From Iodine to Actinium: Which Radiopharmaceuticals Are Used in Russia

What Is Radionuclide Therapy

Radionuclide therapy (RNT) involves administering (or oral intake as tablets) a special radiopharmaceutical that "finds" tumor cells in the body and destroys them from within through targeted radiation exposure without damaging healthy tissues. The radiation range from drug molecules is measured in millimeters. This is especially important in metastatic cancer when tumors are numerous and scattered throughout the body.

The method is one of the treatment options for oncological diseases, alongside drug therapy and surgery, as well as radiation therapy (including brachytherapy) and radiosurgery for certain cancer types.

Which Diseases Are Treated with RNT in Russia

Radionuclide therapy is used for a wide spectrum of oncological and non-oncological diseases, although historically in Russia and worldwide two conditions dominate – thyroid cancer and pain syndrome therapy due to bone metastases.

Main types of RNT used in Russia – in the table

Advanced Radiopharmaceuticals Used in Russia for RNT

The last three years have been marked by intensive implementation of new radiopharmaceuticals that until recently were only available abroad. Additionally, Russia's nuclear pharmacies (i.e., RP production sites) are developing drugs used uniquely in the Russian Federation.

Beta-Emitting Radiopharmaceuticals

Lutetium-177 Based Drugs

• Lu-177-PSMA. Used to treat metastatic castration-resistant prostate cancer when the tumor has stopped responding to hormonal and chemotherapy. After administration, radioactive lutetium-177 attaches to the PSMA carrier molecule, which finds a specific protein on the surface of prostate cancer cells and binds to it. Lutetium then irradiates the tumor with particles at a distance of only 2-3 mm, destroying cancer cells while practically not affecting healthy tissues.
• 177Lu-DOTATATE. Used to treat neuroendocrine tumors – rare neoplasms arising from cells of the endocrine and nervous systems, often affecting the pancreas, intestines, and lungs. These tumors respond poorly to conventional chemotherapy. The drug works on the principle of "targeted delivery": the octreotate molecule mimics the hormone somatostatin, to whose receptors neuroendocrine tumors are very sensitive. When the drug finds these receptors, radioactive lutetium-177 begins irradiating tumor cells. In Russia, the drug was first used in 2024 in patients with pancreatic cancer.

188Re-preparations (Rhenium-188) – Rhenium-188 is a universal therapeutic isotope used to treat several types of diseases: bone metastases from various cancers, primary and metastatic liver cancer (radioembolization), and chronic inflammatory joint diseases (radiosynoviorthesis for rheumatoid arthritis). The advantage of rhenium-188 is that it can be obtained from tungsten-188/rhenium-188 generator systems directly at medical facilities, solving the short half-life problem (17 hours) – no urgent delivery needed as with other isotopes. For liver cancer treatment, rhenium-188 is incorporated into microspheres that are introduced via catheter into the artery feeding the tumor – they block blood supply while simultaneously irradiating the neoplasm. In Russia, rhenium-188 based drugs are synthesized in the nuclear pharmacy of A. Tsyb MRRC (Obninsk), where they are developed and used within clinical trials.

Russia also has access to modern RPs based on isotopes that emit α (alpha) particles.

They are more effective in fighting tumor cells compared to β (beta) isotopes due to significantly higher radiation energy. Additionally, with alpha particles, there is minimal damage to surrounding healthy tissues and bone marrow. Production of such drugs, on the other hand, requires serious technological infrastructure and rapid logistics, since they have short half-lives.

223Ra-dichloride, known under the trade name Xofigo. The drug is used to treat castration-resistant prostate cancer with multiple bone metastases in the absence of visceral organ involvement. The drug is unique in that radium-223 is chemically similar to calcium and naturally incorporates into bone tissue, accumulating specifically at metastatic sites where active bone formation occurs. Studies showed an increase in overall survival of 3.6 months, reduction in pain syndrome, and delay of skeletal complications such as fractures with low toxicity. Since 2024, Russia has established domestic production of "Radium chloride, 223Ra" by Prostor Pharma at Ural Federal University in Yekaterinburg – the drug is included in the List of Essential and Vital Medicines and is available through mandatory health insurance at major oncology dispensaries (Sverdlovsk Regional Oncology Dispensary in Yekaterinburg has treated over 1,500 patients). Previously, only imported Xofigo manufactured by Bayer was used.

