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Vallot D, Brillouet S, Pondard S, Vija L, Texier JS, Dierickx L, Courbon F. Impact of different models based on blood samples and images for bone marrow dosimetry after 177Lu-labeled somatostatin-receptor therapy. EJNMMI Phys 2024; 11:32. [PMID: 38564043 PMCID: PMC10987460 DOI: 10.1186/s40658-024-00615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Peptide receptor radionuclide therapy with 177Lu-DOTATATE is a recognized option for treating neuroendocrine tumors and has few toxicities, except for the kidneys and bone marrow. The bone marrow dose is generally derived from a SPECT/CT image-based method with four timepoints or from a blood-based method with up to 9 timepoints, but there is still no reference method. This retrospective single-center study on the same cohort of patients compared the calculated bone marrow dose administered with both methods using mono, bi- or tri-exponential models. For the image-based method, the dose was estimated using Planetdose© software. Pearson correlation coefficients were calculated. We also studied the impact of late timepoints for both methods. RESULTS The bone marrow dose was calculated for 131 treatments with the blood-based method and for 17 with the image-based method. In the former, the median absorbed dose was 15.3, 20.5 and 28.3 mGy/GBq with the mono-, bi- and tri-exponential model, respectively. With the image-based method, the median absorbed dose was 63.9, 41.9 and 60.8 with the mono-, bi- and tri-exponential model, respectively. Blood samples after 24h post-injection did not evidence any change in the absorbed bone marrow dose with the bi-exponential model. On the contrary, the 6-day post-injection timepoint was more informative with the image-based model. CONCLUSION This study confirms that the estimated bone marrow dose is significantly lower with the blood-based method than with the image-based method. The blood-based method with a bi-exponential model proved particularly useful, without the need for blood samples after 24h post-injection. Nevertheless, this blood-based method is based on an assumption that needs to be more validated. The important difference between the two methods does not allow to determine the optimal one to estimate the true absorbed dose and further studies are necessary to compare with biological effects.
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Chicheportiche A, Sason M, Zidan M, Godefroy J, Krausz Y, Gross DJ, Grozinsky-Glasberg S, Ben-Haim S. Impact of Single-Time-Point Estimates of 177Lu-PRRT Absorbed Doses on Patient Management: Validation of a Trained Multiple-Linear-Regression Model in 159 Patients and 477 Therapy Cycles. J Nucl Med 2023; 64:1610-1616. [PMID: 37500259 DOI: 10.2967/jnumed.122.264923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 05/31/2023] [Indexed: 07/29/2023] Open
Abstract
Dosimetry after 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) enables estimation of radiation doses absorbed by normal organs and target lesions. This process is time-consuming and requires multiple posttreatment studies on several subsequent days. In a previous study, we described a newly developed multiple-linear-regression model to predict absorbed doses (ADs) from a single-time-point (STP) posttreatment study acquired 168 h after the first infusion and 24 h after the following ones, with similar results to the standard multiple-time-point (MTP) protocol. The present study aimed to validate this model in a large patient cohort and to assess whether STP dosimetry affects patient management decisions compared with our MTP protocol. Methods: Quantitative 177Lu-DOTATATE SPECT/CT post-PRRT data from 159 consecutive patients (172 therapies, 477 therapy cycles) were retrospectively analyzed. ADs obtained from an STP model were compared with those obtained using an MTP model. We evaluated the impact of the STP model on the decision on whether PRRT should be stopped because of an expected kidney AD exceeding the safety threshold. We hypothesized that patient management based on the STP model does not differ from that based on the MTP model in at least 90% of the cases. Results: There was no difference in management decisions between the MTP and STP models in 170 of 172 therapies (98.8%). A Fisher χ2 test for combined probabilities produced a composite P value of 0.0003. Mean cumulative AD relative differences between the STP and MTP models were 0.8% ± 8.0%, -7.7% ± 4.8%, 0.0% ± 11.4%, -2.8% ± 6.3%, and -2.1% ± 18.4% for kidneys, bone marrow, liver, spleen, and tumors, respectively (Pearson r = 0.99 for all), for patients who underwent 4 therapy cycles. Similar results were obtained with fewer therapy cycles. Conclusion: Estimated radiation ADs and patient management decisions were similar with the STP and MTP models. The STP model can simplify the dosimetry process while also reducing scanner and staff time and improving patient comfort.
