PET/CT for the assessment and quantification of 90Y biodistribution after selective internal radiotherapy (SIRT) of liver metastases

Werner, Matthias; Brechtel, Klaus; Beyer, Thomas; Dittmann, Helmut; Pfannenberg, Christina; Kupferschläger, Jürgen

doi:10.1007/s00259-009-1317-4

Cited by 47 publications

(38 citation statements)

References 4 publications

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“…90 Y is a pure b-emitter, and therefore dosimetry and imaging have historically required concurrent administration of 111 In-DTPA-D-Phe 1 -octreotide whereas 177 Lu-DOTATATE emits g-and b-radiation, allowing essential dosimetry measurements and imaging to be performed from the same administration. There have been reports on the feasibility of 90 Y PET/CT; the main limitation is the data acquisition time (33,34).…”

Section: Discussionmentioning

confidence: 99%

¹⁷⁷Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

Gains¹,

Bomanji²,

Fersht³

et al. 2011

J Nucl Med

150

141

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This study tested the principle that 68 Ga-DOTATATE PET/CT may be used to select children with primary refractory or relapsed high-risk neuroblastoma for treatment with 177 Lu-DOTATATE and evaluated whether this is a viable therapeutic option for those children. Methods: Between 2008 and 2010, 8 children with relapsed or refractory high-risk neuroblastoma were studied with 68 Ga-DOTATATE PET/CT. The criterion of eligibility for 177 Lu-DOTATATE therapy was uptake on the diagnostic scan equal to or higher than that of the liver. Results: Of the 8 children imaged, 6 had abnormally high uptake on the 68 Ga-DOTATATE PET/CT scan and proceeded to treatment. Patients received 2 or 3 administrations of 177 Lu-DOTATATE at a median interval of 9 wk and a median administered activity of 7.3 GBq. Of the 6 children treated, 5 had stable disease by the response evaluation criteria in solid tumors (RECIST). Of these 5 children, 2 had an initial metabolic response and reduction in the size of their lesions, and 1 patient had a persistent partial metabolic response and reduction in size of the lesions on CT, although the disease was stable by RECIST. One had progressive disease. Three children had grade 3 and 1 child had grade 4 thrombocytopenia. No significant renal toxicity has been seen. Conclusion: 68 Ga-DOTATATE can be used to image children with neuroblastoma and identify those suitable for molecular radiotherapy with 177 Lu-DOTATATE. We have shown, for what is to our knowledge the first time, that treatment with 177 Lu-DOTATATE is safe and feasible in children with relapsed or primary refractory high-risk neuroblastoma. We plan to evaluate this approach formally in a phase I-II clinical trial.

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Section: Discussionmentioning

confidence: 99%

¹⁷⁷Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

Gains¹,

Bomanji²,

Fersht³

et al. 2011

J Nucl Med

150

141

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“…92 Data available in 13 patients showed a marked decrease in 18 F-FDG uptake of liver metastases in 10 of 13 patients, reaching even normal hepatic 18 F-FDG uptake in 3 out of 10 patients. This decline paralleled a decrease in tumor markers (carcinoembryonic antigen [CEA], Ca19-9, CA 15-3, and special markers for neuroendocrine tumors [Cyfra 21-1, ProGRP, NSE]) which also decreased in all the 10 patients, reaching normal levels approximately 3 months after 90 Y-radioembolization in 5 out of 10 patients. A recently published study in 58 patients with breast cancer liver metastases treated with 90 Y-radioembolisation has shown that [18F]-FDG PET-CT performed 3 months after treatment was the strongest predictor of overall survival (67 weeks in responders vs 43 weeks in nonresponders) whereas response on CT-MRI could not predict survival 93 .…”

Section: Y Radioembolizationmentioning

confidence: 83%

“…However, subsequent work conducted by Werner et al suggested that good quality 90 Y PET-CT can be obtained without the need for additional copper ring or advanced timeof-flight. 90 . More recently, a study by D'Arienzo et al has shown that 90 Y-PET provided very good quality images of liver tumors 2 hours after 90 Y radioembolization which correlated with FDG uptake in the target lesions on the pretreatment PET-CT.…”

Section: Y Radioembolizationmentioning

confidence: 95%

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Positron Emission Tomography-Computed Tomography in Liver Imaging

