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Liubchenko G, Böning G, Zacherl M, Rumiantcev M, Unterrainer LM, Gildehaus FJ, Brendel M, Resch S, Bartenstein P, Ziegler SI, Delker A. Image-based dosimetry for [ 225Ac]Ac-PSMA-I&T therapy and the effect of daughter-specific pharmacokinetics. Eur J Nucl Med Mol Imaging 2024; 51:2504-2514. [PMID: 38512484 DOI: 10.1007/s00259-024-06681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Although 221Fr and 213Bi have sufficient gamma emission probabilities, quantitative SPECT after [225Ac]Ac-PSMA-I&T therapy remains challenging due to low therapeutic activities. Furthermore, 221Fr and 213Bi may underlie a different pharmacokinetics due to alpha recoil. We conducted a quantitative SPECT study and a urine analysis to investigate the pharmacokinetics of 221Fr and 213Bi and the impact on image-based lesion and kidney dosimetry. METHODS Five patients (7.7 ± 0.2 MBq [225Ac]Ac-PSMA-I&T) underwent an abdominal SPECT/CT (1 h) at 24 and 48 h (Siemens Symbia T2, high-energy collimator, 440 keV/218 keV (width 20%), 78 keV (width 50%)). Quantitative SPECT was reconstructed using MAP-EM with attenuation and transmission-dependent scatter corrections and resolution modelling. Time-activity curves for kidneys (CT-based) and lesions (80% isocontour 24 h) were fitted mono-exponentially. Urine samples collected along with each SPECT/CT were measured in a gamma counter until secular equilibrium was reached. RESULTS Mean kidney and lesion effective half-lives were as follows: 213Bi, 27 ± 6/38 ± 10 h; 221Fr, 24 ± 6/38 ± 11 h; 78 keV, 23 ± 7/39 ± 13 h. The 213Bi-to-221Fr kidney SUV ratio increased by an average of 9% from 24 to 48 h. Urine analysis revealed an increasing 213Bi-to-225Ac ratio (24 h, 0.98 ± 0.15; 48 h, 1.08 ± 0.09). Mean kidney and lesion absorbed doses were 0.17 ± 0.06 and 0.36 ± 0.1 Sv RBE = 5 /MBq using 221Fr and 213Bi SPECT images, compared to 0.16 ± 0.05/0.18 ± 0.06 and 0.36 ± 0.1/0.38 ± 0.1 Sv RBE = 5 /MBq considering either the 221Fr or 213Bi SPECT. CONCLUSION SPECT/CT imaging and urine analysis showed minor differences of up to 10% in the daughter-specific pharmacokinetics. These variances had a minimal impact on the lesion and kidney dosimetry which remained within 8%.
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Affiliation(s)
- Grigory Liubchenko
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany.
| | - Guido Böning
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Mathias Zacherl
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Mikhail Rumiantcev
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Lena M Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Franz Josef Gildehaus
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
- SyNergy, University of Munich, Munich, Germany
- DZNE - German Center for Neurodegenerative Diseases, Munich, Germany
| | - Sandra Resch
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Sibylle I Ziegler
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
| | - Astrid Delker
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Marchioninstrasse 15, 81377, Munich, Germany
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Stokke C, Gnesin S, Tran-Gia J, Cicone F, Holm S, Cremonesi M, Blakkisrud J, Wendler T, Gillings N, Herrmann K, Mottaghy FM, Gear J. EANM guidance document: dosimetry for first-in-human studies and early phase clinical trials. Eur J Nucl Med Mol Imaging 2024; 51:1268-1286. [PMID: 38366197 PMCID: PMC10957710 DOI: 10.1007/s00259-024-06640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
The numbers of diagnostic and therapeutic nuclear medicine agents under investigation are rapidly increasing. Both novel emitters and novel carrier molecules require careful selection of measurement procedures. This document provides guidance relevant to dosimetry for first-in human and early phase clinical trials of such novel agents. The guideline includes a short introduction to different emitters and carrier molecules, followed by recommendations on the methods for activity measurement, pharmacokinetic analyses, as well as absorbed dose calculations and uncertainty analyses. The optimal use of preclinical information and studies involving diagnostic analogues is discussed. Good practice reporting is emphasised, and relevant dosimetry parameters and method descriptions to be included are listed. Three examples of first-in-human dosimetry studies, both for diagnostic tracers and radionuclide therapies, are given.
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Affiliation(s)
- Caroline Stokke
- Department of Diagnostic Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
- Department of Physics, University of Oslo, Oslo, Norway.
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Francesco Cicone
- Nuclear Medicine Unit, Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Søren Holm
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marta Cremonesi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, IRCCS, Milan, Italy
| | - Johan Blakkisrud
- Department of Diagnostic Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas Wendler
- Computer-Aided Medical Procedures and Augmented Reality, Technische Universität München, Munich, Germany
- Clinical Computational Medical Imaging Research, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Nic Gillings
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases (NCT), NCT West, Heidelberg, Germany
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK
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Cicone F, Sjögreen Gleisner K, Sarnelli A, Indovina L, Gear J, Gnesin S, Kraeber-Bodéré F, Bischof Delaloye A, Valentini V, Cremonesi M. The contest between internal and external-beam dosimetry: The Zeno's paradox of Achilles and the tortoise. Phys Med 2024; 117:103188. [PMID: 38042710 DOI: 10.1016/j.ejmp.2023.103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
Radionuclide therapy, also called molecular radiotherapy (MRT), has come of age, with several novel radiopharmaceuticals being approved for clinical use or under development in the last decade. External beam radiotherapy (EBRT) is a well-established treatment modality, with about half of all oncologic patients expected to receive at least one external radiation treatment over their disease course. The efficacy and the toxicity of both types of treatment rely on the interaction of radiation with biological tissues. Dosimetry played a fundamental role in the scientific and technological evolution of EBRT, and absorbed doses to the target and to the organs at risk are calculated on a routine basis. In contrast, in MRT the usefulness of internal dosimetry has long been questioned, and a structured path to include absorbed dose calculation is missing. However, following a similar route of development as EBRT, MRT treatments could probably be optimized in a significant proportion of patients, likely based on dosimetry and radiobiology. In the present paper we describe the differences and the similarities between internal and external-beam dosimetry in the context of radiation treatments, and we retrace the main stages of their development over the last decades.
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Affiliation(s)
- Francesco Cicone
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Nuclear Medicine Unit, "Mater Domini" University Hospital, Catanzaro, Italy.
| | | | - Anna Sarnelli
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Luca Indovina
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
| | - Françoise Kraeber-Bodéré
- Nantes Université, Université Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000 Nantes, France
| | | | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Della Gala G, Santoro M, Rasoatsaratanany GA, Paolani G, Strolin S, Strigari L. A single centre intercomparison between commercial treatment planning systems for 90Y radioembolization using virtual and experimental phantoms. Phys Med 2023; 116:103172. [PMID: 38001000 DOI: 10.1016/j.ejmp.2023.103172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Dedicated Treatment Planning Systems (TPSs) were developed to personalize 90Y-transarterial radioembolization. This study evaluated the agreement among four commercial TPSs assessing volumes of interest (VOIs) volumes and dose metrics. METHODS A homogeneous (EH) and an anthropomorphic phantom with hot and cold inserts (EA) filled with 99mTc-pertechnetate were acquired with a SPECT/CT scanner. Their virtual versions (VH and VA, respectively) and a phantom with activity inside a single voxel (VK) were generated by an in-house MATLAB script. Images and delineated VOIs were imported into the TPSs to compute voxel-based absorbed dose distributions with various dose deposition approaches: local deposition method (LDM) and dose kernel convolution (DKC) with/without local density correction (LDC). VOI volumes and mean absorbed doses were assessed against their median value across TPSs. Dose-volume histograms (DVHs) and VK-derived dose profiles were evaluated. RESULTS Small (<2.1 %) and large (up to 42.4 %) relative volume differences were observed on large (>500 ml) and small VOIs, respectively. Mean absorbed doses relative differences were < 3 % except for small VOIs with steep dose gradients (up to 89.1 % in the VA Cold Sphere VOI). Within the same TPS, LDC negligibly affected the mean absorbed dose, while DKC and LDM showed differences up to 63 %. DHVs were mostly overlapped in experimental phantoms, with some differences in the virtual versions. Dose profiles agreed within 1 %. CONCLUSION TPSs showed an overall good agreement except for small VOI volumes and mean absorbed doses of VOIs with steep dose gradients. These discrepancies should be considered in the dosimetry uncertainty assessment, thus requiring an appropriate harmonization.
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Affiliation(s)
- Giuseppe Della Gala
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Miriam Santoro
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Garoson Albertine Rasoatsaratanany
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy; International Center for Theoretical Physics (ICTP), Strada Costiera, 11, 34151, Trieste, Italy
| | - Giulia Paolani
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy.
