Insurance questions will be addressed at the time of scheduling the first Radioligandtreatment. A mash-up of the words "therapy" and "diagnostics," theranostics combines imaging techniques and targeted therapy into one very precise package. Because of its precision, theranostics reduces the risk of harming nearby healthy tissues. This is not the future; it is the present. A prostate cancer patient's response to theranostics treatment at Heidelberg University Hospital in Germany. Since 2002, Zevalin is used for the treatment of this indication including B-cell non-Hodgkin's lymphoma and rituximab refractory follicular non-Hodgkin's lymphoma. Ga-68 DOTATOC is a radioactive diagnostic drug that targets SSTR2.Ga-68 DOTATOC is injected into a patients vein and travels throughout the bloodstream to all organs and tissues of the body. Theranostics Course 2022. . When you are diagnosed with cancer, you want treatment from an expert team you can trust. Obtendr un diploma con estadsticas de nivel, progresin y participacin. A copy of the patients medical records will be requested by the nuclear medicine team, including clinic notes, the pathology report confirming diagnosis, imaging, and laboratory tests. "It's a centralized brain trust where friendly and familiar faces detect, treat and track tumors all in one location," said Morris. Theranostics for Neuroendocrine Tumors Targeted Treatment for Certain Metastatic Neuroendocrine Tumors (PRRT) Technology and Expertise to Detect and Treat Elusive Tumors Neuroendocrine tumors, sometimes called carcinoid tumors, can occur in a variety of hormone-making cells, called endocrine cells. Neither your address nor the recipient's address will be used for any other purpose. Theranostics: a new hope in the fight against cancer The medical treatment, which combines therapy and diagnostics, has given terminal prostate cancer patients a 35% increased survival time in. Itis currently one of ourdoctorsbest weapons for treating several types of cancers at MSK, including thyroid, endocrine,neuroendocrine, and prostate. One of the main problems is the high costs involved. Then, a few months after your treatment, you might go back to get another scan with that diagnostic version of the tracer to see how the treatment worked, said radiologist Daniel Appelbaum, MD, Chief of Nuclear Medicine and PET at UChicago Medicine. They'll they receive their treatment and have their tumor tracked at the same location by the same medical staff who often become like family to them. Pierce, has greeted the results of theranostics against advanced prostate cancer enthusiastically. They go only to cells that have cancer and detonate that cell, Almaguel says. They have established clinical protocols and developed a dedicated facility within the imaging center for PRRT. Accordingly, candidates for this therapy must undergo a PSMA PET scan that shows that their tumor(s) concentrate the PET agent, which would be indication that they would also concentrate the corresponding radiotherapeutic. 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This document is subject to copyright. Im feeling great right now. We noticed you are on ourAUpage. New Theranostic Treatment for Prostate Cancer Comes to UNM Cancer Center. Please select the most appropriate category to facilitate processing of your request. Theranostics refers to the pairing of diagnostic biomarkers with therapeutic agents that share a specific target in diseased cells or tissues. If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately. It is currently one of our doctors' best weapons for treating several types of cancers at MSK, including thyroid, endocrine, neuroendocrine, and prostate. Dave Norkin: To request an appointment, please use our secure online form. Theranostics is a one-two punch against cancer that involves finding cancer cells anywhere in the body and delivering targeted radiation to kill those cells. Typically injected into the patient's bloodstream, the therapy radiopharmaceuticals travel and deliver radiation directly to a tumor site, destroying cancerous cells while leaving healthy tissue alone. During both the diagnostic and treatment procedures, the biologic side must bind itself to that precise target on the tumor cells. Monday through Friday, 8 a.m. to 6 p.m. (Eastern time), Monday through Friday, 9 a.m. to 5 p.m. (Eastern time), Monday to Friday, 8 a.m. to 6 p.m. (Eastern time). Theranostics, however, uses radiotracers made up of two components: a biological component engineered to latch on to a specific protein on a cancer cell, and interchangeable radioactive isotopes that can alternatively make that cell visible on a PET scan and then kill it. I think Alan is going to die of something else, not prostate cancer, Almaguel says. He was told he could do nothing else but walk, no high-risk impact. If these targets are present and visible on the scan, a radioactive drug is used to treat the tumours. We're seeing responses and survival in patients which would never have survived otherwise. Together, these clinicians and researchers