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Affiliation(s)
- Alexandre Chicheportiche
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel;
| | - Moshe Sason
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mahmoud Zidan
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy Godefroy
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yodphat Krausz
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Hebrew University of Jerusalem, Jerusalem, Israel; and
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Hebrew University of Jerusalem, Jerusalem, Israel; and
| | - Simona Ben-Haim
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- University College London, London, United Kingdom
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Bin Said M, Abdul Razak H, Musarudin M. Does Single Computed Tomography Attenuation Correction able to Surrogate Serial Computed Tomography Attenuation Correction in Single-Photon Emission Computed Therapy Imaging for Peptide Receptor Radionuclide Therapy Dosimetry Result? J Med Phys 2022; 47:189-193. [PMID: 36212205 PMCID: PMC9543000 DOI: 10.4103/jmp.jmp_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Peptide Receptor Radionuclide Therapy (PRRT) is the administration of a radionuclide, such as the Lu-177 label, along with a pharmaceutical agent to destroy the lesion cell. The first cycle of Lu-177 DOTA-TATE is an excellent way to estimate radionuclide uptake for organs at risk. To estimate the absorbed dose for a kidney, serial SPECT-CT imaging with up to five sets is required. In general, serial CT on patients would result in additional external exposure and extra time consuming, especially for low dose CT such as cone beam CT technology. However, by introducing a new method, such as optimized single CT (24 h) to perform with serial SPECT attenuation correction, additional external exposure from serial CT exposure could be reduced.
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Kennedy J, Chicheportiche A, Keidar Z. Quantitative SPECT/CT for dosimetry of peptide receptor radionuclide therapy. Semin Nucl Med 2021; 52:229-242. [PMID: 34911637 DOI: 10.1053/j.semnuclmed.2021.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neuroendocrine tumors (NETs) are uncommon malignancies of increasing incidence and prevalence. As these slow growing tumors usually overexpress somatostatin receptors (SSTRs), the use of 68Ga-DOTA-peptides (gallium-68 chelated with dodecane tetra-acetic acid to somatostatin), which bind to the SSTRs, allows for PET based imaging and selection of patients for peptide receptor radionuclide therapy (PRRT). PRRT with radiolabeled somatostatin analogues such as 177Lu-DOTATATE (lutetium-177-[DOTA,Tyr3]-octreotate), is mainly used for the treatment of metastatic or inoperable NETs. However, PRRT is generally administered at a fixed injected activity in order not to exceed dose limits in critical organs, which is suboptimal given the variability in radiopharmaceutical uptake among patients. Advances in SPECT (single photon emission computed tomography) imaging enable the absolute quantitative measure of the true radiopharmaceutical distribution providing for PRRT dosimetry in each patient. Personalized PRRT based on patient-specific dosimetry could improve therapeutic efficacy by optimizing effective tumor absorbed dose while limiting treatment related radiotoxicity.
