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The 2026 ASTRO Multidisciplinary Radiopharmaceutical Therapy Symposium
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| Why Now is the Time to Build a Radiopharmaceutical Therapy Practice
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| Dustin Boothe, MD
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| Dustin Boothe argued that now is an ideal time to build radiopharmaceutical therapy programs, balancing a clear patient-care mission (access, research, comprehensive care, skill growth) with a realistic understanding of margins. He emphasized that program success hinges on mastering reimbursement and pricing—Medicare’s average wholesale price–based payments, highly variable commercial contracts, rebates, practice aggregation, and hospital 340B and silo dynamics—while treating radiopharmaceuticals as a service line that can generate value beyond drug revenue.
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| Increasing Access to Radiopharmaceutical Therapy: From Availability to Quality Access
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| Phillip Koo, MD, FACS
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| Phillip Koo emphasized that the field has moved from asking “Can we deliver radioligand therapy?” to “Are we delivering it well?” With more than 790 active Pluvicto sites in the U.S. and most eligible patients living within 30 miles of a center, the focus now is on equitable access, closing referral and awareness gaps, and addressing community–academic and socioeconomic divides. He called for expanding capacity responsibly by pairing growth with standardized, high-quality, and safe care pathways so that variability in practice does not define the field.
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| Addressing Unmet Needs in Radiopharmaceutical Therapy
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| Ravi Patel, MD, PhD
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| Ravi Patel outlined how rapidly expanding radiopharmaceutical therapy is outpacing current infrastructure, especially outside academic centers, and argued that true access requires more than just having the drugs available. He highlighted the complementary strengths and weaknesses of radiation oncology and nuclear medicine, calling for shared programs, revenue models, and full-service teams to handle authorizations, toxicity, logistics, and imaging.
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| Safety and Efficacy of 177Lu-PSMA-617 versus Established Therapies in mCRPC: Pooled Evidence from Randomized Phase II/III Trials
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| Mohammad Ganiyani, MD
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| Mohammad Ganiyani presented a meta-analysis of seven randomized phase II/III trials showing that 177Lu-PSMA-617 reduced the risk of progression by about 36% compared with standard therapies in mCRPC, but did not demonstrate a statistically significant overall survival advantage in pooled analysis. Overall rates of grade ≥3 toxicity were similar between 177Lu-PSMA-617 and control arms; however, grade ≥3 thrombocytopenia was notably more frequent with 177Lu-PSMA-617, underscoring the importance of baseline marrow assessment and close platelet monitoring during treatment.
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| Quantitative Radium-223 SPECT/CT for Tumor Dosimetry in Combined SBRT and RPT: Retrospective Analysis from a Phase II Trial
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| David Adam, PhD, MS
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| The ASTRO 2026 plenary from David Adam showed that quantitative radium-223 SPECT/CT–based dosimetry can be feasibly integrated with stereotactic body radiotherapy (SBRT) planning in oligometastatic prostate cancer. Dr. Adam emphasized technical cautions around small-target contouring, voxel-level uncertainty, and assumptions about relative biological effectiveness, but concluded that SPECT-guided alpha-RPT dosimetry is a promising tool to optimize future SBRT + radiopharmaceutical regimens.
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| Personalized Multi-Timepoint Voxel Level Dosimetry in Patients with mCRPC Treated with 177Lu-PSMA-617 Therapy
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| Mustafa Basree, DO
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| Mustafa Basree showed that multi‑timepoint voxel-level dosimetry with 177Lu‑PSMA‑617 in mCRPC is feasible in routine practice and can meaningfully inform treatment decisions. In 19 high‑risk patients, Monte Carlo SPECT/CT-based dosimetry after cycle 1 identified organ doses similar to VISION, supported safe continuation in about two‑thirds, and suggested many could even receive additional cycles beyond six based on kidney and salivary gland constraints.
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| Factors Influencing Lesion Level Response after 177Lu-PSMA-Radioligand Therapy on Post Therapy SPECT/CT with Artificial Intelligence Annotation
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| Brandon Mancini, MD
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| Brandon Mancini showed that quantitative post‑therapy SPECT/CT from a given 177Lu‑PSMA‑617 cycle can meaningfully predict how individual metastases will behave by the next cycle, using an AI-based segmentation and multinomial model with class AUCs up to 0.88 for complete response. Lesions with higher SUVpeak tended to achieve complete response, higher SUVmax aligned with stable or partial responses, and higher SUVmean predicted progression, while larger baseline volume reduced the chance of complete response.
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