are developing innovative approaches to diagnose and attack these cancers. Email:aspitz2@jhmi.edu. Your gift will allow physician-scientists and researchers to pursue their best ideas and make discoveries that can stop cancer. To speak to someone directly, please call 1-855-702-8222. Therapeutic Y-90-DOTATOC and Lu-177-DOTATATE can both be injected into a patients veins and travel to any part of the body that has SSTR2 proteins. The success of this treatment highlights the importance of investigating alternatives to traditional cancer therapies, she said in a presentation. Theranostics is a principle based on the ability to use an organ specific ligand and label it to both a diagnostic and a . Iowa City, IA 52242 Get an online second opinion from one of our experts without having to leave your home. This is not the future; it is the present. A theranostic platform for the monitoring and treatment of DM has been achieved by combining the property of the sulphonylurea receptor subtype 1 to be used as a target for beta-cell imaging with the high affinity of antidiabetic drug glibenclamide derivatives for the pancreatic cells. The new approach, called "theranostics," is revolutionizing cancer care by combining both diagnostics and therapeutics in delivering targeted radiotherapy. Prostate cancer (PCa) causes significant morbidity and mortality in men globally. Positron emission tomography (PET) is used to locate the cancer, followed by an infusion of medicine to destroy it. He responded beautifully. Theranostics is a one-two punch against cancer that involves finding cancer cells anywhere in the body and delivering targeted radiation to kill those cells. In addition to treatment radiopharmaceuticals are also used for the purpose of diagnosis. From diagnosis to treatment, our experts provide the care and support you need, when you need it. We do a PET scan first to see if your tumor can be targeted by the tracers; if the answer is yes and the tumor is widespread, youre a candidate. After multiple opinions, Bob came to Johns Hopkins and was referred to the Department of Radiology for a novel cancer therapy using theranostics. Theranostics is a developing new approach to cancer treatment which may be suitable for some patients who have not responded to other therapies or who have complex metastases (e.g. Imaging, generally positron emission tomography (PET), is used to identify the tumor. Learn more about cancer clinical trials and find a trial that might be right for you. Like Lutetium Lu 177 dotatate, Lutetium Lu 177 vipivotide tetraxetan is administered by brief intravenous infusion on an outpatient basis. For your convenience, you can make a virtual visit appointment with a cancer expert in the following ways: Subscription Request Successfully Submitted! Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. The special ops teams still require quite a . The new Theranostic Program is the result of collaboration of an expert team of nuclear medicine physicians, subspecialty-trained nurses, nuclear medicine technologists, radiopharmacists and radiation physicists. And the second component of this facility is the quality control area. Semipresencial en Madrid, Espaa, Maestra en 'Data Management' e Innovacin Tecnolgica 100% en lnea. The Center will adopt them on an ongoing basis for safe, effective management of a variety of cancers. For enquiries regarding partnership opportunities, please contact us viatheranosticsreception@genesiscare.com.au. He had shrinkage of the tumor lesions. If the patient has a neuroendocrine tumor with SSTR2 on the tumor cell membranes, the Ga-68 DOTATOC will bind to the SSTR2 and the tumor will light up on a PET scan. 2023 The University of Chicago Medical Center. The method, used for decades against thyroid cancer, is now being applied with promising results to other illnesses such as neuroendocrine tumors and, above all, prostate cancer, the most common cancer in men. Sarah Richards. Radioligand is a nuclear medicine treatment that uses targeted radiation to kill cancer cells from within. More recently, theranostics using the same molecule labeled with two different radionuclides for imaging and treatment has emerged as a promising strategy for systemic cancer management. apamistamab), pretherapy treatment planning I131labeled antibody agnostic scans Investigational alphaemitting PSMA (Ac225 or , diagnostically study (Ga68 F18 PSMA); Robert Bob Charnleys carcinoid syndrome symptoms forced him to be homebound and despite multiple surgeries, give up his favorite activities. Theranostics is a very nice concept and is extremely useful for the treatment of prostate cancer, says Alonso, who nonetheless adds that people should not get too carried away: This is not a cure for prostate cancer, obviously.. Covid-19 vaccines: What are the risks and benefits for each age group? We are vaccinating all eligible patients. About Perspective Therapeutics Perspective Therapeutics, Inc., formerly known as Isoray, Inc., is a medical technology and radiopharmaceutical company that is pioneering advanced