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Affiliation(s)
- John Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Alexandre Chicheportiche
- Department of Nuclear Medicine and Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Chicheportiche A, Sason M, Godefroy J, Krausz Y, Zidan M, Oleinikov K, Meirovitz A, Gross DJ, Grozinsky-Glasberg S, Ben-Haim S. Simple model for estimation of absorbed dose by organs and tumors after PRRT from a single SPECT/CT study. EJNMMI Phys 2021; 8:63. [PMID: 34436698 PMCID: PMC8390741 DOI: 10.1186/s40658-021-00409-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background Following each cycle of peptide receptor radionuclide therapy (PRRT), absorbed doses by tumors and normal organs are typically calculated from three quantitative single-photon emission computed tomography (SPECT)/computed tomography (CT) studies acquired at t1 = 24 h, t2 = 96 h, t3 = 168 h after the first cycle of treatment and from a single study at t1 after the subsequent cycles. In the present study, we have assessed the feasibility of a single SPECT/CT study after each PRRT cycle using a trained multiple linear regression (MLR) model for absorbed dose calculation and have evaluated its impact on patient management. Quantitative [177Lu]-DOTA-TATE SPECT/CT data after PRRT of seventy-two consecutive metastatic neuroendocrine tumors patients were retrospectively evaluated. A set of 40 consecutive studies was used to train the MLR model. The two independent variables of the model included the time of imaging after administration of the treatment and the radiopharmaceutical activity concentration in a given organ/tumor. The dependent variable was the dose absorbed by the organ/tumor obtained with the standard protocol. For bone marrow dosimetry, the independent variables included the time of imaging, and the blood and remainder of the body activity concentration. The model was evaluated in 32 consecutive patients. Absorbed doses were assessed for kidneys, bone marrow, liver, spleen and tumor sites. Results There was no difference in management decisions, whether PRRT can be safely continued or not because unsafe absorbed dose to risk organs between the standard and the MLR model-based protocol using a single SPECT/CT study performed at t3 = 168 h after the first cycle and at t1 = 24 h after the subsequent cycles. Cumulative absorbed doses were obtained with mean relative differences of − 0.5% ± 5.4%, 1.6% ± 15.1%, − 6.2% ± 7.3%, − 5.5% ± 5.8% and 2.9% ± 12.7% for kidneys, bone marrow, liver, spleen and tumors, respectively (Pearson’s r correlation coefficient 0.99, 0.91, 0.99, 0.99 and 0.97, respectively). Conclusion Dosimetry calculations using a MLR model with a single SPECT/CT study are in good agreement with the standard protocol, while avoiding the use of dosimetry software and enabling improved patient comfort and reduced scanner and staff time. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00409-z.
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Affiliation(s)
- Alexandre Chicheportiche
- Department of Nuclear Medicine & Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel.
| | - Moshe Sason
- Department of Nuclear Medicine & Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Jeremy Godefroy
- Department of Nuclear Medicine & Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Yodphat Krausz
- Department of Nuclear Medicine & Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Mahmoud Zidan
- Department of Nuclear Medicine & Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Amichay Meirovitz
- Oncology Department and Radiation Therapy Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine & Biophysics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jerusalem, Israel.,Institute of Nuclear Medicine, University College London Hospitals, London, UK
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Mix M, Renaud T, Kind F, Nemer U, Yousetzadeh-Nowsha E, Moalosi TCG, Omrane MA, Meyer PT, Ruf J. Kidney doses in 177Lu-based radioligand therapy in prostate cancer: Is dose estimation based on reduced dosimetry measurements feasible? J Nucl Med 2021; 63:253-258. [PMID: 34088773 DOI: 10.2967/jnumed.121.262245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
