Treatment and side effects

On the day of your treatment, please attend the Nuclear Medicine Department at the time indicated on your appointment letter. You will be admitted to Onslow Ward and taken to a room that has been designed for this type of therapy. The room has its own toilet, shower TV, DVD player, fridge, tea and coffee making facilities and WiFi. The room will have been prepared, with some surfaces covered with cling film and absorbent pads. This is because after the PRRT is given, your bodily fluids will be slightly radioactive. Covering some surfaces helps to prevent radioactive contamination in the room. 

The nuclear medicine consultant will see you. You will have a small tube called a cannula inserted into a vein in each of your arms (two needles in total). Further blood tests may be taken if required at this point. You will also be given some anti-sickness and anti-inflammatory medication to reduce the side effects of the therapy. 

Drips of amino acids and saline will be given to you via one of the cannulas; this will last for about four hours. The amino acids help prevent your kidneys from being damaged by the radiation. The saline helps to keep you well hydrated during the therapy.

One hour after starting the amino acid and saline drips, the PRRT will be given to you via the other cannula. The staff with you will wear aprons, gloves and overshoes, and use additional equipment to shield them from the radiation. From this point you will become radioactive, so staff will remain at a distance from you whenever possible. This will not compromise your care and you will be closely monitored at all times.

Before, during and after the PRRT is given, your blood pressure and pulse will be monitored. This is because of the small risk of carcinoid crisis – see the possible side effects section below for details. Monitoring will continue regularly after the administration. 

After you have received the PRRT, you must remain in the treatment room until the following morning. This is to make sure the radiation protection of staff and other patients on the ward. For the remainder of the first day, you will be asked to drink plenty of fluids and use the toilet often. This flushes any excess radioactivity from your body. Please sit when you use the toilet in the treatment room. We also recommend that you shower in the morning after your treatment. 

On the morning after treatment, your medical physicist will escort you to the Nuclear Medicine department for a scan. This will involve lying on a scanner for around an hour, while a gamma camera slowly moves around you. The scan looks at where the PRRT has gone to in your body. While you have the scan, the medical physicist will clean your treatment room, check your belongings for radioactivity, and prepare your discharge paperwork. 

After your scan, the medical physicist will explain your radiation protection instructions, because you will remain slightly radioactive for a period of time after discharge. You will be given a yellow card to carry to remind you of these restrictions. You can then return home. 

You will be given some further anti-sickness and anti-inflammatory medication to take for five days after discharge.

Between cycles of PRRT, you will have blood tests every two weeks to check your blood, liver and kidney function. The Nuclear Medicine team will receive and monitor these blood results. If your blood count falls significantly, we may need to delay the next cycle of PRRT, or refer you for additional procedures (such as a blood transfusion).

You will have an appointment with the Nuclear Medicine team in the week before your next cycle to check if you’re suitable for your next treatment cycle. You will be able to discuss any side effects, questions or issues at this appointment.

Most patients do not experience any side effects. However, some of the most common ones are listed below:

Short-term side effects:

• Tiredness
• Loss of appetite
• Nausea and vomiting – you will be given anti-sickness medication
• Fall in blood count – usually temporary, but may delay your next cycle
• Carcinoid Crisis – you will be monitored closely for signs of flushing, increased heart rate and breathlessness and will receive additional medication if required. This may also prolong your hospital stay. 
      

Long-term side effects:

• Impaired kidney function – you will receive amino acids during your treatment to minimise this. Your kidney function will also be regularly monitored, before and after your treatment.
• Bone marrow disease – this is a rare side effect

 

When to seek help?

Please contact your oncology team if you require any medical help. If you require radiation protection assistance, please contact Nuclear Medicine Physics.

After you have received four cycles of PRRT, you will have blood tests every two weeks for six weeks. After this point, you will be followed up by your oncologist, who will refer you for further imaging tests to see how you have responded to the treatment.