you have other plans for the production of radiopharmaceuticals?
Yes, because of the existence of glucose metabolism in the area of brain it is not possible to find it by using FDG. So, producing special radiopharmaceuticals for the brain cancers will be done in future at the nuclear medicine part of the Razavi Hospital. Another plan of the center is to produce radioactive substances required for the resistant cases to treatment of prostate and neuroendocrine cancers, cooperating with atomic energy organization.