225Ac-PSMA (Actinium-225 PSMA) – Used to treat particularly aggressive metastatic castration-resistant prostate cancer when other methods, including lutetium-177, prove ineffective. Actinium-225 is a next-generation alpha-emitter, much more powerful than lutetium: it causes irreversible DNA breaks in cancer cells, and not only actinium itself but also its decay products (francium-221, astatine-217, bismuth-213) also emit alpha particles, creating a "chain reaction" of tumor destruction. The particle range is only 0.1 mm, protecting healthy tissues. First used in Russia in 2023 at the NMRC of Radiology.

Theranostics

Russia also has access to theranostics – a nuclear medicine method combining diagnosis and treatment into a unified system. The principle involves using the same carrier molecule with different isotopes: first with a diagnostic one (for imaging and determining patient suitability for treatment), then with a therapeutic one (for targeted tumor destruction). The most successful theranostic pair – gallium-68 (Ga-68) / lutetium-177 (Lu-177) for treating neuroendocrine tumors – is used in several private medical centers in Russia. Read more about this type of treatment in an interview with EMC Institute of Oncology Director Nidal Salim.

Who Produces Radiopharmaceuticals

One of the main tasks of nuclear medicine is radiopharmaceutical production and supply. As of 2025, Russia has 22 operating nuclear pharmacies in Rosatom research centers, university and clinical departments, producing drugs for therapy and diagnostics (read more about radionuclide diagnostics in a Marus Media article).

Among the largest producers are research institutes of Rosatom corporation. For instance, Karpov Research Institute of Physical Chemistry in Obninsk is the largest supplier of I-131. At the institute, where in 2026 the largest radionuclide plant in Europe according to GMP standards is planned to open, over 25 types of isotopes and RPs will be produced, including those based on Lu-177, Ac-225, and Ra-223.

Lu-177 is supplied by NIIAR in Ulyanovsk Oblast. The isotope is used in clinical practice at FNKTsRiO FMBA, A. Tsyb MRRC, N.N. Blokhin NMRC of Oncology, and Granov Russian Research Center of Radiology.

Domestic Radium chloride, 223Ra is produced at Yeltsin Ural Federal University (Yekaterinburg) jointly with Prostor Pharma. In Tomsk, microspheres with Y-90 (yttrium) are serially produced for liver cancer radioembolization. Such therapy is conducted at A. Tsyb MRRC in Obninsk.

Actinium-225 is supplied by Leipunsky Institute of Physics and Power Engineering from Obninsk. In the nuclear pharmacy of NMRC of Radiology, 225Ac-PSMA drug is produced from it.

Russian RNT Competence Centers

Russia has about 15 specialized radionuclide therapy centers with 230 "hot" or "active" beds. "Hot beds" are specially equipped wards with comprehensive radiation safety measures.

Most are located in central Russia (Moscow, Obninsk, Arkhangelsk, Tyumen), but there are centers in the Urals (Chelyabinsk) and Siberia (Krasnoyarsk, Tomsk).

Collectively, Russian clinics performed RNT on 12,297 patients in 2024.

State Clinics

A. Tsyb MRRC – Branch of NMRC of Radiology

Obninsk, Kaluga Oblast

Available Therapy

Lu-177-PSMA, 177Lu-DOTATATE, 223Ra-dichloride, 225Ac-PSMA, I-131 sodium iodide, Y-90 (yttrium) and Re-188 (rhenium), Sm-153 Samarium Oxabiphor

Description

Leading state RNT center with own RP production. The entire spectrum of advanced methods is used, and possibilities of modern RPs are studied, for example based on Re-188 (rhenium).

FNKTsRiO FMBA

Dimitrovgrad, Ulyanovsk Oblast

Available Therapy

89Sr (strontium), 153Sm (samarium), 223Ra-dichloride, I-131 sodium iodide

Description

Has the largest radionuclide therapy department (37 active beds) with a building specially equipped according to radiation safety standards. Own radionuclide production. Uses both Russian and European RPs and advanced RNT treatment protocols.

N.N. Blokhin NMRC of Oncology

Moscow

Available Therapy

I-131, 177Lu-PSMA, 177Lu-DOTATATE, 223Ra-dichloride

Description

Conducts innovative PSMA-targeted radioligand therapy for patients with metastatic castration-resistant prostate cancer. Provides full spectrum of treatment and diagnostics for all oncological diseases, specializes in complex clinical cases.