Sharma

Martin

Zerizer

2013

Seminars in Ultrasound, CT and MRI

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“…The radiometal itself may also alter the pharmacokinetics, especially when the compound is metabolized. However, most of the kidney uptake is not somatostatin receptor-dependent, and, for example, 111 In-DOTATOC has proven useful-although not with perfect accuracy-at predicting the kidney toxicity in 90 Y-DOTATOC therapy (12,15 (18)(19)(20). The goal of the present study was to assess whether direct 90 Y PET of a first 90 Y PRRT cycle could also provide accurate dosimetry to optimize the injected activity of the following cycles.…”

mentioning

confidence: 97%

4-Step Renal Dosimetry Dependent on Cortex Geometry Applied to ⁹⁰Y Peptide Receptor Radiotherapy: Evaluation Using a Fillable Kidney Phantom Imaged by ⁹⁰Y PET

Walrand

Jamar²,

Elmbt³

et al. 2010

J Nucl Med

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Accurate dosimetry in 90 Y peptide receptor radionuclide therapy (PRRT) helps to optimize the injected activity, to prevent kidney or red marrow toxicity, while giving the highest absorbed dose to tumors. The aim of this study was to evaluate whether direct 90 Y bismuth germanate or lutetium yttrium orthosilicate time-of-flight PET was accurate enough to provide dosimetry estimates suitable to 90 Y PRRT. Method: To overcome the statistical uncertainty arising from the low 90 Y positron counting rate, the computation of the cortex mean-absorbed dose was divided into 4 steps: delineation of the cortex volume of interest (VOI) on the CT scan, determination of the recovery coefficient from the cortex VOI using the point-spread function of the whole imaging process, determination of the mean cortex-absorbed dose per unit cumulated activity in the cortex (S cortex)cortex value) from the cortex VOI using a 90 Y voxel S value kernel, and determination of the number of decays in the cortex VOI from the PET reconstruction. Our 4-step method was evaluated using an anthropomorphic abdominal phantom containing a fillable kidney phantom based on the MIRD kidney model. Vertebrae with an attenuation similar to that of bone were also modeled. Two tumors were modeled by 7-mL hollow acrylic spheres and the spleen by a plastic bag. Activities corresponded to typical tissue uptake in a first 90 Y-DOTATOC cycle of 4.4 GBq, considered as free of significant renal toxicity. Eight successive 45-min scans were acquired on both systems. Results: Both PET systems were successful in determining absorbed dose to modeled tumors but failed to provide accurate red marrow dosimetry. Renal cortex dosimetry was reproducible for both PET systems, with an accuracy of 3% for the bismuth germanate system but only 18% for the lutetium yttrium orthosilicate time-of-flight system, which was hindered by the natural radioactivity of the crystal, especially in the most attenuated area of the kidney. Conclusion: This study supports the use of direct 90 Y PET of the first PRRT cycle to assess the kidney-absorbed dose and optimize the injected activity of the following cycles.Key Words: PET/CT; radiobiology/dosimetry; radionuclide therapy; PET; PRRT; dosimetry; kidney; 90 Y J Nucl Med 2010; 51:1969 51: -1973 51: DOI: 10.2967 Pept ide receptor radionuclide therapy (PRRT) with 90 Y is widely used for internal radiotherapy of neuroendocrine tumors (1). 90 Y has a long b 2 range that, although suboptimal for small tumors, irradiates rather uniformly larger tumors that often display heterogeneous perfusion. This irradiation ability was confirmed in an animal model, in which a combination of 90 Y-and 177 Lu-labeled somatostatin analog showed a better tumor response than either radioisotope alone (2). Used alone, 90 Y PRRT is frequently administrated in several cycles. The dose fractionation has proven less toxic for the kidney (3) because it allows DNA repair in normal tissues between cycles, without a noticeable reduction of the tumor response (4).Assessment of...

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PET/CT for the assessment and quantification of 90Y biodistribution after selective internal radiotherapy (SIRT) of liver metastases

Cited by 47 publications

References 4 publications

¹⁷⁷Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

¹⁷⁷Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

Positron Emission Tomography-Computed Tomography in Liver Imaging

4-Step Renal Dosimetry Dependent on Cortex Geometry Applied to ⁹⁰Y Peptide Receptor Radiotherapy: Evaluation Using a Fillable Kidney Phantom Imaged by ⁹⁰Y PET

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PET/CT for the assessment and quantification of 90Y biodistribution after selective internal radiotherapy (SIRT) of liver metastases

Cited by 47 publications

References 4 publications

177Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

177Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

Positron Emission Tomography-Computed Tomography in Liver Imaging

4-Step Renal Dosimetry Dependent on Cortex Geometry Applied to 90Y Peptide Receptor Radiotherapy: Evaluation Using a Fillable Kidney Phantom Imaged by 90Y PET

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¹⁷⁷Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

¹⁷⁷Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma

4-Step Renal Dosimetry Dependent on Cortex Geometry Applied to ⁹⁰Y Peptide Receptor Radiotherapy: Evaluation Using a Fillable Kidney Phantom Imaged by ⁹⁰Y PET