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Theranostics is derived from a combination of the words “Therapy” and “Diagnostics”. These personalised nuclear medicine technologies are able to simultaneously or sequentially diagnose and treat cancer. Theranostics@AARO is a specialized clinic harnessing the capabilities of Theranostics in delivering cutting edge cancer treatment.

Our Theranostics Therapies

Liver Cancer Therapy

  • Yttrium-90 Selective Internal Radiation Therapy (SIRT)

Prostate CancerProstate Cancer Therapy

  • Radium-223 Therapy (Xofigo)
  • Lutetium-177 Prostate Specific Membrane Antigen (PSMA) Therapy

Lung CancerNeuroendocrine Cancer Therapy

  • Lutetium-177 Octreotate Therapy

Radium-223 Therapy (Xofigo)
Radium 223 (Xofigo) is a radioactive pharmaceutical that is used to treat castrate resistant Prostate Cancer, symptomatic Bone
Metastases and no known Visceral Metastatic Disease.

How does Radium-223 Therapy (Xofigo) work?
Radium-223 (Xofigo) is an alpha-emitting radioisotope that mimics Calcium. When injected, Radium-223 will circulate through
the body and form complexes with bony mineral Hydroxyapatite at the areas of increased bony turnover, such as bone

As such, Radium-223 (Xofigo) radioactivity can uniquely target areas of sclerotic bony metastases, causing DNA damage to the
cancer cells while relatively sparing normal bone due to the short radiation range.

What are the expected outcomes of Radium-223 Therapy (Xofigo)?
The aim of the therapy is to control the bony metastases and to reduce symptoms of bony pain (if present).

Radium-223 (Xofigo) therapy is a therapeutic agent that was shown to significantly extend overall survival in patients.
This was demonstrated in a double blind, randomised, placebo controlled phase III clinical trial of 921 patients with
castrate resistant Prostate Cancer with symptomatic bony metastases and no known visceral metastases (Alsympca

Following therapy, there is typically mild-moderate response in PSA levels (50% will have a drop of more that 30%),
while drop in ALP levels is typically more dramatic.

Yttrium-90 Selective Internal Radiation Therapy
Selective Internal Radiation Therapy (SIRT) is a form of Targeted Brachytherapy / Radiation Therapy developed to treat liver cancers. Sometimes referred to as radioembolisation, it
aims to target and destroy liver tumours.

How Does Yttrium-90 Selective Internal Radiation Therapy (SIRT) Work as a Liver Cancer Therapy?
The principle of brachytherapy involves delivering tumoricidal doses of radiation to the cancer but limiting quantities to normal adjacent tissue. Radiation is tumoricidal if sufficient
energy can be delivered to the target cells.

Targeted Internal Radiation Therapy offers super-selective therapy of tumours while effectively sparing normal liver parenchyma.

Simply put, small radioactive beads are targeted at a tumour through the patient’s blood vessels in the liver. These radioactive beads give off radiation over a limited, short distance, leaving the surrounding tissue unharmed.

The therapeutic basis of Microsphere Therapy is based on known vascular supply changes occurring in Hepatocarcinogenesis. Typically, liver parenchyma (functional tissue) is supplied mainly via the portal vein with a small supply from the hepatic artery.

In Hepatocellular Carcinoma and some Dysplastic nodules, this is reversed. Hepatic Arterial supply accounts for the majority of vascular supply (approximately 80%), and blood flow is preferentially distributed to the tumour relative to normal liver parenchyma. Meaning that a patient suffering from HCC has a majority of their blood flow being supplied to the
tumour as opposed to the functional tissue of the liver.

Yttrium-90 microspheres, when given, will preferentially flow to the tumour because of the increased Arterial Vascular supply. The diameter of SIR-Spheres enables them to become implanted in the tumour microvasculature. However, they are too large to pass through the end arterioles into the hepatic sinusoids, which have a restrictive diameter of 8-10 micron.

This preferential stasis of microspheres within the tumour bed coupled with the limited range and high-energy emission of the Yttrium-90 allows a high tumour radiation dosage with
little exposure to surrounding liver parenchyma in theory.


SIRT is generally a safe and effective liver cancer therapy, with no immediate side effects expected.

Outcomes depend on the team’s experience and are generally better in tertiary institutions with multidisciplinary expertise.

The reported survival benefits are similar to that of oral Sorafenib treatment, which has been considered the standard of care for patients with advanced Unresectable Hepatocellular Carcinomas – where other treatment options have proven ineffective.

However, there are better quality of life scores reported, lower side effects and improved progression, free survival and time to tumour progression.

Our Cancer Specialist