The radiation dose to the kidneys should be monitored in prostate cancer patients treated with radioligand therapy (RLT) targeting the prostate-specific membrane antigen (PSMA). We analyzed whether pretherapeutic kidney function is predictive of subsequent kidney dose and to what extend the cumulative kidney dose after multiple therapy cycles at the end of treatment can be predicted from a dosimetry based on the first cycle. Methods: Data of 59 patients treated with at least 2 cycles of 177Lu-PSMA-617 (PSMA-RLT) were analyzed. Treatment (median: 6 GBq/cycle) was performed at 6-8 week intervals, accompanied by voxel-based 3D-dosimetry (measured kidney dose) with SPECT/CT on each of days 0-3 and once during days 6-9. Pretherapeutic kidney function (eGFR, MAG3-clearance) was correlated to the kidney doses. Cumulative kidney doses at the end of treatment were compared to a dose estimation based on the population-based mean kidney dose, individual first cycle kidney dose and mean kidney doses of cycles 1, 3 and 5 per administered activity. Results: A total of 176 PSMA-RLT cycles were performed with a median of 3 cycles per patient. The average kidney dose per administered activity of all 176 cycles was 0.67 ± 0.24 Gy/GBq (range 0.21 - 1.60). MAG3-clearance and eGFR were no reliable predictors of subsequent absorbed kidney dose and showed only small effect sizes (R2 = 0.080 and 0.014, P = 0.039 and 0.375). All simplified estimations of cumulative kidney dose correlated significantly (P < 0.001) with measured kidney doses: Estimations based on the individual first-cycle dose were more accurate than the use of the population-based average kidney dose (R2 = 0.853 vs. R2 = 0.560). Dose estimation was best when the doses of cycles 3 and 5 were included as well (R2 = 0.960). Conclusion: Pretherapeutic renal function was not predictive for subsequent kidney dose during therapy. Extrapolation of individual data from dosimetry of the first cycle was highly predictive for the cumulative kidney dose at the end of treatment. This is further improved by the integration of dose information from every other cycle. In any case, because of a high interindividual variance, an individual dosimetry is advisable.
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Affiliation(s)
- Michael Mix
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Renaud
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Felix Kind
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ursula Nemer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Elham Yousetzadeh-Nowsha
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tumelo C G Moalosi
- Department of Medical Imaging and Clinical Oncology, Nuclear Medicine Division, Faculty of Medicine and Health Science, Stellenbosch University, South Africa
| | - Mohamed Aymen Omrane
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Garcia-Torralba E, Spada F, Lim KHJ, Jacobs T, Barriuso J, Mansoor W, McNamara MG, Hubner RA, Manoharan P, Fazio N, Valle JW, Lamarca A. Knowns and unknowns of bone metastases in patients with neuroendocrine neoplasms: A systematic review and meta-analysis. Cancer Treat Rev 2021; 94:102168. [PMID: 33730627 DOI: 10.1016/j.ctrv.2021.102168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to develop an evidence-based summary of current knowledge of bone metastases (BMs) in neuroendocrine neoplasms (NENs), inform diagnosis and treatment and standardise management between institutions. METHODS PubMed, Medline, EMBASE and meeting proceedings were searched for eligible studies reporting data on patients with BMs and NENs of any grade of differentiation and site; poorly-differentiated large/small cell lung cancer were excluded. Data were extracted and analysed using STATA v.12. Meta-analysis of proportions for calculation of estimated pooled prevalence of BM and calculation of weighted pooled frequency and weighted pooled mean for other variables of interest was performed . RESULTS A total of 149 studies met the eligibility criteria. Pooled prevalence of BMs was 18.4% (95% CI 15.4-21.5). BMs were mainly metachronous with initial diagnosis of NEN (61.2%) and predominantly osteoblastic; around 61% were multifocal, with a predisposition in axial skeleton. PET/CT seemed to provide (together with MRI) the highest sensitivity and specificity for BM detection. Almost half of patients (46.4%) reported BM-related symptoms: pain (66%) and skeletal-related events (SREs, fracture/spinal cord compression) (26.2%; weightedweighted mean time-to-SRE 9.9 months). Management of BMs was multimodal [bisphosphonates and bone-modifying agents (45.2%), external beam radiotherapy (34.9%), surgery (14.8%)] and supported by little evidence. Overall survival (OS) from the time of diagnosis of BMs was long [weighted mean 50.9 months (95% CI 40.0-61.9)]. Patients with BMs had shorter OS [48.8 months (95% CI 37.9-59.6)] compared to patients without BMs [87.4 months (95% CI 74.9-100.0); p = 0.001]. Poor performance status and BM-related symptoms were also associated with worse OS. CONCLUSIONS BMs in patients with NENs remain underdiagnosed and undertreated. Recommendations for management of BMs derived from current knowledge are provided. Prospective studies to inform management are required.