Granov Russian Research Center of Radiology

St. Petersburg

Available Therapy

I-131, Re-188, 223Ra

Description

Actively develops innovative prolonged-action RPs based on Re-188. The only center in Northwestern Federal District with full spectrum of radionuclide diagnostics and therapy. Unique combination of RNT, proton therapy, and transplantology at one site.

Tomsk National Research Medical Center

Tomsk

Available Therapy

177Lu-DOTATATE, 89Sr

Description

First to apply peptide receptor RNT with lutetium-177 DOTA-TATE for metastatic neuroendocrine cancer beyond the Urals. Unique systemic radiotherapy methods with strontium, neutron and intraoperative electron therapy. Joint development of innovative RPs with Tomsk Polytechnic University.

RRCR (Russian Scientific Center of Roentgenology and Radiology)

Moscow

Available Therapy

I-131, 153Sm, 177Lu-PSMA

Description

One of the oldest radionuclide therapy centers in Russia. Conducts over 600 cycles of radionuclide PSMA therapy per year. Individual I-131 capsule manufacturing on day of request.

Private Medical Centers

EMC Moscow + MMOC

Moscow

Available Therapy

177Lu-DOTATATE, 177Lu-PSMA, 223Ra, 153Sm, I-131 + Theranostics

Description

MMOC radionuclide therapy department is equipped with modern European-made equipment. Uses RPs exclusively manufactured in EU countries. Specially equipped wards with specialized ventilation and sewage systems for safe RNT. Individual diagnostic and treatment plan selection. Comprehensive diagnostics on PET/CT Biograph mCT and SPECT/CT Symbia Intevo Bold.

JSC Medicina – Institute of Nuclear Medicine, Khimki

Khimki, Moscow Oblast

Available Therapy

I-131, 177Lu-DOTATATE, 177Lu-PSMA, 223Ra, 153Sm, 89Sr

Description

Radionuclide therapy department deployed on 14 active beds with modern comfort-enhanced wards. Own cyclotron-radiochemical complex GE PetTrace 880 for RP production, including Lu-177 based drugs. Precision RP packaging line with individual dose calculation. High level of radiation safety: decontamination of air from wards and sewage effluents. JCI international accreditation.

MIBS

St. Petersburg

Available Therapy

177Lu-PSMA, 177Lu-DOTATATE, 223Ra

Description

Ability to combine different types of therapy within one facility: radiation therapy, radiosurgery, chemotherapy. One of St. Petersburg's largest private oncology centers with full treatment cycle.

FAQ

Is radionuclide therapy available to foreigners?

Yes, for more detailed information contact the medical institution or Marus consultants.

What is the cost of advanced RNT therapy?

Treatment with advanced RPs, for example, 177Lu-PSMA, 177Lu-DOTATATE, 223Ra, Re-188 will cost between 400 to 600 thousand rubles or approximately USD 5,000–7,500 per cycle.

What are the limitations for systemic RNT?

Besides absolute contraindications, each radiopharmaceutical has specific requirements: for example, 177Lu-PSMA requires sufficient PSMA expression according to PET/CT data, for 177Lu-DOTATATE – somatostatin receptor expression. For Ra-223 therapy, this would be absence of visceral metastases (liver, lungs, brain); for Ac-225 therapy – resistance or insufficient response to 177Lu-PSMA therapy.

What are the side effects of RNT?

Side effects depend on the type of radiopharmaceutical. Common ones include temporary nausea and weakness in the first days after administration, moderate decrease in blood counts (leukocytes, platelets) with recovery in 4–6 weeks. With radioligand therapy (177Lu-PSMA, 177Lu-DOTATATE), dry mouth is possible due to accumulation in salivary glands. With radioiodine therapy – temporary salivary gland swelling, taste changes. Serious complications (kidney, liver dysfunction) are rare and more often associated with multiple courses. In most cases, RNT is tolerated better than chemotherapy – patients maintain daily activity.

Can RNT be performed multiple times?

Yes, RNT is usually conducted in courses. Standard 177Lu-PSMA or 177Lu-DOTATATE protocol provides for 4–6 cycles with 6–8 week intervals between administrations. For radioiodine therapy, the number of courses is determined individually depending on disease dynamics. Repeated courses of 223Ra-dichloride (6 injections with 4-week intervals) are also possible when necessary. Key condition for repeat RNT – blood count recovery and preserved kidney function. Decision on number of courses is made based on control examinations (PET/CT, blood tests, efficacy assessment). Some patients can receive RNT for years with good tolerance.