Nuclear Medicine Department of Jinshazhou Hospital of Guangzhou University of Chinese Medicine Receives Authorization for ¹⁷⁷Lu-Based Nuclear Medicine Procedures, Officially Launching Advanced Radioligand Therapy

In October 2026, the Nuclear Medicine Department of our hospital received authorization to conduct ¹⁷⁷Lu (lutetium-177)-based nuclear medicine diagnostic and therapeutic procedures. This confirms that the department has completed the required acceptance and verification procedures covering facility renovations, radiation protection infrastructure, equipment provision and configuration, personnel qualifications, and quality control systems. The department is now officially authorized to independently provide ¹⁷⁷Lu radioligand therapy (RLT).
¹⁷⁷Lu radioligand therapy is an advanced technology in precision oncology and translational nuclear medicine. It follows the theranostic approach of “molecular imaging for diagnosis, followed by targeted treatment and post-treatment molecular imaging for follow-up assessment.” This approach offers a new treatment option for patients with difficult-to-treat malignancies, including metastatic castration-resistant prostate cancer that has progressed despite standard treatment, as well as somatostatin receptor-positive neuroendocrine tumors.

I. Scientific Principles of ¹⁷⁷Lu Radioligand Therapy

¹⁷⁷Lu is an artificially produced radionuclide that can be obtained through neutron activation. It decays primarily through β-emission, accompanied by γ-photon emission.

1. β-particles: With a maximum energy of approximately 498 keV and an average range in tissue of approximately 0.67 mm, β-particles deliver radiation primarily to microscopic tumor regions where the radiopharmaceutical binds to its target. They can directly induce double-strand breaks in tumor cell DNA, triggering apoptosis. Their short range significantly reduces radiation exposure to surrounding normal tissues, distinguishing this approach from external beam radiation therapy.

2. γ-rays: With energies of approximately 113 keV and 208 keV, these emissions can be detected by SPECT/CT, allowing visualization of the radiopharmaceutical’s biodistribution and the degree of targeted uptake in tumor lesions. This information supports patient selection, pre-treatment target verification, radiation dose assessment during the treatment course, and post-treatment response assessment, forming the foundation of theranostics in nuclear medicine.

¹⁷⁷Lu itself has no intrinsic tumor-targeting properties. It must be linked to a specific targeting ligand to form a radioligand therapeutic agent:

1. Ligand: Specifically recognizes target antigens highly expressed on tumor cell membranes, serving as a “molecular guidance system.”
2. Chelator: Links the ligand to the ¹⁷⁷Lu radionuclide, ensuring stable binding in the body and minimizing in vivo dechelation of the radionuclide.
3. ¹⁷⁷Lu radionuclide: Serves as the cytotoxic therapeutic component.
Following intravenous administration, the radiopharmaceutical circulates through the bloodstream and selectively accumulates in primary tumors and metastatic lesions that highly express the corresponding molecular target. Uptake by normal tissues lacking the target is minimal, enabling systemic targeted internal radiation therapy that can simultaneously treat multiple metastatic lesions throughout the body.

Figure 1: Pluvicto (¹⁷⁷Lu-PSMA-617) injection — finished vial and packaging

II. Main Clinical Indications and Patient Selection Criteria

¹⁷⁷Lu therapy is not a broad-spectrum anticancer treatment. Molecular imaging-based target assessment must be performed first, and treatment may proceed only after a multidisciplinary team (MDT) confirms that the patient meets the relevant indications.

1. ¹⁷⁷Lu-PSMA: For PSMA-Positive Metastatic Castration-Resistant Prostate Cancer (mCRPC)
Prostate-specific membrane antigen (PSMA) is highly expressed on the cell membranes of the vast majority of prostate cancers, while its expression in normal prostate tissue is very low.

Eligible patients: Patients with metastatic castration-resistant prostate cancer whose disease has progressed despite standard first- or second-line treatments, including androgen deprivation therapy, novel hormonal agents, and chemotherapy; whose lesions demonstrate high PSMA expression on ⁶⁸Ga-PSMA PET/CT; and who have no absolute contraindications to treatment.

Treatment goals: To inhibit tumor proliferation, control metastatic lesions throughout the body, prolong overall survival and progression-free survival, relieve tumor-related symptoms such as bone pain, and improve quality of life in patients with advanced disease.

Figure 2: Schematic of the mechanism of ¹⁷⁷Lu-PSMA

2. ¹⁷⁷Lu-DOTATATE (PRRT, Peptide Receptor Radionuclide Therapy): For Somatostatin Receptor-Positive Neuroendocrine Tumors
Neuroendocrine neoplasms (NENs) commonly express somatostatin receptors (SSTRs), particularly the SSTR2 subtype. DOTATATE, a somatostatin analog, specifically binds to these receptors.