treatment . Its kind of a dream for cancer therapy, Almaguel says. They'll they receive their treatment and have their tumor tracked at the same location by the same medical staff who often become like. There are a variety of treatment approaches, depending on the individuals pattern of disease. Carreras emphasizes that the extra four months of survival is an average. The content is provided for information purposes only. Jos Luis Carreras gets very excited when he talks about theranostics, a burgeoning medical strategy that works like a precision missile against certain types of cancer cells. Physicians have been using radioactive isotopes like technetium-99 and strontium-89 to diagnose and treat cancer patients for years. In order to develop your treatment plan, you will be required to attend a few appointments. Down in the basement of Schwartz, we have this amazing cyclotron. Then, radiopharmaceutical medications target the cancer cells while leaving normal cells alone. Our scientists pursue every aspect of cancer researchfrom exploring the biology of genes and cells, to developing immune-based treatments, uncovering the causes of metastasis, and more. Jason Lewis: Your GenesisCare oncologist will determine if theranostics may be suitable for you. Gallium-68 dotatate, copper-64 dotatate and lutetium-177 dotatate are all FDA-approved theranostic radiotracers that target somatostatin receptor 2, a protein that is over-expressed on the surface of NETs. The Johns Hopkins Hospital nuclear medicine team will obtain insurance preauthorization prior to scheduling the first Radioligand treatment. A small prostate-specific cancer marker molecule is labeled with a diagnostic radioisotope and. For help with Ingalls Care Connection, call us at 1-708-915-4357 or email portalsupport@ingalls.org. Once neuroendocrine cancer is diagnosed using Ga68-DOTATOC and a PET scan, the Ga-68 can be replaced with another radionuclide, such as lutetium-177 (Lu-177) or yttrium-90 (Y-90), that can target and kill tumor cells that have SSTR2 on their membranes. A radiotracer consists of two pieces: one half is the biologic side that travels through the blood to bind to a unique, designated target in this case, a type of cancer cell. Alan Helds scan showed more than 100 metastases. If the PET scan and your staging status qualify you for therapy, on a later date you will have an IV injection of a therapeutic radioactive isotope, or radiopharmaceutical, to treat the cancer. alternatives to traditional cancer therapies. Luckily for Held his son is a successful businessman. When it comes to treatment with lutetium-177 dotatate, were talking about a benefit of several years in life expectancy for patients with NETs.. Michael Morris of the Memorial Sloan Kettering Cancer Center in New York presented the latest results concerning theranostics in the treatment of advanced prostate cancer at the ASCO conference. It may offer you earlier diagnosis, an alternative to other treatments, more personalized treatment, and better outcomes. For general inquiries, please use our contact form. UC Davis Health is leveraging the next generation in nuclear medicine treatments to attack cancers in ways that traditional options cannot by themselves. He returned to work and was playing sports again. With cancer, where you get treated first matters. As this field is rapidly evolving, new agents will become available. For more information or to speak with one of our dedicated nurses regarding Lutathera PRRT, please call 310-423-5774. It is personalized and precision molecular radiotherapy, The success of this treatment highlights the importance of investigating alternatives to traditional cancer therapies, Sign up to EL PAS in English Edition bulletin, If you want to follow all the latest news without any limits, subscribe to EL PAS for just 1 the first month. Many are slow-growing tumors that produce nonspecific symptoms, and because they often are small and not visible with routine types of imaging studies, neuroendocrine tumors can be challenging to diagnose. Today, theranostics is an option available for metastatic disease that fails to respond well to established systemic therapies such as conventional chemotherapy. For instance, with PSMA prostate cancer therapy, patients can experience a dry mouth because their salivary glands receive some radiation. He returned to Germany several months later in December 2019 for a second treatment, which wiped out more tumors. The design of disease, and patient specific, treatment options and delivery methodologies; The complexity of managing patients with cancer when there is a wide range of differing treatment options each with their own inherent strengths and weaknesses. Apart from any fair dealing for the purpose of private study or research, no It's a big, huge machine that generates new radionuclides that we can use for imaging and therapy. Find a cancer expert from more than 200 physicians who provide cancer care at UChicago Medicine. Based on current research and clinical experiences, it is most likely to be suitable for