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Gustafsson J, Ljungberg M, Alm Carlsson G, Larsson E, Warfvinge CF, Asp P, Sjögreen Gleisner K. Averaging of absorbed doses: How matter matters. Med Phys 2023; 50:6600-6613. [PMID: 37272586 DOI: 10.1002/mp.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Dosimetry in radionuclide therapy often requires the calculation of average absorbed doses within and between spatial regions, for example, for voxel-based dosimetry methods, for paired organs, or across multiple tumors. Formation of such averages can be made in different ways, starting from different definitions. PURPOSE The aim of this study is to formally specify different averaging strategies for absorbed doses, and to compare their results when applied to absorbed dose distributions that are non-uniform within and between regions. METHODS For averaging within regions, two definitions of the average absorbed dose are considered: the simple average over the region (the region average) and the average when weighting by the mass density (density-weighted region average). The latter is shown to follow from the definition of mean absorbed dose according to the ICRU, and to be consistent with the MIRD formalism. For averaging between different spatial regions, three definitions follow: the volume-weighted, the mass-weighted, and the unweighted average. With respect to characterizing non-uniformity, the different average definitions lead to the use of dose-volume histograms (DVHs) (region average), dose-mass histograms (DMHs) (density-weighted region average), and unweighted histograms (unweighted average). Average absorbed doses are calculated for three worked examples, starting from the different definitions. The first, schematic, example concerns the calculation of the average absorbed dose between two regions with different volumes or mass densities. The second, stylized, example concerns voxel-based dosimetry, for which the average absorbed-dose rate within a region is calculated. The geometries studied include three 177 Lu-filled voxelized spheres, where the sphere masses are held constant while the material compositions, densities, and volumes are varied. For comparison, the mean absorbed-dose rates obtained using unit-density sphere S-values are also included. The third example concerns SPECT/CT-based tumor dosimetry for five patients undergoing therapy with 177 Lu-PSMA and six patients undergoing therapy with 177 Lu-DOTA-TATE, for which the average absorbed-dose rates across multiple tumors are calculated. For the second and third examples, analyses also include representations by histograms. RESULTS Example 1 shows that the average absorbed doses, calculated using different definitions, can differ considerably if the masses and absorbed doses for two regions are markedly different. From example 2 it is seen that the density-weighted region average is stable under different activity and density distributions and is also in line with results using S-values. In contrast, the region average varies as function of the activity distribution. In example 3, the absorbed dose rates for individual tumors differ by (1.1 ± 4.3)% and (-0.1 ± 0.4)% with maximum deviations of +34.4% and -1.4% for 177 Lu-PSMA and 177 Lu-DOTA-TATE, respectively, when calculated as region averages or density-weighted region averages, with largest deviations obtained when the density is non-uniform. The average absorbed doses calculated across all tumors are similar when comparing mass-weighted and volume-weighted averages but these differ substantially from unweighted averages. CONCLUSION Different strategies for averaging of absorbed doses within and between regions can lead to substantially different absorbed-dose estimates. At reporting of radionuclide therapy dosimetry, it is important to specify the averaging strategy applied.
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Affiliation(s)
| | | | - Gudrun Alm Carlsson
- Department of Radiation Physics, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Erik Larsson
- Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Carl Fredrik Warfvinge
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pernilla Asp
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Salman M, Guatelli S, Rosenfeld AB, Malaroda A. Assessment of cross-dose contributions from tumors within computational phantoms using a Geant4 radiation dosimetry tool exploiting hybrid analytical/voxelised geometries. Med Phys 2023; 50:6580-6588. [PMID: 37288878 DOI: 10.1002/mp.16544] [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: 10/13/2022] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Dosimetry software tools developed for Radiopharmaceutical Therapy, such as OLINDA/EXM or IDAC-Dose, account only for radiation dose to organs from radiopharmaceutical taken up in other organs. PURPOSE The aim of this study is to present a methodology, that can be applied to any voxelised computational model, able to account for cross-dose to organs from tumors of any shape and number enclosed within an organ. METHODS A Geant4 application using hybrid analytical/voxelised geometries has been developed as an extension to the ICRP110_HumanPhantom Geant4 advanced example and validated against ICRP publication 133. In this new Geant4 application, tumors are defined using the Geant4 Parallel Geometry functionality, which allows the co-existence of two independent geometries in the same Monte Carlo simulation. The methodology was validated by estimating total dose to healthy tissue from 90 Y and from 177 Lu distributed within tumors of various sizes localized within the liver of the ICRP110 adult male phantom. RESULTS Agreement of the Geant4 application with ICRP133 was within 5% when masses were adjusted for blood content. Total dose to healthy liver and to tumors was found to agree within 1% when compared to the ground truth. CONCLUSIONS The methodology presented in this work can be extended to investigate total dose to healthy tissue from systemic uptake of radiopharmaceuticals in tumors of different sizes using any voxelised computational dosimetric model.
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Affiliation(s)
- Muhammad Salman
- Centre for Medical Radiation Physics and School of Physics, University of Wollongong, Wollongong, Australia
| | - Susanna Guatelli
- Centre for Medical Radiation Physics and School of Physics, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics and School of Physics, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alessandra Malaroda
- Centre for Medical Radiation Physics and School of Physics, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Nuclear Medicine and PET Department, Nepean Blue Mountains Local Health District, Blue Mountains, Australia
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Taprogge J, Vergara-Gil A, Leek F, Abreu C, Vávrová L, Carnegie-Peake L, Schumann S, Eberlein U, Lassmann M, Schurrat T, Luster M, Verburg FA, Vallot D, Vija L, Courbon F, Newbold K, Bardiès M, Flux G. Normal organ dosimetry for thyroid cancer patients treated with radioiodine as part of the multi-centre multi-national Horizon 2020 MEDIRAD project. Eur J Nucl Med Mol Imaging 2023; 50:3225-3234. [PMID: 37300572 PMCID: PMC10256579 DOI: 10.1007/s00259-023-06295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Dosimetry is rarely performed for the treatment of differentiated thyroid cancer patients with Na[131I]I (radioiodine), and information regarding absorbed doses delivered is limited. Collection of dosimetry data in a multi-centre setting requires standardised quantitative imaging and dosimetry. A multi-national, multi-centre clinical study was performed to assess absorbed doses delivered to normal organs for differentiated thyroid cancer patients treated with Na[131I]I. METHODS Patients were enrolled in four centres and administered fixed activities of 1.1 or 3.7 GBq of Na[131I]I using rhTSH stimulation or under thyroid hormone withdrawal according to local protocols. Patients were imaged using SPECT(/CT) at variable imaging time-points following standardised acquisition and reconstruction protocols. Whole-body retention data were collected. Dosimetry for normal organs was performed at two dosimetry centres and results collated. RESULTS One hundred and five patients were recruited. Median absorbed doses per unit administered activity of 0.44, 0.14, 0.05 and 0.16 mGy/MBq were determined for the salivary glands of patients treated at centre 1, 2, 3 and 4, respectively. Median whole-body absorbed doses for 1.1 and 3.7 GBq were 0.05 Gy and 0.16 Gy, respectively. Median whole-body absorbed doses per unit administered activity of 0.04, 0.05, 0.04 and 0.04 mGy/MBq were calculated for centre 1, 2, 3 and 4, respectively. CONCLUSIONS A wide range of normal organ doses were observed for differentiated thyroid cancer patients treated with Na[131I]I, highlighting the necessity for individualised dosimetry. The results show that data may be collated from multiple centres if minimum standards for the acquisition and dosimetry protocols can be achieved.
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Affiliation(s)
- Jan Taprogge
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK.
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Alex Vergara-Gil
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM Université Paul Sabatier, Toulouse, France
| | - Francesca Leek
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Carla Abreu
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Lenka Vávrová
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Lily Carnegie-Peake
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Sarah Schumann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Tino Schurrat
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Frederik A Verburg
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Delphine Vallot
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | - Lavinia Vija
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | | | - Kate Newbold
- Thyroid Unit, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Manuel Bardiès
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM Université Paul Sabatier, Toulouse, France
- Institut de Recherches en Cancérologie de Montpellier, UMR 1194, INSERM Université de Montpellier, 34298, Montpellier, France
| | - Glenn Flux
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
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8
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Gabiña PM, Gleisner KS, Cremonesi M, Stokke C, Flux G, Cicone F, Konijnenberg M, Aldridge M, Sandstrom M, Chiesa C, Paphiti M, Hippeläinen E, Uribe C, Solny P, Gnesin S, Bernhardt P, Chouin N, Costa PF, Glatting G, Verburg F, Gear J. Results from an EANM survey on time estimates and personnel responsible for main tasks in molecular radiotherapy dosimetry. Eur J Nucl Med Mol Imaging 2023; 50:2595-2604. [PMID: 37129712 DOI: 10.1007/s00259-023-06215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Pablo Mínguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Plaza Cruces S/N, 48903, Barakaldo, Spain
- Faculty of Engineering, Department of Applied Physics, UPV/EHU, Bilbao, Spain
| | | | - Marta Cremonesi
- Radiation Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo Di Oncologia, Milan, Italy
| | - Caroline Stokke
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden NHSFT and Institute of Cancer Research, Sutton, UK
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
- Nuclear Medicine Unit, University Hospital "Mater Domini", Catanzaro, Italy
| | - Mark Konijnenberg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matt Aldridge
- Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, ME16 9QQ, UK
| | - Mattias Sandstrom
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Carlo Chiesa
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Maria Paphiti
- Medical Physics Department, Pammakaristos Hospital of Divine Providence, Iakovaton 43, 11144, Athens, Greece
| | - Eero Hippeläinen
- Department of Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Carlos Uribe
- Functional Imaging, BC Cancer, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Pavel Solny
- National Radiation Protection Institute, Bartoskova 1450/28, 140 00, Praha 4, Nusle, Czech Republic
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Peter Bernhardt
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, University, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering (MFT), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nicolas Chouin
- Nantes Université, Inserm, CNRS, Université d'Angers, Oniris, CRCI2NA, Nantes, France
| | - Pedro Fragoso Costa
- Department of Nuclear Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Gerhard Glatting
- Medical Radiation Physics, Department of Nuclear Medicine, Ulm University, Ulm, Germany
| | - Frederik Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT and Institute of Cancer Research, Sutton, UK.