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Affiliation(s)
- Esmeralda Garcia-Torralba
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Haematology and Medical Oncology, Hospital Morales Meseguer, Murcia, Spain
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Kok Haw Jonathan Lim
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Timothy Jacobs
- Medical Library, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jorge Barriuso
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Was Mansoor
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Mairéad G McNamara
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard A Hubner
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Angela Lamarca
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
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Chicheportiche A, Ben-Haim S, Grozinsky-Glasberg S, Oleinikov K, Meirovitz A, Gross DJ, Godefroy J. Dosimetry after peptide receptor radionuclide therapy: impact of reduced number of post-treatment studies on absorbed dose calculation and on patient management. EJNMMI Phys 2020; 7:5. [PMID: 31975156 PMCID: PMC6977807 DOI: 10.1186/s40658-020-0273-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/16/2020] [Indexed: 12/25/2022] Open
Abstract
Background After each cycle of [177Lu]-DOTA-TATE peptide receptor radionuclide therapy (PRRT) dosimetry is performed to enable precise calculation of the radiation-absorbed dose to tumors and normal organs. Absorbed doses are routinely calculated from three quantitative single-photon emission computed tomography (SPECT) studies corrected by computed tomography (CT) acquired at t1 = 24 h, t2 = 96 h, and t3 = 168 h after the first cycle of treatment. After following cycles, a single SPECT/CT study is performed. The aim of the present study is to assess the feasibility of a “two time point” quantitative SPECT/CT protocol after the first PRRT cycle and its impact on patient management. Quantitative SPECT/CT data of 25 consecutive patients with metastatic neuroendocrine tumors after PRRT were retrospectively analyzed. Radiation-absorbed doses calculated using the standard protocol with three SPECT/CT studies acquired at (t1, t2, t3) were compared to those obtained from three different “two time point” protocols with SPECT/CT studies performed at (t1, t2), (t1, t3), or (t2, t3). Results The best agreement for the cumulative doses absorbed by the kidneys, bone marrow, liver, spleen, and tumors with the conventional protocol was obtained with the (t1, t3) protocol with mean relative differences of − 1.0% ± 2.4%, 0.4% ± 3.1%, − 0.9% ± 4.0%, − 0.8% ± 1.1%, and − 0.5% ± 2.0%, respectively, and correlation coefficients of r = 0.99 for all. In all patients, there was no difference in the management decision of whether or not to stop PRRT because of unsafe absorbed dose to risk organs using either the standard protocol or the (t1, t3) protocol. Conclusion These preliminary results demonstrate that dosimetry calculations using two quantitative SPECT/CT studies acquired at 24 and 168 h after the first PRRT cycle are feasible and are in good agreement with the standard imaging protocol with no change in patient management decisions, while enabling improved patient comfort and reduced scanner and staff time.
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Affiliation(s)
- Alexandre Chicheportiche
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
| | - Simona Ben-Haim
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.,Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Amichay Meirovitz
- Oncology Department and Radiation Therapy Unit, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Jeremy Godefroy
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
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9
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Chicheportiche A, Grozinsky-Glasberg S, Gross DJ, Krausz Y, Salmon A, Meirovitz A, Freedman N, Godefroy J. Predictive power of the post-treatment scans after the initial or first two courses of [ 177Lu]-DOTA-TATE. EJNMMI Phys 2018; 5:36. [PMID: 30535780 PMCID: PMC6286905 DOI: 10.1186/s40658-018-0234-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/20/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND 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. 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. RESULTS Patients 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. CONCLUSIONS The 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.
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Affiliation(s)
- Alexandre Chicheportiche
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Yodphat Krausz
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Asher Salmon
- Oncology Department and Radiation Therapy Unit, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Amichay Meirovitz
- Oncology Department and Radiation Therapy Unit, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Nanette Freedman
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Jeremy Godefroy
- Department of Nuclear Medicine & Biophysics, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel
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