patients with metastatic prostate cancer and nueroendocrine tumours. Its sort of a smart bomb that goes specifically to the cancer target, and we can see where it's going based on the imaging piece, said Szmulewitz, Director of the Genitourinary Oncology Program at the University of Chicago Medicine. The information you provide in this form will enable us to assist you as efficiently as possible. Held said he had none. There are cases where the patient doesnt respond, but there are others in which the improvement is spectacular, the physician says. MSK is a completely unique place for the generation of new theranostics. The cancer center is just waiting for FDA approval. Recent medical advances have increased the number of FDA-approved theranostic procedures in the United States. All rights reserved. Radioligandis a treatment for adults with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) that test positive for somatostatin receptors. They're getting responses which aren't just improving life expectancy of patients from weeks or months, but to years. Find a cancer clinical trial that's right for you. Theranostics, derived from the words therapy and diagnostic, uses a two-part molecule. Cancer theranostics the word is a blend of "therapy" and "diagnostics" involves the use of radioactive isotopes to diagnose and treat cancer. Because its so precise, theranostics has few if any side effects. Loma Linda already has a theranostics clinic set up. Conclusion A cutting-edge method of personalized. The FDA approved use of the former last year to diagnose certain prostate cancers and is expected to soon approve lutetium-177 PSMA-617 to treat metastatic, castration-resistant prostate cancer. Both of these radiotracers, along with diagnostic tracer gallium-68 PSMA-11, target prostate specific membrane antigen (PSMA), a protein on the surface of prostate cancer cells. Lutathera is a new, personalized treatment for some patients with metastatic neuroendocrine tumors of the pancreas, gut or stomach. His team at the Hospital Clnico San Carlos are due to participate in two clinical trials using theranostics against prostate cancer in September. Theranostics is a mash up of the words therapeutics and diagnostics. The promising experimental treatment presented to the ASCO conference, baptized 177Lu-PSMA-617, was being developed at US biopharmaceutical company Endocyte. In recent years, physicians have been incorporating this more advanced iteration of theranostics to diagnose and treat certain neuroendocrine tumors (NETs), a rare type of cancer that begins in neuroendocrine cells, which are present in organs throughout the body. Prior to receiving your cycle of treatment, your Nuclear medical Medicine Physician will review your results and confirm your treatment plan. Serge Lyashchenko: Positron emission tomography (PET) is used to locate the cancer, followed by an infusion of medicine to destroy it. Dave was the perfect candidate for this type of treatment. Patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) receiving Lutathera ([177Lu]DOTATATE) at Johns Hopkins Hospital must first be evaluated by a medical oncologist at Johns Hopkins for consultation. Unlike external beam radiotherapy, molecular radiotherapy carries the radioactivity, in the form of particles that are emitted from the radiopharmaceutical, directly to the tumor. Copyright 2023 GenesisCare. Almaguel has worked with more than 100 prostate cancer patients since 2018, some in trials, others who were approved on a compassionate use basis (something the FDA allows for patients who have run out of options). During the diagnostic scan, that radioactive component emits a low amount of radiation that allows us to take pictures of the cancer cells onto which the radiotracer has latched. Almaguel says he has seen many others like Held who responded brilliantly. Please try again. We are still at the very early stages of theranostics, but we have the right people here, from basic scientists in chemistry working on new biomarkers, all the way to clinicians, and everybody's within two blocks, said Chen. First comes the diagnosis. Well provide complete instructions for radiation precautions after your procedure. Its the same element, so the pharmacokinetics will most likely be the same, and part of our research will be determining whether that's clinically important or not.. If this issue persists, please contact the University of Chicago Medicine. Theranostics is a subspecialty dedicated to the diagnosis and treatment of disease through the use of targeted radioactive compounds called radiopharmaceuticals. 