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9
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Favaretto C, Grundler PV, Talip Z, Landolt S, Sepini L, Köster U, Müller C, Schibli R, Geistlich S, van der Meulen NP. 161Tb-DOTATOC Production Using a Fully Automated Disposable Cassette System: A First Step Toward the Introduction of 161Tb into the Clinic. J Nucl Med 2023:jnumed.122.265268. [PMID: 37201956 DOI: 10.2967/jnumed.122.265268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/01/2023] [Indexed: 05/20/2023] Open
Abstract
161Tb is an interesting radionuclide for application in the treatment of neuroendocrine neoplasms' small metastases and single cancer cells because of its conversion and Auger-electron emission. Tb has coordination chemistry similar to that of Lu; therefore, like 177Lu, it can stably radiolabel DOTATOC, one of the leading peptides used for the treatment of neuroendocrine neoplasms. However, 161Tb is a recently developed radionuclide that has not yet been specified for clinical use. Therefore, the aim of the current work was to characterize and specify 161Tb and to develop a protocol for the synthesis and quality control of 161Tb-DOTATOC with a fully automated process conforming to good-manufacturing-practice guidelines, in view of its clinical use. Methods: 161Tb, produced by neutron irradiation of 160Gd in high-flux reactors followed by radiochemical separation from its target material, was characterized regarding its radionuclidic purity, chemical purity, endotoxin level, and radiochemical purity (RCP) in analogy to what is described in the European Pharmacopoeia for no-carrier-added 177Lu. In addition, 161Tb was introduced into a fully automated cassette-module synthesis to produce 161Tb-DOTATOC, as used for 177Lu-DOTATOC. The quality and stability of the produced radiopharmaceutical in terms of identity, RCP, and ethanol and endotoxin content were assessed by means of high-performance liquid chromatography, gas chromatography, and an endotoxin test, respectively. Results: 161Tb produced under the described conditions showed, as the no-carrier-added 177Lu, a pH of 1-2, radionuclidic purity and RCP of more than 99.9%, and an endotoxin level below the permitted range (175 IU/mL), indicating its appropriate quality for clinical use. In addition, an efficient and robust procedure for the automated production and quality control of 161Tb-DOTATOC with clinically applicable specifications and activity levels, that is, 1.0-7.4 GBq in 20 mL, was developed. The radiopharmaceutical's quality control was also developed using chromatographic methods, which confirmed the product's stability (RCP ≥ 95%) over 24 h. Conclusion: The current study demonstrated that 161Tb has appropriate features for clinical use. The developed synthesis protocol guarantees high yields and safe preparation of injectable 161Tb-DOTATOC. The investigated approach could be translated to other DOTA-derivatized peptides; thus, 161Tb could be successfully applied in clinical practice for radionuclide therapy.
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Affiliation(s)
- Chiara Favaretto
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
- Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland
| | - Pascal V Grundler
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Zeynep Talip
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Stefan Landolt
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Lebogang Sepini
- Radiochemistry, South African Nuclear Energy Corp., Brits, South Africa
| | - Ulli Köster
- Institut Laue-Langevin, Grenoble, France; and
| | - Cristina Müller
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
- Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland
| | - Susanne Geistlich
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Nicholas P van der Meulen
- Center for Radiopharmaceutical Sciences, ETH-Paul Scherrer Institute, Villigen-PSI, Switzerland;
- Laboratory of Radiochemistry, Paul Scherrer Institute, Villigen-PSI, Switzerland
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10
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El Ghalbzouri T, El Bardouni T, El Bakkali J. S-values estimation of positron-emitting radionuclides in the ICRP voxel-based adult male organs using a new Geant4-based code DoseCalcs: validation study. Phys Eng Sci Med 2023; 46:645-657. [PMID: 36940065 DOI: 10.1007/s13246-023-01239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
Identifying the organs and tissues at risk from internal radiation exposure caused by radiopharmaceuticals requires determining the absorbed dose. The absorbed dose for radiopharmaceuticals is calculated by multiplying cumulated activity in source organs by the S-value, a crucial quantity that connects the energy deposited in the target organ and the emitting source one. It is defined as the ratio of absorbed energy in the target organ per unit of mass and unit of nuclear transition in the source organ. In this study, we used a new Geant4-based code called DoseCalcs to estimate the S-values for four positron-emitting radionuclides ([Formula: see text]C, [Formula: see text]N, [Formula: see text]O, and [Formula: see text]F) using decay and energy data from International Commission on Radiological Protection (ICRP) Publication 107. Twenty-three regions were simulated as radiation sources in the ICRP voxelized adult model developed in ICRP Publication 110. The Livermore physics packages were tailored to radionuclide photon mono-energy and [Formula: see text]-mean energy. The estimated S-values based on [Formula: see text]-mean energy show good agreement with those in the OpenDose data whose values were calculated using the full [Formula: see text] spectrum. The results provide new S-values data for selected source regions; hence, they could be used for comparison and adult-patient dose estimation.
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Affiliation(s)
- Tarik El Ghalbzouri
- Radiation and Nuclear Systems Group, FS, Abdelmalek Essaadi University, Tetouan, Morocco.
| | - Tarek El Bardouni
- Radiation and Nuclear Systems Group, FS, Abdelmalek Essaadi University, Tetouan, Morocco
| | - Jaafar El Bakkali
- Radiation and Nuclear Systems Group, FS, Abdelmalek Essaadi University, Tetouan, Morocco.,Nuclear Medicine Department, Military Hospital Mohammed V, Rabat, Morocco
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11
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El Ghalbzouri T, El Bardouni T, El Bakkali J, Ziani H, Doudouh A. Validation of the DoseCalcs Monte Carlo code for estimating the 18F S-values for ICRP adult and 15-year-old male and female phantoms. Radiol Phys Technol 2023; 16:212-226. [PMID: 36917405 DOI: 10.1007/s12194-023-00709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
Internal radiation exposure using radiopharmaceuticals, as in nuclear medicine procedures, necessitates the estimation of the S-value to determine and improve the estimates of absorbed doses in at-risk organs and tissues. The S value is defined as the absorbed dose in the target organ per unit of nuclear transformation in the source organ. It is calculated using the specific absorbed fraction, which is an important quantity that connects the deposited energy in the target and emitting source organs. In this study, we applied DoseCalcs, a new Geant4-based tool, to estimate the S values of [Formula: see text]F using nuclear data from ICRP Publication 107. Geometrical data from ICRP Publications 110 and 143 were used to select four models representing male and female phantoms for adults and 15 years old to study the variability in the S-values arising from variations in anatomy and initial energy validations, because we used the [Formula: see text] mean energy instead of the full beta spectrum. The [Formula: see text]F-released photons and [Formula: see text] from 26 source organs were tracked using the Geant4 Livermore package. Accordingly, the S-values were calculated for 141 target organs. The results for the adult male and female phantoms were compared with the OpenDose reference data. These results agreed well with OpenDose, the average ratio for self-absorption S-values was 1.015, and the average ratios for the cross-irradiation were 1.2 and 1.22 for the AM and AF, respectively. This indicates the accuracy of DoseCalcs for subsequent use in estimating [Formula: see text]F S-values using voxelized geometries.
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Affiliation(s)
- Tarik El Ghalbzouri
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco.
| | - Tarek El Bardouni
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - Jaafar El Bakkali
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
- Nuclear Medicine Department, Military Hospital Mohammed V, Rabat, Morocco
| | - Hafssa Ziani
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - Abderrahim Doudouh
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
- Nuclear Medicine Department, Military Hospital Mohammed V, Rabat, Morocco
- Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat, Morocco
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12
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Lin W, Aluicio-Sarduy E, Houson HA, Barnhart TE, Tekin V, Jeffery JJ, Weichmann AM, Barrett KE, Lapi SE, Engle JW. Theranostic cobalt-55/58m for neurotensin receptor-mediated radiotherapy in vivo: A pilot study with dosimetry. Nucl Med Biol 2023; 118-119:108329. [PMID: 36805869 PMCID: PMC10121947 DOI: 10.1016/j.nucmedbio.2023.108329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
Neurotensin receptor 1 (NTSR1) can stimulate tumor proliferation through neurotensin (NTS) activation and are overexpressed by a variety of cancers. The high binding affinity of NTS/NTSR1 makes radiolabeled NTS derivatives interesting for cancer diagnosis and staging. Internalization of NTS/NTSR1 also suggests therapeutic application with high LET alpha particles and low energy electrons. We investigated the therapeutic efficacy of [58mCo]Co-NOTA-NT-20.3 in vivo using murine models xenografted with NTSR1-positive HT29 human colorectal adenocarcinoma cells, and utilized [55Co]Co-NOTA-NT-20.3 for dosimetry. METHODS Targeting properties and cytotoxicity of [55/58mCo]Co-NOTA-NT-20.3 were assessed with HT29 cells. Female nude mice were xenografted with HT29 tumors and administered [55Co or 58mCo]Co-NOTA-NT-20.3 to evaluate pharmacokinetics or for therapy, respectively. Dosimetry calculations followed the Medical Internal Radiation Dose (MIRD) formalism and human absorbed dose rate per unit activity were obtained from OpenDose. The pilot therapy study consisted of two groups (each N = 3) receiving 110 ± 15 MBq and 26 ± 6 MBq [58mCo]Co-NOTA-NT-20.3 one week after tumor inoculation, and control (N = 3). Tumor sizes and masses were measured twice a week after therapy. Complete blood count and kidney histology were also performed to assess toxicity. RESULTS HPLC measured radiochemical purity of [55,58mCo]Co-NOTA-NT-20.3 > 99 %. Labeled compounds retained NTS targeting properties. [58mCo]Co-NOTA-NT-20.3 exhibited cytotoxicity for HT29 cells and was >15× more potent than [58mCo]CoCl2. Xenografted tumors responded modestly to administered doses, but mice showed no signs of radiotoxicity. Absorbed dose to tumor and kidney with 110 MBq [58mCo]Co-NOTA-NT-20.3 were 0.6 Gy and 0.8 Gy, respectively, and other organs received less than half of the absorbed dose to tumor. Off-target radiation dose from cobalt-58g was small but reduces the therapeutic window. CONCLUSION The enhanced in vitro cytotoxicity and high tumor-to-background led us to investigate the therapeutic efficacy of [58mCo]Co-NOTA-NT-20.3 in vivo. Although we were unable to induce tumor response commensurate with [177Lu]Lu-NT127 (NLys-Lys-Pro-Tyr-Tle-Leu) studies involving similar time-integrated activity, the absence of observed toxicity may constitute an opportunity for targeting vectors with improved uptake and/or retention to avoid the aftereffects of other high-LET radioactive emissions. Future studies with higher uptake, activity and/or multiple dosing regimens are warranted. The theranostic approach employed in this work was crucial for dosimetry analysis.
