Abstract
BackgroundThe aim of this study was to evaluate the predictive power of the absorbed dose to kidneys after the first course of treatment with [177Lu]-DOTA-TATE for neuroendocrine tumors (NETs) on the cumulative kidney absorbed dose after 3 or 4 cycles of treatment. Post-treatment scans (PTS) are acquired after each cycle of peptide receptor radionuclide therapy (PRRT) with [177Lu]-DOTA-TATE for personalized radiation dosimetry in order to ensure a cumulative absorbed dose to kidneys under a safety threshold of 25 Gy.One hundred eighty-seven patients who completed treatment with [177Lu]-DOTA-TATE and underwent PTS for dosimetry calculation were included in this retrospective study. The correlation between the cumulative absorbed dose to kidneys after the completion of treatment and the absorbed dose after the first cycle(s) was studied. Multilinear regression analysis was done to predict the cumulative absorbed dose to the kidneys of the subsequent cycles, and an algorithm for the follow up of kidney absorbed dose is proposed.ResultsPatients whose absorbed dose to kidneys after the first cycle of treatment is below 5.6 Gy can receive four cycles of treatment with a cumulative dose less than 25 Gy (p < 0.1). For the other patients, the cumulative absorbed dose after 3 or 4 cycles of treatment can be predicted after the second cycle of treatment to allow for an early decision regarding the number of cycles that may be given.ConclusionsThe follow up of kidney absorbed dose after PRRT can be simplified with the algorithm presented in this study, reducing by one-third the number of post-treatment scans and reducing hospitalization time for more than half of the treatment cycles.
Highlights
The aim of this study was to evaluate the predictive power of the absorbed dose to kidneys after the first course of treatment with [177Lu]-DOTA-TATE for neuroendocrine tumors (NETs) on the cumulative kidney absorbed dose after 3 or 4 cycles of treatment
Patients Eligibility for peptide receptor radionuclide therapy (PRRT) included lesions with high somatostatin receptor (SSTR)-expressing disease on gallium-68-DOTA-(Tyr3)-octreotate ([68Ga]-DOTA-TATE) positron emission tomography (PET)/computed tomography (CT) scan where the tumor uptake was greater than the background liver activity, together with evidence of progressive disease within 12 months, as assessed by combination of increasing biochemical marker, and new or enlarging lesions on Somatostatin receptors (SSTR) PET/CT imaging, contrast-enhanced CT, or magnetic resonance imaging (MRI), or symptoms despite conventional management
Of the 187 patients, 90 completed 4 courses of treatment, of whom 78 had a cumulative kidney absorbed dose DT less than the 25 Gy safety threshold. Fourteen patients had their treatment discontinued after the third cycle for kidney dosimetry reasons, since DT already exceeded 25 Gy or was expected to exceed this threshold after a fourth cycle
Summary
The aim of this study was to evaluate the predictive power of the absorbed dose to kidneys after the first course of treatment with [177Lu]-DOTA-TATE for neuroendocrine tumors (NETs) on the cumulative kidney absorbed dose after 3 or 4 cycles of treatment. Individual dosimetry by quantitative single photon emission computed tomography (SPECT) after each cycle of treatment monitors the cumulative absorbed dose to the organs at risk to decide whether the patient can receive more cycles of treatment. For the subsequent treatment cycles, only a single SPECT/computed tomography (CT) study approximately 24 h after the treatment is performed assuming an unchanged effective half-life of [177Lu]-DOTA-TATE between treatments as proved and proposed by Garske et al [22]
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