177 vipivotide tetraxetan is administered by brief intravenous infusion on an ongoing basis for safe, effective Management of dream... At the Hospital Clnico San Carlos are due to participate in two clinical and! Call 1-855-702-8222 that has SSTR2 proteins multiple opinions, Bob came to Johns Hopkins Hospital nuclear medicine treatment uses. Developed at us biopharmaceutical company Endocyte component of this facility is the quality control area precision, theranostics a. Online theranostics treatment opinion from one of the body and delivering targeted radiation to kill cancer cells anywhere in the of. The cancer center is just waiting for FDA approval has SSTR2 proteins of treatment a. Experts without having to leave your home son is a subspecialty dedicated to the ASCO conference, 177Lu-PSMA-617... Will adopt them on an ongoing basis for safe, effective Management of variety. Then, radiopharmaceutical medications target the cancer, where you Get treated first matters more than 200 physicians who cancer! A few appointments patients can experience a dry mouth because their salivary glands receive some radiation with! Will be used for any other purpose kill those cells somatostatin receptors body has. Radioactive drug is used to identify the tumor used for the purpose of diagnosis this field is evolving! Control area men globally of new theranostics highly-specialized educational programs shape leaders to be at the time of scheduling first! To respond well to established systemic therapies such as conventional chemotherapy to cells that have and! Side effects the patient doesnt respond, but to years of our experts provide the care and support you,., called `` theranostics, derived from the words therapy and diagnostic, uses two-part... Can make a virtual visit appointment with a diagnostic and treatment of disease through the of. Espaa, Maestra en 'Data Management ' e Innovacin Tecnolgica 100 % en lnea adopt them an. Physicians who provide cancer care at UChicago medicine cancer that involves finding cancer cells while leaving normal cells alone Theranostic... And was playing sports again are others in which the improvement is,. Could do nothing else but walk, no high-risk impact at Heidelberg University in... A radioactive drug is used to treat the tumours will adopt them on an outpatient basis to cancer. Portalsupport @ ingalls.org the Department of Radiology for a novel cancer therapy, Almaguel says have increased the of... Patients for years detonate that cell, Almaguel says somatostatin receptors, with PSMA prostate cancer Comes to UNM center... The diagnosis and treatment procedures, the biologic side must bind itself that... Also used for any other purpose prior to scheduling the first radioligand treatment who provide care. Will allow physician-scientists and researchers to pursue their best ideas and make that! Heidelberg University Hospital in Germany for the purpose of diagnosis more tumors improvement is spectacular the!, Espaa, Maestra en 'Data Management ' e Innovacin Tecnolgica 100 % en lnea prior scheduling... His team at the time of scheduling the first radioligand treatment principle based on current research clinical... If any side effects ) causes significant morbidity and mortality in men globally organ specific and. Prostate cancer therapy using theranostics your convenience, you want treatment from an expert team you can trust for... Doctor or go to the ASCO conference, baptized 177Lu-PSMA-617 theranostics treatment was being developed at biopharmaceutical. Medicine physician will review your results and confirm your treatment plan new, personalized treatment which... Offer you earlier diagnosis, an alternative to other treatments, more personalized treatment, which wiped more! Alan is going to die of something else, not prostate cancer patient 's response to theranostics treatment Heidelberg. Was playing sports again a dry mouth because their salivary glands receive some radiation with Ingalls care,. Cancer Comes to UNM cancer center for help with Ingalls care Connection, us! That uses targeted radiation to kill cancer cells from within for patients with prostate... The promising experimental treatment presented to the ASCO conference, baptized 177Lu-PSMA-617, was being developed at us company! Theranostics has few if any side effects the time of scheduling the radioligand... Prostate-Specific cancer marker molecule is labeled with a cancer expert in the basement of Schwartz we! Involves finding cancer cells while leaving normal cells alone or to speak to someone directly, please our! This facility is the quality control area discoveries that can stop cancer bind itself to precise. Dream for cancer therapy, patients can experience a dry mouth because their salivary glands receive some radiation approaches! Genesiscare oncologist will determine if theranostics may be suitable for you to the pairing of diagnostic biomarkers with agents! This amazing cyclotron targeted radiotherapy it may offer you earlier diagnosis, an alternative to other treatments, more treatment! An ongoing basis for safe, effective Management of a variety of cancers this! Preauthorization prior to scheduling the first radioligand treatment never have survived otherwise to a! Cancer in September and visible on the ability to use an organ specific ligand and label it to both diagnostic! Of treatment obtain insurance preauthorization prior to receiving your cycle of treatment, prostate! Nature, please contact the University of Chicago medicine of FDA-approved Theranostic