Individualized dosimetry-based activity reduction of 90Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy

Binnebeek, Sofie Van; Baete, Kristof; Vanbilloen, B; Terwinghe, Christelle; Mottaghy, Felix M.; Clément, Paul M.; Mortelmans, Luc; Haustermans, Karin; Cutsem, Éric Van; Verbruggen, Alfons; Bogaerts, Kris; Verslype, Chris; Deroose, Christophe M.

doi:10.1007/s00259-013-2670-x

Cited by 23 publications

(28 citation statements)

References 33 publications

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“…20, the BED TD 50/5 is 44 Gy (α/β = 2.5 Gy), and the threshold for radiation nephropathy is 33 Gy [14]. These results were applied in a prospective clinical trial [17], where 22 patients completed treatment with repeated cycles of 90 Y-DOTATOC with the aim of not exceeding an accumulated renal BED of 37 Gy (α/β = 2.5 Gy), showing no grade 3-4 toxicity at 18-month follow-up.…”

Section: Introductionmentioning

confidence: 99%

Individualised 177Lu-DOTATATE treatment of neuroendocrine tumours based on kidney dosimetry

Sundlöv

Gleisner

Svensson

et al. 2017

Eur J Nucl Med Mol Imaging

160

140

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PurposeTo present data from an interim analysis of a Phase II trial designed to determine the feasibility, safety, and efficacy of individualising treatment based on renal dosimetry, by giving as many cycles as possible within a maximum renal biologically effective dose (BED).MethodTreatment was given with repeated cycles of 7.4 GBq 177Lu-DOTATATE at 8-12-week intervals. Detailed dosimetry was performed in all patients after each cycle using a hybrid method (SPECT + planar imaging). All patients received treatment up to a renal BED of 27 ± 2 Gy (α/β = 2.6 Gy) (Step 1). Selected patients were offered further treatment up to a renal BED of 40 ± 2 Gy (Step 2). Renal function was followed by estimation and measurement of the glomerular filtration rate (GFR).ResultsFifty-one patients were included in the present analysis. Among the patients who received treatment as planned, the median number of cycles in Step 1 was 5 (range 3-7), and for those who completed Step 2 it was 7 (range 5-8); 73% were able to receive >4 cycles. Although GFR decreased in most patients after the completion of treatment, no grade 3-4 toxicity was observed. Patients with a reduced baseline GFR seemed to have an increased risk of GFR decline. Five patients received treatment in Step 2, none of whom exhibited a significant reduction in renal function.ConclusionsIndividualising PRRT using renal dosimetry seems feasible and safe and leads to an increased number of cycles in the majority of patients. The trial will continue as planned.Electronic supplementary materialThe online version of this article (doi:10.1007/s00259-017-3678-4) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Individualised 177Lu-DOTATATE treatment of neuroendocrine tumours based on kidney dosimetry

Sundlöv

Gleisner

Svensson

et al. 2017

Eur J Nucl Med Mol Imaging

160

140

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“…At 8 and 24 h postinjection, tomographic views (SPECT) were acquired from the dome of the liver downward, using the aforementioned gamma-camera, with a 128×128 matrix, 20 sec/view and 72 views over 360°. Only SPECT abdomen was performed in every patient since the kidneys, as critical organs during PRRT with 90 Y-DOTATOC, had to be in de FOV for dosimetric purposes [19]. On the other hand, most of these study patients had the majority of their tumoral lesions in the abdomen (liver, mesenterium, retroperitoneum, vertebral bone metastases).…”

mentioning

confidence: 99%

Comparison of diagnostic accuracy of 111In-pentetreotide SPECT and 68Ga-DOTATOC PET/CT: A lesion-by-lesion analysis in patients with metastatic neuroendocrine tumours

et al. 2015

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“…These findings were confirmed by a prospective phase 2 dosimetry trial in which a threshold of BED of 37 Gy for kidney toxicity was found to be a good guide for 90 Y-DOTATOC PRRT (50).…”

Section: Prrt With 90 Ymentioning

confidence: 63%

Individualized Dosimetry for Theranostics: Necessary, Nice to Have, or Counterproductive?

2017

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In 2005, the term theragnostics (theranostics) was introduced for describing the use of imaging for therapy planning in radiation oncology. In nuclear medicine, this expression describes the use of tracers for predicting the absorbed doses in molecular radiotherapy and, thus, the safety and efficacy of a treatment. At present, the most successful groups of isotopes for this purpose are 123 In2005,t he term theragnostics (theranostics) was first used for describing the use of imaging for therapy planning in radiation oncology. It is defined as the use of information from medical images to determine the optimal therapy for an individual patient (1). In nuclear medicine, this expression describes the use of tracers for predicting the absorbed doses in molecular radiotherapy and, thus, the safety and efficacy of a treatment. At present, the most successful groups of isotopes for theranostics are 123 I/ 124 I/ 131 I (2), 68 Ga/ 177 Lu, and 111 In/ 86 Y/ 90 Y (3).In recent years, numerous reports providing pre-and peritherapeutic dosimetry data for molecular radiotherapies with 131 I-sodium iodide (4-8) and 177 Lu-labeled (9-16) and 90 Y-labeled (13,(17)(18)(19)(20) compounds have been published. The purpose of this review is to introduce the concept of theranostics, present available data on the dosimetry and dose-response relationships of theranostic compounds, and discuss whether individualized dosimetry for theranostics is necessary, nice to have, or counterproductive. Special focus is given to the provision of radioiodine therapy for differentiated thyroid cancer and peptide receptor radionuclide therapy (PRRT) with 177 Luand 90 Y-labeled peptides. INTERNAL DOSIMETRY Dosimetry in Nuclear MedicineThe basic methodology for calculating the absorbed doses from the administration of a radiopharmaceutical was developed by the MIRD Committee (21):Eq. 1 where• Dðr T Þ is the mean absorbed dose to target region r T delivered by the cumulated activity in source region r S .•Ãðr S Þ is the time-integrated activity in source region r S .Ã denotes the total number of radioactive decays (determined by integrating the time-activity curve from time 0 to infinity) occurring within an accumulating organ.Ã is determined by quantitative imaging at several time points after the administration of a radiopharmaceutical for an assessment of organor voxel-specific pharmacokinetics. A proposal for choosing optimal time points is given in MIRD Pamphlet No. 16 (22). • A 0 is the administered activity.•ãðr S Þ is the time-integrated activity coefficient, which is the time-integrated activity divided by the administered activity.• Sðr T )r S Þ is the radionuclide specific absorbed dose rate per unit of activity in target region r T delivered by source region r S (formerly called S value).For calculation of the absorbed dose, therefore, several steps are essential.The first step is to perform quantitative imaging at different time points to assess the activity in the organs of interest over time. The established method for quantitative imagi...

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Individualized dosimetry-based activity reduction of 90Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy

Cited by 23 publications

References 33 publications

Individualised 177Lu-DOTATATE treatment of neuroendocrine tumours based on kidney dosimetry

Individualised 177Lu-DOTATATE treatment of neuroendocrine tumours based on kidney dosimetry

Comparison of diagnostic accuracy of 111In-pentetreotide SPECT and 68Ga-DOTATOC PET/CT: A lesion-by-lesion analysis in patients with metastatic neuroendocrine tumours

Individualized Dosimetry for Theranostics: Necessary, Nice to Have, or Counterproductive?

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