Theranostics in Radiation Oncology: What is it and Why is it Important?

The 2026 American College of Radiation Oncologists (ACRO) Summit serves as a platform for radiation oncologists to gather and share ideas on the latest and greatest in radiation oncology. Theranostics was among those escalating and newer topics on display.

At ACRO, Brandon Mancini, MD, MBA, FACRO, co-hosted a presentation titled “Theranostics in radiation oncology: Building programs, empowering teams, shaping the future”. Prior to that talk, he spoke with CancerNetwork® about the reality of theranostics within radiation oncology. The discussion detailed everything from the literal definition of theranostics to where the future of theranostics might lie, like combinations with immunotherapy.

Read the full discussion below:

CancerNetwork: What is theranostics?

Mancini: Theranostics is literally a combination of the terms “therapy” and “diagnostics”. Typically, that diagnostic is a PET scan where someone gets an injection, and you’re identifying whether a certain type of target on a tumor exists within that person’s body, or within that tumor that they might have. Then the therapy is a medication or radio pharmaceutical, that’s injected and goes and connects with that exact same target, but it’s delivering focal radiation for 24 hours a day, 7 days a week, for several weeks, but at the millimeter type level, with very little damage or irritation to surrounding tissues. It’s therapy merging with diagnostics, theranostics, and it’s a form of precision medicine that is definitely emerging and getting more well-known across the world.

Why is theranostics an important topic in radiation oncology right now?

Theranostics, in general, is this escalating field within radiation oncology, nuclear medicine, and oncology and beyond. This is a neat opportunity, with ACRO being one of the salient meetings in radiation oncology, to continue the conversation, get more in-depth into theranostics, and to excite or motivate people to consider this as part of their practice each day.

What are some of the key takeaways from your discussion on theranostics at ACRO?

It’s going to be reviewing exactly what theranostics is, for those who may not be aware, reviewing the data that has led to the FDA approval of the agents we use each day, reviewing why radiation oncology plays an important role within this space, and a call to action to motivate people to be interested, involved, and consider incorporating this into their cancer care every day.

What do institutions need to build a successful theranostics program?

[You need] a clinical champion. You need good physics support and good clinical support from nursing and nuclear medicine technologists and/or radiation therapists, and a good referral collaborative effort between other specialties. Whether that’s nuclear medicine, medical oncology, or some of the surgical specialties, you need that comprehensive mindset because for a lot of radiation oncologists, it would be an add-on to what they’re used to doing each day with brachytherapy or external beam radiation. So, a good team of nursing and other sub-specialists to make sure that the patient journey is good and care is delivered in a high-quality manner, and that it can be successfully incorporated into standard practice without too much of a hassle.

What has your experience been with the theranostics program at BAMF Health?

We’re unique in the sense that we are a dedicated theranostic center, where we are vertically integrated, and we do radiopharmaceutical production of the imaging agents. Those diagnostic tests that we’re talking about, where we’re producing the radiopharmaceutical, we’re imaging that patient on site, where we’re able to expeditiously determine if they qualify for the theranostic type treatment. Then we deliver that treatment on our second floor. We’re a fully integrated center to ensure that patients entering who might qualify for theranostics can have everything accounted for. We also run somewhere between 20 and 30 clinical trials, where [we are] looking to expand beyond the current indications in prostate cancer and neuroendocrine tumors. These unique theranostic-only centers are becoming more prevalent and will continue to grow over the years. It’s an exciting time for the field.

What emerging theranostic tools are exciting?

Some of the emerging things within theranostics include different radioisotopes—right now, the FDA-approved treatments are called beta emitters, so [they’re an] effective but more gentle treatment, and they do work, but for some folks, they don't. There are therapies called alpha emitters, which are more potent, pack a bigger punch, and may potentially have more success in treating more resistant or stubborn cancers. There’s a lot of evolution in the type of targets that are being investigated. Clinical trials are currently covering somewhere between 10 and 20 different tumor types. Again, there are only 2 FDA-approved treatments: one is for prostate cancer, and one is for neuroendocrine tumor. Just the thought and the ability to dive into additional targets to try and find solutions for things like breast cancer, pancreatic cancer, [colorectal] cancer, gynecologic cancers, etc, is incredibly exciting. You’re just seeing a ton of investment from an infrastructure, research, and clinical trials perspective to advancing this. There are somewhere around 100 clinical trials looking at different agents. Some of the most exciting aspects are just the fact that there's so much excitement within the field.

Where do you see the space going in the next 3 to 5 years?

People are seeing the promise, and some have quoted theranostics as an additional pillar within cancer care for the years to come. In those next 3 to 5 years, that’s what we’re going to see. We’re going to continue to see evolution. The therapies are going to get better. People [will] live longer with a better quality of life, and we're going to see more FDA-approved agents so that people beyond prostate cancer and neuroendocrine tumors can have additional options in this space. Even those with prostate cancer or neuroendocrine tumors will have additional options to continue to maintain good quality and quantity of life as well. A lot of promise. We’ll also be seeing things like combination therapies, potentially combining with immunotherapy, targeted agents, or chemotherapies, along with that theranostic agent. It’s limitless. As far as where this will go, we’ll see personalized dosing, personalized treatment schedules, and probably much larger doses than we give now, extending those treatments beyond what we give now. We’re in [theranostics’] infancy, and it’s going to grow exponentially over the next few years.