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Affiliation(s)
- Wilson Lin
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave., Madison, WI 53705, United States.
| | - Eduardo Aluicio-Sarduy
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave., Madison, WI 53705, United States
| | - Hailey A Houson
- Department of Radiology, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL 35294, United States
| | - Todd E Barnhart
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave., Madison, WI 53705, United States
| | - Volkan Tekin
- Department of Radiology, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL 35294, United States
| | - Justin J Jeffery
- University of Wisconsin Carbone Cancer Center, Madison, WI 53705, United States
| | - Ashley M Weichmann
- University of Wisconsin Carbone Cancer Center, Madison, WI 53705, United States
| | - Kendall E Barrett
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave., Madison, WI 53705, United States
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, 1824 6th Ave South, Birmingham, AL 35294, United States
| | - Jonathan W Engle
- Department of Medical Physics, University of Wisconsin, 1111 Highland Ave., Madison, WI 53705, United States; Department of Radiology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792, United States
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13
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Resch S, Takayama Fouladgar S, Zacherl M, Sheikh GT, Liubchenko G, Rumiantcev M, Unterrainer LM, Wenter V, Bartenstein P, Ziegler SI, Ilhan H, Beyer L, Böning G, Delker A. Investigation of image-based lesion and kidney dosimetry protocols for 177Lu-PSMA-I&T therapy with and without a late SPECT/CT acquisition. EJNMMI Phys 2023; 10:11. [PMID: 36757516 PMCID: PMC9911578 DOI: 10.1186/s40658-023-00529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND 177Lu-PSMA therapy has been successfully used to prolong the survival of patients with metastatic castration-resistant prostate cancer. Patient-specific dosimetry based on serial quantitative SPECT/CT imaging can support the understanding of dose-effect relationships. However, multiple SPECT/CT measurements can be challenging for patients, which motivates the investigation of efficient sampling schedules and their impact on dosimetry. In this study, different time samplings with respect to the number and timing of SPECT/CT acquisitions with and without a late measurement were investigated. MATERIALS AND METHODS In total, 43 lesions and 10 kidneys of 5 patients receiving 177Lu-PSMA-I&T therapy were investigated. Whole-body SPECT/CT measurements were performed at 1, 2, 3 and 7 days post-injection. For both lesions (isocontour-based segmentation) and kidneys (CT-based segmentation), a reference model was employed including all four time points. To identify the best-matching fit function out of a pre-defined set of models, visual inspection, coefficients of variation and sum of squared errors were considered as goodness-of-fit criteria. Biologically effective doses (BEDs) calculated with different time samplings (days 1, 2, 3/1, 2, 7/1, 3, 7/2, 3, 7 and 1, 2/1, 3/1, 7) were compared to the reference. RESULTS The best-fit function was found to be a mono-exponential model for lesions and a bi-exponential model with a population-based parameter and two free parameters for kidneys. The BEDs calculated with the time sampling 1, 3, 7 days showed the lowest deviations from the reference for lesions with 4 ± 5%. Without day 7, still 86% of all lesions showed deviations from the reference < 10%. The outlier deviations showed a positive correlation with the effective half-life of the respective lesions. For kidneys, including days 1, 2, 3 achieved the best results with 0 ± 1%. Generally, deviations for kidneys were found to be small for all time samplings (max. 13%). CONCLUSIONS For combined optimization of the SPECT/CT time sampling for kidney and lesion dosimetry during 177Lu-PSMA-I&T therapy, the sampling with days 1, 3, 7 showed the smallest deviation from the reference. Without a late acquisition, using the schedule with days 1, 2, 3 is likewise feasible.
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Affiliation(s)
- Sandra Resch
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Sarah Takayama Fouladgar
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Mathias Zacherl
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Gabriel T. Sheikh
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Grigory Liubchenko
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Mikhail Rumiantcev
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Lena M. Unterrainer
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Vera Wenter
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Sibylle I. Ziegler
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Harun Ilhan
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Leonie Beyer
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Guido Böning
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Astrid Delker
- grid.5252.00000 0004 1936 973XDepartment of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
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14
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Added Value of Scintillating Element in Cerenkov-Induced Photodynamic Therapy. Pharmaceuticals (Basel) 2023. [DOI: 10.3390/ph16020143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cerenkov-induced photodynamic therapy (CR-PDT) with the use of Gallium-68 (68Ga) as an unsealed radioactive source has been proposed as an alternative strategy to X-ray-induced photodynamic therapy (X-PDT). This new strategy still aims to produce a photodynamic effect with the use of nanoparticles, namely, AGuIX. Recently, we replaced Gd from the AGuIX@ platform with Terbium (Tb) as a nanoscintillator and added 5-(4-carboxyphenyl succinimide ester)-10,15,20-triphenylporphyrin (P1) as a photosensitizer (referred to as AGuIX@Tb-P1). Although Cerenkov luminescence from 68Ga positrons is involved in nanoscintillator and photosensitizer activation, the cytotoxic effect obtained by PDT remains controversial. Herein, we tested whether free 68Ga could substitute X-rays of X-PDT to obtain a cytotoxic phototherapeutic effect. Results were compared with those obtained with AGuIX@Gd-P1 nanoparticles. We showed, by Monte Carlo simulations, the contribution of Tb scintillation in P1 activation by an energy transfer between Tb and P1 after Cerenkov radiation, compared to the Gd-based nanoparticles. We confirmed the involvement of the type II PDT reaction during 68Ga-mediated Cerenkov luminescence, id est, the transfer of photon to AGuIX@Tb-P1 which, in turn, generated P1-mediated singlet oxygen. The effect of 68Ga on cell survival was studied by clonogenic assays using human glioblastoma U-251 MG cells. Exposure of pre-treated cells with AGuIX@Tb-P1 to 68Ga resulted in the decrease in cell clone formation, unlike AGuIX@Gd-P1. We conclude that CR-PDT could be an alternative of X-PDT.
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15
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Scarinci I, Valente M, Pérez P. A Machine Learning based model for a Dose Point Kernel calculation. RESEARCH SQUARE 2023:rs.3.rs-2419706. [PMID: 36711517 PMCID: PMC9882689 DOI: 10.21203/rs.3.rs-2419706/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Absorbed dose calculation by kernel convolution requires the prior determination of dose point kernels (DPK). This study shows applications of machine learning to generate the DPKs for monoenergetic sources and a model to obtain DPKs for beta emitters. METHODS DPK for monoenergetic electron sources were calculated using the FLUKA Monte Carlo (MC) code for many materials of clinical interest and initial energies ranging from 10 to 3000 keV. Three machine learning (ML) algorithms were trained using the MC DPKs. Electron monoenergetic scaled DPKs (sDPKs) were used to assess the corresponding sDPKs for beta emitters typically used in nuclear medicine, which were compared against reference published data. Finally, the ML sDPK approach was applied to a patient-specific case calculating the dose voxel kernels (DVK) for a hepatic radioembolization treatment with \(^{90}\)Y. RESULTS The three trained machine learning models demonstrated a promising capacity to predict the sDPK for both monoenergetic emissions and beta emitters of clinical interest attaining differences lower than \(10%\) in the mean average percentage error (MAPE) as compared with previous studies. Furthermore, differences lower than \(7 %\) were obtained for the absorbed dose in patient-specific dosimetry comparing against full stochastic MC calculations. CONCLUSION An ML model was developed to assess dosimetry calculations in nuclear medicine. The implemented approach has shown the capacity to accurately predict the sDPK for monoenergetic beta sources in a wide range of energy in different materials. The ML model to calculate the sDPK for beta-emitting radionuclides allowed to obtain VDK useful to achieve reliable patient-specific absorbed dose distributions required remarkable short computation times.
