靶向放射性核素治疗是一种针对转移性癌症的新兴治疗概念，如果可以通过核医学成像描绘肿瘤并且还可以根据特定靶点的表达（治疗学）进行靶向治疗，则可以考虑这种治疗。这种治疗模式还可以与传统放疗竞争或补充，例如，如果 MRI 不能完全捕获疾病的范围，包括微观转移。针对甲状腺癌、某些表达生长抑素受体 2 的肿瘤和表达前列腺特异性膜抗原 (PSMA) 的前列腺癌患者的靶向放射性核素治疗已获得批准，并且针对转移性癌症患者的多种靶向放射性核素治疗方法正在开发中。例如使用成纤维细胞激活蛋白（FAP）作为靶标）。尽管在已批准的靶向放射性核素疗法的癌症中，脑转移很少见，但没有先验的理由认为，如果靶标得到表达并且不受血脑屏障的屏蔽，则此类治疗不会对脑转移有效。在这里，我们讨论脑部和软脑膜转移患者的靶向放射性核素治疗的当前技术水平和机会。© 作者 2024。由牛津大学出版社代表神经肿瘤学会出版。版权所有。如需商业重复使用，请联系 reprints@oup.com 获取转载和转载的翻译权。所有其他权限都可以通过我们网站文章页面上的权限链接通过我们的 RightsLink 服务获得 - 如需了解更多信息，请联系journals.permissions@oup.com。

Targeted radionuclide therapy is an emerging therapeutic concept for metastatic cancer that can be considered if a tumor can be delineated by nuclear medicine imaging and also targeted based on expression of a particular target (thera-nostics). This mode of treatment can also compete with or supplement conventional radiotherapy e.g., if MRI does not fully capture the extent of disease, including microscopic metastases. Targeted radionuclide therapy for patients with thyroid cancer, with certain somatostatin receptor 2-expressing tumors and with prostate-specific membrane antigen (PSMA)-expressing prostate cancer are approved, and numerous approaches of targeted radionuclide therapy for patients with metastatic cancer are in development (e.g. using fibroblast activation protein (FAP) as a target). Although brain metastases are rare in the cancers with approved targeted radionuclide therapies, there is no a priori reason to assume that such treatments would not be effective against brain metastases if the targets are expressed and not shielded by the blood brain barrier. Here, we discuss the current state of the art and opportunities of targeted radionuclide therapies for patients with brain and leptomeningeal metastases.© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.