Eligible patients: Patients with well-differentiated neuroendocrine tumors (primarily G1 and G2, as well as selected well-differentiated G3 tumors following appropriate evaluation) that are unresectable and have distant metastases, including gastroenteropancreatic neuroendocrine tumors and pulmonary neuroendocrine tumors, with high somatostatin receptor expression confirmed by ⁶⁸Ga-DOTATATE PET/CT.

Treatment goals: To control tumor burden, alleviate hormone-related clinical syndromes (such as flushing, diarrhea, and hypoglycemia), and delay disease progression.

Brief overview of contraindications: This treatment is unsuitable for patients with severe renal impairment (as radiopharmaceuticals are primarily excreted through the kidneys, which are dose-limiting organs), severe bone marrow suppression, pregnancy or breastfeeding, negative target imaging findings, or a very limited life expectancy.

Figure 3: Mechanism of action of ¹⁷⁷Lu-DOTATATE

Figure 4: Schematic of radionuclide-drug conjugates

Theranostics is a key area of advancement in precision oncology, and ¹⁷⁷Lu radioligand therapy is a leading technology in this field. Obtaining this authorization marks an important milestone in the development of nuclear medicine at our hospital. The Nuclear Medicine Department now has the full range of capabilities required to independently perform molecular target assessment using PET/CT, administer ¹⁷⁷Lu radioligand therapy, conduct SPECT/CT-based patient-specific dosimetry, and provide post-treatment response assessment and follow-up, establishing a complete diagnostic and therapeutic pathway. Building on the established multidisciplinary team (MDT) approach at the Oncology Diagnosis and Treatment Center of Jinshazhou Hospital of Guangzhou University of Chinese Medicine, the department brings together specialists in urology, oncology, gastroenterology, pathology, diagnostic imaging, and nephrology for joint case reviews. Through baseline assessments, risk stratification, adverse event prevention and management, and comprehensive care throughout the treatment course, the team is establishing a standardized clinical pathway for ¹⁷⁷Lu therapy. This initiative provides new precision treatment options for patients with advanced prostate cancer, somatostatin receptor-positive neuroendocrine tumors, and other malignancies, while further strengthening our hospital’s capabilities in precision radionuclide diagnosis and therapy.

III. Frequently Asked Questions About ¹⁷⁷Lu Therapy

Q1: How does ¹⁷⁷Lu radioligand therapy fundamentally differ from conventional external beam radiation therapy and chemotherapy?
A: Conventional external beam radiation therapy delivers radiation from outside the body to treat localized lesions, making it difficult to target multiple small metastatic lesions throughout the body. Chemotherapy uses systemic cytotoxic drugs that can also damage normal rapidly dividing cells and have relatively nonspecific effects. In contrast, ¹⁷⁷Lu radioligand therapy (RLT) is a form of targeted internal radiation therapy that identifies tumors through specific molecular targets. The radiopharmaceutical circulates through the body, selectively accumulates in tumor lesions, and delivers radiation primarily at those sites. As a systemic treatment, it can target multiple metastatic lesions simultaneously while limiting damage to normal tissues. However, dose-related toxicity can still affect certain organs, particularly the kidneys and bone marrow, making careful assessment and monitoring essential.

Q2: What radiation protection measures are required after ¹⁷⁷Lu therapy? Can family members stay with the patient?
A: Following ¹⁷⁷Lu administration, radioactive material remains in the patient’s body. Patients therefore need a short period of hospitalization in a dedicated radiation-protected nuclear medicine ward. Because the patient's excreta may contain radioactive material, they must be collected and handled according to established radiation safety protocols. Before discharge, medical staff assess the residual radioactivity in the patient’s body and provide individualized radiation safety instructions to patients and their families. These include maintaining a safe distance from family members, temporarily avoiding close contact with pregnant women and infants or young children, following appropriate precautions for handling excreta, and washing clothing separately. When radiation protection instructions are followed correctly, radiation exposure to family members remains within established safety limits. There is no need for excessive concern, but patients and their families must strictly follow the nuclear medicine physician’s guidance.

Q3: Can all patients with prostate cancer or neuroendocrine tumors receive ¹⁷⁷Lu therapy?
A: No. A key requirement is high expression of the corresponding molecular target on tumor cells. Target-specific PET/CT imaging (⁶⁸Ga-PSMA or ⁶⁸Ga-DOTATATE) must therefore be performed before treatment. If the tumor is negative for the relevant target, it cannot adequately take up the ¹⁷⁷Lu-labeled radioligand, and treatment will be ineffective. Kidney function, bone marrow function, and underlying medical conditions must also be evaluated. Treatment suitability can only be determined after a comprehensive MDT assessment.

Q4: How many treatment cycles are required for ¹⁷⁷Lu therapy?
A: Standard treatment regimens generally consist of 4–6 cycles, with an interval of 6–8 weeks between cycles. Before each administration, organ function and disease status must be assessed. The treatment plan is adjusted as needed based on therapeutic response and adverse effects, and not all patients are able to complete the full course.