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Affiliation(s)
- Ignacio Scarinci
- Instituto de Física Enrique Gaviola (IFEG), CONICET, Av. Medina Allende s/n, Córdoba, 5000, Córdoba, Argentina.,Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n,, Córdoba, 5000, Córdoba, Argentina
| | - Mauro Valente
- Instituto de Física Enrique Gaviola (IFEG), CONICET, Av. Medina Allende s/n, Córdoba, 5000, Córdoba, Argentina.,Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n,, Córdoba, 5000, Córdoba, Argentina.,Centro de Excelencia en Física e Ingeniería en Salud (CFIS) & Departamento de Ciencias Físicas, Universidad de la Frontera, Avenida Francisco Salazar 01145, Temuco, 4811230, Cautín, Chile.,Corresponding author(s).
| | - Pedro Pérez
- Instituto de Física Enrique Gaviola (IFEG), CONICET, Av. Medina Allende s/n, Córdoba, 5000, Córdoba, Argentina.,Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n,, Córdoba, 5000, Córdoba, Argentina
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Intercomparison of S-Factor values calculated in Zubal voxelized phantom for eleven radionuclides commonly used in targeted prostate cancer therapy. Phys Eng Sci Med 2022; 45:1251-1256. [PMID: 36315382 DOI: 10.1007/s13246-022-01191-7] [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: 08/15/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
In this study we aimed at comparing various radionuclides ordinarily used in targeted prostate cancer therapy, thereby evaluating S-Factor parameter in the prostate organs as well as in its surrounding healthy tissues, namely the urinary bladder and rectum. InterDosi code version 1.1 was used to estimate S-Factor values in Zubal voxelized phantom for 11 radionuclides, namely 225Ac, 21At, 67Cu, 125I, 131I, 212Pb, 177Lu, 223Ra, 161 Tb, 227Th and 90Y. The prostate organ was considered the source of different ionizing radiation emitted by the radionuclides cited above. The results showed that among all studied alpha-emitting radionuclides, 225 Ac, 223 Ra and 227 Th provide equidistantly the highest self-irradiation S-Factors whereas, 211At provides the lowest cross-irradiation S-Factors. On the other hand, considering only beta-emitting radionuclides, it is shown that 177Lu and 90Y induce respectively lowest and highest cross-absorption S-Factors on the surrounding healthy organs. We conclude that 177Lu and 211At are more adequate for prostate radionuclide therapy because they can relatively prevent surrounding organs from radiation toxicity and at the same time provide sufficient dose to treat the prostate tumor.
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17
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Ferreira CV, Mendes BM, Paixão L, Lima TV, Santos-Oliveira R, Fonseca TC. Calculation of absorbed dose in paediatric phantoms using Monte Carlo techniques for 18F-FDG and 99mTc-DMSA and the new TIAC. Appl Radiat Isot 2022; 191:110526. [DOI: 10.1016/j.apradiso.2022.110526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
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18
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Ghalbzouri TE, Bardouni TE, Bakkali JE, Satti H, Arectout A, Berriban I, Nouayti A, Yerrou R. Photon-specific absorbed fraction estimates in stylized ORNL and voxelized ICRP adult male phantoms using a new developed Geant4-based code "DoseCalcs": a validation study. Radiol Phys Technol 2022; 15:323-339. [PMID: 36065049 DOI: 10.1007/s12194-022-00672-4] [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: 03/29/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 10/14/2022]
Abstract
When a radiotracer is injected into a patient's body as part of a nuclear medicine investigation, the entire body is exposed to the ionizing radiation emitted, which can cause biological damage. Therefore, it is important to predict the internal radiation dose to properly balance the advantages of radiological examinations. Currently, various Monte Carlo tools, such as MCNP, Geant4, and GATE, are available to estimate internal radiation dosimetry-related quantities, such as S values (S) and specific absorbed fractions (SAF). Such codes make physics easier for physicists who are experienced with computer programming; however, programming and/or simulation inputs remain a time-consuming and intensive task. In this study, we present a newly developed Geant4-based code for internal dosimetry calculations, namely "DoseCalcs". To assess the performance of the geometrical methods and computational capabilities of our developed tool, we used the GDML, TEXT, STL, and C++ methods to model the ORNL adult phantom, and a voxel-based structure to construct the ICRP adult male. SAFs in the ORNL and ICRP adult male phantoms for eight discrete mono-energetic photons with energies ranging from 0.01 to 2 MeV are calculated with DoseCalcs and compared to ORNL and OpenDose reference data. The two phantoms showed good agreement with both references, which indicates the accuracy of DoseCalcs for subsequent use in estimating internal dosimetry quantities using a variety of geometrical methods.
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Affiliation(s)
- Tarik El Ghalbzouri
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco.
| | - Tarek El Bardouni
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - Jaafar El Bakkali
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco.,Nuclear Medicine Department, Military Hospital Mohammed V, Rabat, Morocco
| | - Hicham Satti
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - Assia Arectout
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - Iman Berriban
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - A Nouayti
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
| | - Randa Yerrou
- ERSN Laboratory, Physics Department, Faculty of Sciences, University Abdelmalek Essaadi, Tetouan, Morocco
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Initial Testing of an Approximated, Fast Calculation Procedure for Personalized Dosimetry in Radionuclide Therapy Based on Planar Whole-Body Scan and Monte-Carlo Specific Dose Rates from the OpenDose Project. Life (Basel) 2022; 12:life12091303. [PMID: 36143340 PMCID: PMC9503858 DOI: 10.3390/life12091303] [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: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Individualized dosimetry in nuclear medicine is currently at least advisable in order to obtain the best risk–benefit balance in terms of the maximal dose to lesions and under-threshold doses to radiosensitive organs. This article aims to propose a procedure for fast dosimetric calculations based on planar whole-body scintigraphy (WBS) images and developed to be employed in everyday clinical practice. Methods: For simplicity and legacy reasons, the method is based on planar imaging dosimetry, complemented with some assumptions on the radiopharmaceutical kinetics empirically derived from single-photon emission tomography/computed tomography (SPECT/CT) image analysis. The idea is to exploit a rough estimate of the time-integrated activity as has been suggested for SPECT/CT dosimetry but using planar images. The resulting further reduction in dose estimation accuracy is moderated by the use of a high-precision Monte-Carlo S-factor, such as those available within the OpenDose project. Results: We moved the problem of individualized dosimetry to a transformed space where comparing doses was imparted to the ICRP Average Male/Female computational phantom, resulting from an activity distribution related to patient’s pharmaceutical uptake. This is a fast method for the personalized dosimetric evaluation of radionuclide therapy, bearing in mind that the resulting doses are meaningful in comparison with thresholds calculated in the same framework. Conclusion: The simplified scheme proposed here can help the community, or even the single physician, establish a quantitative guide-for-the-eye approach to individualized dosimetry.
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Piwowarska-Bilska H, Kurkowska S, Birkenfeld B. Individualization of Radionuclide Therapies: Challenges and Prospects. Cancers (Basel) 2022; 14:cancers14143418. [PMID: 35884478 PMCID: PMC9316481 DOI: 10.3390/cancers14143418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Currently, patient-specific treatment plans and dosimetry calculations are not routinely performed for radionuclide therapies. In external beam radiotherapy, it is quite the opposite. As a result, a small fraction of patients receives optimal radioactivity. This conservative approach provides “radiation safety” to healthy tissues but delivers a lower than indicated absorbed dose to the tumors, resulting in a lower response rate and a higher disease relapse rate. Evidence shows that better and more predictable outcomes can be achieved with patient-individualized dose assessment. Therefore, the incorporation of individual planning into radionuclide therapies is a high priority for nuclear medicine physicians and medical physicists alike. Internal dosimetry is used in tumor therapy to optimize the absorbed dose to the target tissue. The main reasons for the difficulties in incorporating patients’ internal dosimetry into routine clinical practice are discussed. The article presents the prospects for the routine implementation of personalized radionuclide therapies. Abstract The article presents the problems of clinical implementation of personalized radioisotope therapy. The use of radioactive drugs in the treatment of malignant and benign diseases is rapidly expanding. Currently, in the majority of nuclear medicine departments worldwide, patients receive standard activities of therapeutic radiopharmaceuticals. Intensively conducted clinical trials constantly provide more evidence of a close relationship between the dose of radiopharmaceutical absorbed in pathological tissues and the therapeutic effect of radioisotope therapy. Due to the lack of individual internal dosimetry (based on the quantitative analysis of a series of diagnostic images) before or during the treatment, only a small fraction of patients receives optimal radioactivity. The vast majority of patients receive too-low doses of ionizing radiation to the target tissues. This conservative approach provides “radiation safety” to healthy tissues, but also delivers lower radiopharmaceutical activity to the neoplastic tissue, resulting in a low level of response and a higher relapse rate. The article presents information on the currently used radionuclides in individual radioisotope therapies and on radionuclides newly introduced to the therapeutic market. It discusses the causes of difficulties with the implementation of individualized radioisotope therapies as well as possible changes in the current clinical situation.