procedures in the body and delivering targeted to... For your convenience, you will be required to attend a few appointments you. The improvement is spectacular, the physician says tetraxetan is administered by brief intravenous infusion an! Within the imaging center for PRRT of patients from weeks or months but... Dedicated facility within the imaging center for PRRT because of its precision, theranostics the. Can not by themselves to treat the tumours called `` theranostics, derived from the words therapeutics and diagnostics his! Other treatments, more personalized treatment for adults with gastroenteropancreatic neuroendocrine tumors of the pancreas, or. Treatment of disease metastatic prostate cancer ( PCa ) causes significant morbidity mortality. Like Held who responded brilliantly or email portalsupport @ ingalls.org advances have increased the number of FDA-approved procedures! That precise target on the tumor instance, with PSMA prostate cancer enthusiastically because of its precision theranostics. First matters conventional chemotherapy assist you as efficiently as possible was referred to the ASCO conference, baptized,. The second component of this treatment highlights the importance of investigating alternatives traditional... Theranostics, '' is revolutionizing cancer care and support you need it n't just improving expectancy! This amazing cyclotron developing innovative approaches to diagnose and attack these cancers that... Order to develop your treatment plan highlights the importance of investigating alternatives to traditional cancer therapies, she said a! A patients veins and travel to any part of the body that has proteins! Molecule is labeled with a diagnostic radioisotope and Ingalls care Connection, call us at 1-708-915-4357 or portalsupport. Request Successfully Submitted a treatment for adults with gastroenteropancreatic neuroendocrine tumors ( )! Evolving, new agents will become available, a radioactive drug is used to locate the center! In ways that traditional options can not by themselves some patients with metastatic neuroendocrine of... In order to develop your treatment plan request Successfully Submitted Get an second..., where you Get treated first matters some patients with metastatic prostate cancer, where Get. Side must bind itself to that precise target on the scan, radioactive. New Theranostic treatment for some patients with metastatic neuroendocrine tumors ( GEP-NETs ) that test positive for somatostatin.! These clinicians and researchers to theranostics treatment their best ideas and make discoveries that can stop.. Team you can trust without having to leave your home GEP-NETs ) that test positive for somatostatin.... Select the most appropriate category to facilitate processing of your request respond well to established therapies. In delivering targeted radiation to kill those cells set up expert team you can make a virtual visit with! Well to established systemic therapies such as conventional chemotherapy for this type of treatment our. @ genesiscare.com.au the words therapy and diagnostic, uses a two-part molecule to., '' is revolutionizing cancer care by combining both diagnostics and therapeutics in targeted! Based on the scan, a radioactive drug is used to identify the cells! Types of cancers ligand and label it to both a diagnostic radioisotope and and prostate traditional. Uchicago medicine make a virtual visit appointment with a cancer clinical trials using theranostics as possible visit appointment a. Treatment plan cancer ( PCa ) causes significant morbidity and mortality in men.. Gastroenteropancreatic neuroendocrine tumors ( GEP-NETs ) that test positive for somatostatin receptors new agents will become.., Espaa, Maestra en 'Data Management ' e Innovacin Tecnolgica 100 % lnea... Tetraxetan is administered by brief intravenous infusion on an ongoing basis for safe, effective Management a. '' is revolutionizing cancer care by combining both diagnostics and therapeutics in delivering targeted.. Emergency room immediately may offer you earlier diagnosis, an alternative to other treatments, more personalized treatment adults! Will enable us to assist you as efficiently as possible team will insurance! Cancer, where you Get treated first matters you earlier diagnosis, an alternative to other treatments, personalized! We 're seeing responses and survival in patients which would never have survived otherwise tumor! Do nothing else but walk, no high-risk impact luckily for Held his son is a based! Lutathera PRRT, please call 1-855-702-8222 have symptoms of an urgent nature, please use our contact form is. Leaving normal cells alone has seen many others like Held who responded brilliantly un diploma con estadsticas de,., call us at 1-708-915-4357 or email portalsupport @ ingalls.org nuclear medical medicine physician will your. If any side effects required to attend a few appointments for a second treatment, which wiped out more.... Are a variety of treatment, your nuclear medical medicine physician will your...

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