Démarche d’optimisation des modalités de gestion des déchets lors des traitements au 177Lu-oxodotréotide (Lutathera®)

Abstract

This paper provides an experience report on the handling and disposal procedures of waste contaminated with Lutetium-177 (177Lu, Lu-177) that have been established in the context of peptide receptor-targeted radionuclide therapy with 177Lu dotatate (Lutathera®). Treatments are administered in a dedicated infusion room within the nuclear medicine department where dry waste is separated and collected into appropriate containers. The expected duration of storage in decay was extrapolated from the results of a 2-year iterative measurement study for each type of waste. Effluents from hot sinks are collected in decay tanks whose radioactive concentration measured when closed as full is used to calculate the duration of storage required before discharge. Lu-177 activity eliminated by renal excretion for the 6hours after injection of the radiopharmaceutical was evaluated from the analysis of urine samples. First micturitions are directed to three septic tanks whose efficacy was estimated comparing Lu-177 activity at the inlet and at the outlet of the system. Results of six-monthly controls performed by continuous measurement of radioactive concentration in wastewater were used to evaluate the fraction of the total activity administered annually that is finally discharged into the main sewage system and to define guide values. The impact of hospital radioactive discharge to sewers for the workers exposed at different steps of wastewater treatment was assessed using the numerical model called CIDRRE developed by the Institute of Radiation protection and Nuclear Safety (IRSN).