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Vergnaud L, Giraudet AL, Moreau A, Salvadori J, Imperiale A, Baudier T, Badel JN, Sarrut D. Patient-specific dosimetry adapted to variable number of SPECT/CT time-points per cycle for [Formula: see text]Lu-DOTATATE therapy. EJNMMI Phys 2022; 9:37. [PMID: 35575946 PMCID: PMC9110613 DOI: 10.1186/s40658-022-00462-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of SPECT/CT time-points is important for accurate patient dose estimation in peptide receptor radionuclide therapy. However, it may be limited by the patient's health and logistical reasons. Here, an image-based dosimetric workflow adapted to the number of SPECT/CT acquisitions available throughout the treatment cycles was proposed, taking into account patient-specific pharmacokinetics and usable in clinic for all organs at risk. METHODS Thirteen patients with neuroendocrine tumors were treated with four injections of 7.4 GBq of [Formula: see text]Lu-DOTATATE. Three SPECT/CT images were acquired during the first cycle (1H, 24H and 96H or 144H post-injection) and a single acquisition (24H) for following cycles. Absorbed doses were estimated for kidneys (LK and RK), liver (L), spleen (S), and three surrogates of bone marrow (L2 to L4, L1 to L5 and T9 to L5) that were compared. 3D dose rate distributions were computed with Monte Carlo simulations. Voxel dose rates were averaged at the organ level. The obtained Time Dose-Rate Curves (TDRC) were fitted with a tri-exponential model and time-integrated. This method modeled patient-specific uptake and clearance phases observed at cycle 1. Obtained fitting parameters were reused for the following cycles, scaled to the measure organ dose rate at 24H. An alternative methodology was proposed when some acquisitions were missing based on population average TDRC (named STP-Inter). Seven other patients with three SPECT/CT acquisitions at cycles 1 and 4 were included to estimate the uncertainty of the proposed methods. RESULTS Absorbed doses (in Gy) per cycle available were: 3.1 ± 1.1 (LK), 3.4 ± 1.5 (RK), 4.5 ± 2.8 (L), 4.6 ± 1.8 (S), 0.3 ± 0.2 (bone marrow). There was a significant difference between bone marrow surrogates (L2 to L4 and L1 to L5, Wilcoxon's test: p value < 0.05), and while depicting very doses, all three surrogates were significantly different than dose in background (p value < 0.01). At cycle 1, if the acquisition at 24H is missing and approximated, medians of percentages of dose difference (PDD) compared to the initial tri-exponential function were inferior to 3.3% for all organs. For cycles with one acquisition, the median errors were smaller with a late time-point. For STP-Inter, medians of PDD were inferior to 7.7% for all volumes, but it was shown to depend on the homogeneity of TDRC. CONCLUSION The proposed workflow allows the estimation of organ doses, including bone marrow, from a variable number of time-points acquisitions for patients treated with [Formula: see text]Lu-DOTATATE.
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Affiliation(s)
- Laure Vergnaud
- CREATIS, CNRS UMR 5220, INSERM U 1044, Université de Lyon, INSA-Lyon, Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | | | - Aurélie Moreau
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | - Julien Salvadori
- ICANS - Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - Alessio Imperiale
- ICANS - Institut de cancérologie Strasbourg Europe, Strasbourg, France
| | - Thomas Baudier
- CREATIS, CNRS UMR 5220, INSERM U 1044, Université de Lyon, INSA-Lyon, Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | | | - David Sarrut
- CREATIS, CNRS UMR 5220, INSERM U 1044, Université de Lyon, INSA-Lyon, Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
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Tronchin S, Forster JC, Hickson K, Bezak E. Dosimetry in targeted alpha therapy. A systematic review: current findings and what is needed. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac5fe0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/22/2022] [Indexed: 12/13/2022]
Abstract
Abstract
Objective. A systematic review of dosimetry in Targeted Alpha Therapy (TAT) has been performed, identifying the common issues. Approach. The systematic review was performed in accordance with the PRISMA guidelines, and the literature was searched using the Scopus and PubMed databases. Main results. From the systematic review, three key points should be considered when performing dosimetry in TAT. (1) Biodistribution/Biokinetics: the accuracy of the biodistribution data is a limit to accurate dosimetry in TAT. The biodistribution of alpha-emitting radionuclides throughout the body is difficult to image directly, with surrogate radionuclide imaging, blood/faecal sampling, and animal studies able to provide information. (2) Daughter radionuclides: the decay energy of the alpha-emissions is sufficient to break the bond to the targeting vector, resulting in a release of free daughter radionuclides in the body. Accounting for daughter radionuclide migration is essential. (3) Small-scale dosimetry and microdosimetry: due to the short path length and heterogeneous distribution of alpha-emitters at the target site, small-scale/microdosimetry are important to account for the non-uniform dose distribution in a target region, organ or cell and for assessing the biological effect of alpha-particle radiation. Significance. TAT is a form of cancer treatment capable of delivering a highly localised dose to the tumour environment while sparing the surrounding healthy tissue. Dosimetry is an important part of treatment planning and follow up. Being able to accurately predict the radiation dose to the target region and healthy organs could guide the optimal prescribed activity. Detailed dosimetry models accounting for the three points mentioned above will help give confidence in and guide the clinical application of alpha-emitting radionuclides in targeted cancer therapy.
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EANM dosimetry committee recommendations for dosimetry of 177Lu-labelled somatostatin-receptor- and PSMA-targeting ligands. Eur J Nucl Med Mol Imaging 2022; 49:1778-1809. [PMID: 35284969 PMCID: PMC9015994 DOI: 10.1007/s00259-022-05727-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/13/2022] [Indexed: 12/25/2022]
Abstract
The purpose of the EANM Dosimetry Committee is to provide recommendations and guidance to scientists and clinicians on patient-specific dosimetry. Radiopharmaceuticals labelled with lutetium-177 (177Lu) are increasingly used for therapeutic applications, in particular for the treatment of metastatic neuroendocrine tumours using ligands for somatostatin receptors and prostate adenocarcinoma with small-molecule PSMA-targeting ligands. This paper provides an overview of reported dosimetry data for these therapies and summarises current knowledge about radiation-induced side effects on normal tissues and dose-effect relationships for tumours. Dosimetry methods and data are summarised for kidneys, bone marrow, salivary glands, lacrimal glands, pituitary glands, tumours, and the skin in case of radiopharmaceutical extravasation. Where applicable, taking into account the present status of the field and recent evidence in the literature, guidance is provided. The purpose of these recommendations is to encourage the practice of patient-specific dosimetry in therapy with 177Lu-labelled compounds. The proposed methods should be within the scope of centres offering therapy with 177Lu-labelled ligands for somatostatin receptors or small-molecule PSMA.
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Compartmental Modeling of the Kinetics of 188Re-Labeled Pentaphosphonic Acid in Rats with Bone Callus. Pharm Chem J 2022. [DOI: 10.1007/s11094-021-02528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Danieli R, Milano A, Gallo S, Veronese I, Lascialfari A, Indovina L, Botta F, Ferrari M, Cicchetti A, Raspanti D, Cremonesi M. Personalized Dosimetry in Targeted Radiation Therapy: A Look to Methods, Tools and Critical Aspects. J Pers Med 2022; 12:205. [PMID: 35207693 PMCID: PMC8874397 DOI: 10.3390/jpm12020205] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
Targeted radiation therapy (TRT) is a strategy increasingly adopted for the treatment of different types of cancer. The urge for optimization, as stated by the European Council Directive (2013/59/EURATOM), requires the implementation of a personalized dosimetric approach, similar to what already happens in external beam radiation therapy (EBRT). The purpose of this paper is to provide a thorough introduction to the field of personalized dosimetry in TRT, explaining its rationale in the context of optimization and describing the currently available methodologies. After listing the main therapies currently employed, the clinical workflow for the absorbed dose calculation is described, based on works of the most experienced authors in the literature and recent guidelines. Moreover, the widespread software packages for internal dosimetry are presented and critical aspects discussed. Overall, a selection of the most important and recent articles about this topic is provided.
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Affiliation(s)
- Rachele Danieli
- Dipartimento di Fisica, Università degli Studi di Pavia, Via Bassi 6, 27100 Pavia, Italy;
| | - Alessia Milano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy;
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy
| | - Salvatore Gallo
- Dipartimento di Fisica “Aldo Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (S.G.); (I.V.)
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Ivan Veronese
- Dipartimento di Fisica “Aldo Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (S.G.); (I.V.)
- INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Alessandro Lascialfari
- INFN-Pavia Unit, Department of Physics, University of Pavia, Via Bassi 6, 27100 Pavia, Italy;
| | - Luca Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy;
| | - Francesca Botta
- Medical Physics Unit, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy; (F.B.); (M.F.)
| | - Mahila Ferrari
- Medical Physics Unit, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy; (F.B.); (M.F.)
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy;
| | - Davide Raspanti
- Temasinergie S.p.A., Via Marcello Malpighi 120, 48018 Faenza, Italy;
| | - Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy;
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Estimation of electron-specific absorbed fractions with the InterDosi code using ICRP adult female voxel-based phantom. Appl Radiat Isot 2022; 182:110145. [DOI: 10.1016/j.apradiso.2022.110145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
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Toward three-dimensional patient-specific internal dosimetry using GATE Monte Carlo technique. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Dosimetry in radionuclide therapy: the clinical role of measuring radiation dose. Lancet Oncol 2022; 23:e75-e87. [DOI: 10.1016/s1470-2045(21)00657-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/22/2022]
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Pettinato C, Richetta E, Cremonesi M. Dosimetry with single photon emission tomography (SPECT). Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Neira-Castro S, Guiu-Souto J, Pardo-Montero J. Dosimetry in positron emission tomography. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amato E, Gnesin S, Cicone F, Auditore L. Fundamentals of internal radiation dosimetry. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Auditore L, Pistone D, Amato E, Italiano A. Monte Carlo methods in nuclear medicine. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Lassmann M, Eberlein U, Gear J, Konijnenberg M, Kunikowska J. Dosimetry for Radiopharmaceutical Therapy: The European Perspective. J Nucl Med 2021; 62:73S-79S. [PMID: 34857624 DOI: 10.2967/jnumed.121.262754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
This review presents efforts in Europe over the last few years with respect to standardization of quantitative imaging and dosimetry and comprises the results of several European research projects on practices regarding radiopharmaceutical therapies (RPTs). Because the European Union has regulatory requirements concerning dosimetry in RPTs, the European Association of Nuclear Medicine released a position paper in 2021 on the use of dosimetry under these requirements. The importance of radiobiology for RPTs is elucidated in another position paper by the European Association of Nuclear Medicine. Furthermore, how dosimetry interacts with clinical requirements is described, with several clinical examples. In the future, more efforts need to be undertaken to increase teaching and standardization efforts and to incorporate radiobiology for further individualizing patient treatment, with the aim of improving the outcome and safety of RPTs.
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Affiliation(s)
- Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany;
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; and
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
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Della Gala G, Bardiès M, Tipping J, Strigari L. Overview of commercial treatment planning systems for targeted radionuclide therapy. Phys Med 2021; 92:52-61. [PMID: 34864422 DOI: 10.1016/j.ejmp.2021.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/23/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Targeted Radionuclide Therapy (TRT) is a branch of cancer medicine dealing with the therapeutic use of radioisotopes associated with biological vectors accumulating in the tumors/targets, indicated as Molecular Radiotherapy (MRT), or directly injected into the arteries that supply blood to liver tumour vasculature, indicated as Selective RT (SRT). The aim of this work is to offer a panoramic view on the increasing number of commercially-available TRT treatment planning systems (TPSs). MATERIALS AND METHODS A questionnaire was sent to manufacturers' representatives. Academic software were not considered. Questions were grouped as follows: general information, clinical workflow, calibration procedure, image processing/reconstruction, image registration and segmentation tools, time-activity curve (TAC) fitting and absorbed dose calculation. RESULTS All software reported have CE-marking. TPSs were divided between SRT-dedicated software [4] and MRT [5] dosimetry software. In SRT, since no kinetic process is involved, absorbed dose calculation does not require TAC fitting, and image registration is not fully developed in all TPS. All software requires a radionuclide-specific calibration. In SRT, a relative image calibration can be obtained by scaling the counts to a known activity. Automated VOI contouring and rigid/deformable propagation between different acquisitions time-points is implemented in most TPSs, although DICOM export is rare. Different TAC fits are available depending on the number of time-points. Voxel S-value and Local deposition methods are the most frequent dosimetric approaches; dose-voxel kernel convolution and semi-Monte Carlo method are also available. CONCLUSIONS Available TPSs allows performing personalized dosimetry in clinical practice. Individual variations in methodology/algorithms must be considered in the standardisation/harmonization processes.
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Affiliation(s)
- Giuseppe Della Gala
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manuel Bardiès
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier (ICM), Montpellier F-34298, France; IRCM, UMR 1194 INSERM, Université de Montpellier and Institut Régional du Cancer de Montpellier (ICM), Montpellier F-34298, France
| | - Jill Tipping
- The Christie NHS Foundation Trust, Manchester, UK
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Sarrut D, Bała M, Bardiès M, Bert J, Chauvin M, Chatzipapas K, Dupont M, Etxebeste A, M Fanchon L, Jan S, Kayal G, S Kirov A, Kowalski P, Krzemien W, Labour J, Lenz M, Loudos G, Mehadji B, Ménard L, Morel C, Papadimitroulas P, Rafecas M, Salvadori J, Seiter D, Stockhoff M, Testa E, Trigila C, Pietrzyk U, Vandenberghe S, Verdier MA, Visvikis D, Ziemons K, Zvolský M, Roncali E. Advanced Monte Carlo simulations of emission tomography imaging systems with GATE. Phys Med Biol 2021; 66:10.1088/1361-6560/abf276. [PMID: 33770774 PMCID: PMC10549966 DOI: 10.1088/1361-6560/abf276] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
Built on top of the Geant4 toolkit, GATE is collaboratively developed for more than 15 years to design Monte Carlo simulations of nuclear-based imaging systems. It is, in particular, used by researchers and industrials to design, optimize, understand and create innovative emission tomography systems. In this paper, we reviewed the recent developments that have been proposed to simulate modern detectors and provide a comprehensive report on imaging systems that have been simulated and evaluated in GATE. Additionally, some methodological developments that are not specific for imaging but that can improve detector modeling and provide computation time gains, such as Variance Reduction Techniques and Artificial Intelligence integration, are described and discussed.
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Affiliation(s)
- David Sarrut
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1294, INSA-Lyon, Université Lyon 1, Lyon, France
| | | | - Manuel Bardiès
- Cancer Research Institute of Montpellier, U1194 INSERM/ICM/Montpellier University, 208 Av des Apothicaires, F-34298 Montpellier cedex 5, France
| | - Julien Bert
- LaTIM, INSERM UMR 1101, IBRBS, Faculty of Medicine, Univ Brest, 22 avenue Camille Desmoulins, F-29238, Brest, France
| | - Maxime Chauvin
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | | | - Ane Etxebeste
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1294, INSA-Lyon, Université Lyon 1, Lyon, France
| | - Louise M Fanchon
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, United States of America
| | - Sébastien Jan
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, F-91401, Orsay, France
| | - Gunjan Kayal
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
- SCK CEN, Belgian Nuclear Research Centre, Boeretang 200, Mol 2400, Belgium
| | - Assen S Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, United States of America
| | - Paweł Kowalski
- High Energy Physics Division, National Centre for Nuclear Research, Otwock-Świerk, Poland
| | - Wojciech Krzemien
- High Energy Physics Division, National Centre for Nuclear Research, Otwock-Świerk, Poland
| | - Joey Labour
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1294, INSA-Lyon, Université Lyon 1, Lyon, France
| | - Mirjam Lenz
- FH Aachen University of Applied Sciences, Forschungszentrum Jülich, Jülich, Germany
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - George Loudos
- Bioemission Technology Solutions (BIOEMTECH), Alexandras Av. 116, Athens, Greece
| | | | - Laurent Ménard
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, F-91405 Orsay, France
- Université de Paris, IJCLab, F-91405 Orsay France
| | | | | | - Magdalena Rafecas
- Institute of Medical Engineering, University of Lübeck, Lübeck, Germany
| | - Julien Salvadori
- Department of Nuclear Medicine and Nancyclotep molecular imaging platform, CHRU-Nancy, Université de Lorraine, F-54000, Nancy, France
| | - Daniel Seiter
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53705, United States of America
| | - Mariele Stockhoff
- Medical Image and Signal Processing (MEDISIP), Ghent University, Ghent, Belgium
| | - Etienne Testa
- Univ. Lyon, Univ. Claude Bernard Lyon 1, CNRS/IN2P3, IP2I Lyon, F-69622, Villeurbanne, France
| | - Carlotta Trigila
- Department of Biomedical Engineering, University of California, Davis, CA 95616 United States of America
| | - Uwe Pietrzyk
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | | | - Marc-Antoine Verdier
- Université Paris-Saclay, CNRS/IN2P3, IJCLab, F-91405 Orsay, France
- Université de Paris, IJCLab, F-91405 Orsay France
| | - Dimitris Visvikis
- LaTIM, INSERM UMR 1101, IBRBS, Faculty of Medicine, Univ Brest, 22 avenue Camille Desmoulins, F-29238, Brest, France
| | - Karl Ziemons
- FH Aachen University of Applied Sciences, Forschungszentrum Jülich, Jülich, Germany
| | - Milan Zvolský
- Institute of Medical Engineering, University of Lübeck, Lübeck, Germany
| | - Emilie Roncali
- Department of Biomedical Engineering, University of California, Davis, CA 95616 United States of America
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Ambrosini V, Kunikowska J, Baudin E, Bodei L, Bouvier C, Capdevila J, Cremonesi M, de Herder WW, Dromain C, Falconi M, Fani M, Fanti S, Hicks RJ, Kabasakal L, Kaltsas G, Lewington V, Minozzi S, Cinquini M, Öberg K, Oyen WJG, O'Toole D, Pavel M, Ruszniewski P, Scarpa A, Strosberg J, Sundin A, Taïeb D, Virgolini I, Wild D, Herrmann K, Yao J. Consensus on molecular imaging and theranostics in neuroendocrine neoplasms. Eur J Cancer 2021; 146:56-73. [PMID: 33588146 DOI: 10.1016/j.ejca.2021.01.008] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
Nuclear medicine plays an increasingly important role in the management neuroendocrine neoplasms (NEN). Somatostatin analogue (SSA)-based positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT) have been used in clinical trials and approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). European Association of Nuclear Medicine (EANM) Focus 3 performed a multidisciplinary Delphi process to deliver a balanced perspective on molecular imaging and radionuclide therapy in well-differentiated neuroendocrine tumours (NETs). NETs form in cells that interact with the nervous system or in glands that produce hormones. These cells, called neuroendocrine cells, can be found throughout the body, but NETs are most often found in the abdomen, especially in the gastrointestinal tract. These tumours may also be found in the lungs, pancreas and adrenal glands. In addition to being rare, NETs are also complex and may be difficult to diagnose. Most NETs are non-functioning; however, a minority present with symptoms related to hypersecretion of bioactive compounds. NETs often do not cause symptoms early in the disease process. When diagnosed, substantial number of patients are already found to have metastatic disease. Several societies' guidelines address Neuroendocrine neoplasms (NENs) management; however, many issues are still debated, due to both the difficulty in acquiring strong clinical evidence in a rare and heterogeneous disease and the different availability of diagnostic and therapeutic options across countries. EANM Focus 3 reached consensus on employing 68gallium-labelled somatostatin analogue ([68Ga]Ga-DOTA-SSA)-based PET/CT with diagnostic CT or magnetic resonance imaging (MRI) for unknown primary NET detection, metastatic NET, NET staging/restaging, suspected extra-adrenal pheochromocytoma/paraganglioma and suspected paraganglioma. Consensus was reached on employing 18fluorine-fluoro-2-deoxyglucose ([18F]FDG) PET/CT in neuroendocrine carcinoma, G3 NET and in G1-2 NET with mismatched lesions (CT-positive/[68Ga]Ga-DOTA-SSA-negative). Peptide receptor radionuclide therapy (PRRT) was recommended for second line treatment for gastrointestinal NET with [68Ga]Ga-DOTA-SSA uptake in all lesions, in G1/G2 NET at disease progression, and in a subset of G3 NET provided all lesions are positive at [18F]FDG and [68Ga]Ga-DOTA-SSA. PRRT rechallenge may be used for in patients with stable disease for at least 1 year after therapy completion. An international consensus is not only a prelude to a more standardised management across countries but also serves as a guide for the direction to follow when designing new research studies.
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Affiliation(s)
- Valentina Ambrosini
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Eric Baudin
- Endocrine Oncolgy Unit, Institut Gustave Roussy, Villejuif Cedex, France
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Catherine Bouvier
- International Neuroendocrine Cancer Alliance (INCA), Leamington Spa, UK
| | - Jaume Capdevila
- Medical Oncology Department, Vall Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Cremonesi
- Radiation Research Unit, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Wouter W de Herder
- Erasmus MC & Erasmus MC Cancer Center, ENETS Center of Excellence Rotterdam, Rotterdam, the Netherlands
| | | | - Massimo Falconi
- Pancreas Translational & Research Institute, Scientific Institute San Raffaele Hospital and University Vita-Salute, Milan, Italy
| | - Melpomeni Fani
- Division of Radiopharmaceutical Chemistry, University Hospital Basel, Basel, Switzerland
| | - Stefano Fanti
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Italy; Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Rodney J Hicks
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Levent Kabasakal
- Istanbul University-Cerrahpaşa, Faculty of Medicine, Department of Nuclear Medicine, Turkey
| | - Gregory Kaltsas
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Silvia Minozzi
- Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Cinquini
- Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Kjell Öberg
- Dept of Endocrine Oncology, University Hospital Uppsala, Sweden
| | - Wim J G Oyen
- Humanitas University and Humanitas Clinical and Research Center, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital Arnhem, the Netherlands
| | | | - Marianne Pavel
- Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philippe Ruszniewski
- Department of Pancreatology, Beaujon Hospital, Université de Paris, Clichy, France
| | - Aldo Scarpa
- ARC-NET Centre for Applied Research on Cancer and Department of Pathology, University of Verona, Italy
| | | | - Anders Sundin
- Department of Surgical Sciences, Uppsala University, University Hospital, Sweden
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Ken Herrmann
- Department of Nuclear Medicine, Universitätsklinikum, Essen, Germany.
| | - James Yao
- Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fani M, Weingaertner V, Kolenc Peitl P, Mansi R, Gaonkar RH, Garnuszek P, Mikolajczak R, Novak D, Simoncic U, Hubalewska-Dydejczyk A, Rangger C, Kaeopookum P, Decristoforo C. Selection of the First 99mTc-Labelled Somatostatin Receptor Subtype 2 Antagonist for Clinical Translation-Preclinical Assessment of Two Optimized Candidates. Pharmaceuticals (Basel) 2020; 14:19. [PMID: 33379299 PMCID: PMC7824897 DOI: 10.3390/ph14010019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 02/01/2023] Open
Abstract
Recently, radiolabelled antagonists targeting somatostatin receptors subtype 2 (SST2) in neuroendocrine neoplasms demonstrated certain superior properties over agonists. Within the ERA-PerMED project "TECANT" two 99mTc-Tetramine (N4)-derivatized SST2 antagonists (TECANT-1 and TECANT-2) were studied for the selection of the best candidate for clinical translation. Receptor-affinity, internalization and dissociation studies were performed in human embryonic kidney-293 (HEK293) cells transfected with the human SST2 (HEK-SST2). Log D, protein binding and stability in human serum were assessed. Biodistribution and SPECT/CT studies were carried out in nude mice bearing HEK-SST2 xenografts, together with dosimetric estimations from mouse-to-man. [99mTc]Tc-TECANT-1 showed higher hydrophilicity and lower protein binding than [99mTc]-TECANT-2, while stability was comparable. Both radiotracers revealed similar binding affinity, while [99mTc]Tc-TECANT-1 had higher cellular uptake (>50%, at 2 h/37 °C) and lower dissociation rate (<30%, at 2 h/37 °C). In vivo, [99mTc]Tc-TECANT-1 showed lower blood values, kidney and muscles uptake, whereas tumour uptake was comparable to [99mTc]Tc-TECANT-2. SPECT/CT imaging confirmed the biodistribution results, providing the best tumour-to-background image contrast for [99mTc]Tc-TECANT-1 at 4 h post-injection (p.i.). The estimated radiation dose amounted to approximately 6 µSv/MBq for both radiotracers. This preclinical study provided the basis of selection of [99mTc]Tc-TECANT-1 for clinical translation of the first 99mTc-based SST2 antagonist.
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Affiliation(s)
- Melpomeni Fani
- Division of Radiopharmaceutical Chemistry, University Hospital Basel, Universitätsspital Basel, CH-4031 Basel, Switzerland; (M.F.); (R.M.); (R.H.G.)
| | - Viktoria Weingaertner
- Department of Nuclear Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (V.W.); (C.R.); (P.K.)
| | - Petra Kolenc Peitl
- Department of Nuclear Medicine, University Medical Centre Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia; (P.K.P.); (D.N.)
| | - Rosalba Mansi
- Division of Radiopharmaceutical Chemistry, University Hospital Basel, Universitätsspital Basel, CH-4031 Basel, Switzerland; (M.F.); (R.M.); (R.H.G.)
| | - Raghuvir H. Gaonkar
- Division of Radiopharmaceutical Chemistry, University Hospital Basel, Universitätsspital Basel, CH-4031 Basel, Switzerland; (M.F.); (R.M.); (R.H.G.)
| | - Piotr Garnuszek
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland; (P.G.); (R.M.)
| | - Renata Mikolajczak
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland; (P.G.); (R.M.)
| | - Doroteja Novak
- Department of Nuclear Medicine, University Medical Centre Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia; (P.K.P.); (D.N.)
| | - Urban Simoncic
- Faculty of Mathematics and Physics, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | | | - Christine Rangger
- Department of Nuclear Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (V.W.); (C.R.); (P.K.)
| | - Piriya Kaeopookum
- Department of Nuclear Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (V.W.); (C.R.); (P.K.)
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (V.W.); (C.R.); (P.K.)
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Craig AJ, Rojas B, Wevrett JL, Hamer E, Fenwick A, Gregory R. IPEM topical report: current molecular radiotherapy service provision and guidance on the implications of setting up a dosimetry service. Phys Med Biol 2020; 65:245038. [PMID: 33142274 DOI: 10.1088/1361-6560/abc707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite a growth in molecular radiotherapy treatment (MRT) and an increase in interest, centres still rarely perform MRT dosimetry. The aims of this report were to assess the main reasons why centres are not performing MRT dosimetry and provide advice on the resources required to set-up such a service. A survey based in the United Kingdom was developed to establish how many centres provide an MRT dosimetry service and the main reasons why it is not commonly performed. Twenty-eight per cent of the centres who responded to the survey performed some form of dosimetry, with 88% of those centres performing internal dosimetry. The survey showed that a 'lack of clinical evidence', a 'lack of guidelines' and 'not current UK practice' were the largest obstacles to setting up an MRT dosimetry service. More practical considerations, such as 'lack of software' and 'lack of staff training/expertise', were considered to be of lower significance by the respondents. Following on from the survey, this report gives an overview of the current guidelines, and the evidence available demonstrating the benefits of performing MRT dosimetry. The resources required to perform such techniques are detailed with reference to guidelines, training resources and currently available software. It is hoped that the information presented in this report will allow MRT dosimetry to be performed more frequently and in more centres, both in routine clinical practice and in multicentre trials. Such trials are required to harmonise dosimetry techniques between centres, build on the current evidence base, and provide the data necessary to establish the dose-response relationship for MRT.
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Affiliation(s)
- Allison J Craig
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom. The Institute of Cancer Research, London, United Kingdom. Author to whom any correspondence should be addressed
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Bardiès M, Gear JI. Scientific Developments in Imaging and Dosimetry for Molecular Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 33:117-124. [PMID: 33281018 DOI: 10.1016/j.clon.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/12/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
Molecular radiotherapy is a rapidly developing field with new vector and isotope combinations continually added to market. As with any radiotherapy treatment, it is vital that the absorbed dose and toxicity profile are adequately characterised. Methodologies for absorbed dose calculations for radiopharmaceuticals were generally developed to characterise stochastic effects and not suited to calculations on a patient-specific basis. There has been substantial scientific and technological development within the field of molecular radiotherapy dosimetry to answer this challenge. The development of imaging systems and advanced processing techniques enable the acquisition of accurate measurements of radioactivity within the body. Activity assessment combined with dosimetric models and radiation transport algorithms make individualised absorbed dose calculations not only feasible, but commonplace in a variety of commercially available software packages. The development of dosimetric parameters beyond the absorbed dose has also allowed the possibility to characterise the effect of irradiation by including biological parameters that account for radiation absorbed dose rates, gradients and spatial and temporal energy distribution heterogeneities. Molecular radiotherapy is in an exciting time of its development and the application of dosimetry in this field can only have a positive influence on its continued progression.
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Affiliation(s)
- M Bardiès
- Centre de Recherches en Cancérologie de Toulouse UMR 1037, Toulouse, France; INSERM UMR 1037 Université Toulouse III Paul Sabatier, Toulouse, France
| | - J I Gear
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, Surrey, UK.
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