Bone Marrow Absorbed Doses and Correlations with Hematologic Response During 177Lu-DOTATATE Treatments Are Influenced by Image-Based Dosimetry Method and Presence of Skeletal Metastases
Linn Hagmarker,Johanna Svensson,Tobias Rydén,Martijn van Essen,Anna Sundlöv,Katarina Sjögreen Gleisner,Peter Gjertsson,Peter Bernhardt +7 more
TLDR
The estimated bone marrow absorbed doses by image-based techniques and the correlation with platelets are influenced by the choice of measured vertebrae and the presence of skeletal metastases.Abstract:
This study aimed to compare different image-based methods for bone marrow dosimetry and study the dose–response relationship during treatment with 177Lu-DOTATATE in patients with and without skeletal metastases. Methods: This study included 46 patients with advanced neuroendocrine tumors treated with at least 2 fractions of 177Lu-DOTATATE at Sahlgrenska University Hospital. High- and low-uptake compartments were automatically outlined in planar images collected at 2, 24, 48, and 168 h after injection. The bone marrow absorbed doses were calculated from the cross doses of the high- and low-uptake compartments and the self-dose, using the time–activity concentration curve for the low-uptake compartment. This time–activity concentration curve was adjusted using a fixed constant of 1.8 for the planar dosimetry method and using the activity concentrations in vertebral bodies in SPECT images at 24 h after injection of 177Lu-DOTATATE in 4 hybrid methods: L4-SPECT used the activity concentration in the L4 vertebra, whereas V-SPECT, L-SPECT, and T-SPECT used the median activity concentration in all visible vertebrae, lumbar vertebrae, and thoracic vertebrae, respectively. Results: Using the planar method, L4-SPECT, V-SPECT, L-SPECT, and T-SPECT, the estimated median bone marrow absorbed doses were 0.19, 0.36, 0.40, 0.39, and 0.46 Gy/7.4 GBq, respectively, with respective ranges of 0.12–0.33, 0.15–1.44, 0.19–1.71, 0.21–1.60, and 0.18–2.12 Gy/7.4 GBq. For all methods, the bone marrow absorbed dose significantly correlated with decreased platelet counts. This correlation increased after treatment fraction 2: the Spearman correlation (rs) were −0.49 for the planar method, −0.61 for L4-SPECT, −0.63 for V-SPECT, −0.63 for L-SPECT, and −0.57 for T-SPECT. A separate analysis revealed an increased correlation for patients without skeletal metastases using the planar method (rs = −0.67). In contrast, hybrid methods had poor correlations for patients without metastases and stronger correlations for patients with skeletal metastases (rs = −0.61 to −0.74). The mean bone marrow absorbed doses were 3%–69% higher for patients with skeletal metastases than for patients without. Conclusion: The estimated bone marrow absorbed doses by image-based techniques and the correlation with platelets are influenced by the choice of measured vertebrae and the presence of skeletal metastases.read more
Citations
More filters
Journal ArticleDOI
EANM dosimetry committee recommendations for dosimetry of 177Lu-labelled somatostatin-receptor- and PSMA-targeting ligands
Katarina Sjögreen Gleisner,Nicolas Chouin,Pablo Minguez Gabina,Francesco Cicone,Silvano Gnesin,Caroline Stokke,Mark Konijnenberg,Marta Cremonesi,Frederik A. Verburg,Peter Bernhardt,Uta Eberlein,Jonathan Gear +11 more
TL;DR: The EANM Dosimetry Committee as discussed by the authors provides recommendations and guidance to scientists and clinicians on patient-specific dosimetry for radiopharmaceuticals labelled with lutetium-177 (177Lu).
Journal ArticleDOI
Deep-Learning Generation of Synthetic Intermediate Projections Improves 177Lu SPECT Images Reconstructed with Sparsely Acquired Projections.
TL;DR: Adopting SIPs for sparsely acquired projections considerably recovers image quality and could allow a reduced SPECT acquisition time in clinical dosimetry protocols.
Journal ArticleDOI
Phase II trial demonstrates the efficacy and safety of individualized, dosimetry-based 177Lu-DOTATATE treatment of NET patients
Anna Sundlöv,Katarina Sjögreen Gleisner,Jan Tennvall,Michael Ljungberg,Carl Fredrik Warfvinge,Kajsa Holgersson,Andreas Hallqvist,Peter Bernhardt,Johanna Svensson +8 more
TL;DR: In this paper , the authors evaluated individualized 177 Lu-DOTATATE for which the number of cycles varied based on renal dosimetry, showing the potential to further improve outcome beyond the standard approach, and should be further assessed in randomized trials.
Journal ArticleDOI
Establishment of a clinical SPECT/CT protocol for imaging of 161 Tb
Ida Marin,Tobias Rydén,M Van Essen,Johanna Svensson,Nadezda Gracheva,Ulli Köster,Jan Rijn Zeevaart,N.P. van der Meulen,Cristina Müller,Peter Bernhardt,Peter Bernhardt +10 more
TL;DR: Based on data, SPECT-based dosimetry for 161Tb-labeled radiopharmaceuticals is feasible and extrinsic uniformity correction is recommended to avoid ring artifacts.
Journal ArticleDOI
Clinical Assessment of 177Lu-DOTATATE Quantification by Comparison of SUV-Based Parameters Measured on Both Post-PRRT SPECT/CT and 68Ga-DOTATOC PET/CT in Patients With Neuroendocrine Tumors: A Feasibility Study.
Philippe Thuillier,Meriem Maajem,Ulrike Schick,Frédérique Blanc-Béguin,Simon Hennebicq,Jean-Philippe Metges,Pierre-Yves Salaun,Véronique Kerlan,David Bourhis,Ronan Abgral +9 more
TL;DR: The results suggest the feasibility of 177Lu-DotATATE SPECT/CT quantification in clinical practice and show a strong correlation of several SUV-based parameters with the corresponding in 68Ga-DOTATOC PET/CT.
References
More filters
Journal ArticleDOI
Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors
Jonathan R. Strosberg,Ghassan El-Haddad,Edward M. Wolin,Andrew Eugene Hendifar,James C. Yao,Beth Chasen,Erik Mittra,Pamela L. Kunz,Matthew H. Kulke,Heather A. Jacene,David L. Bushnell,Thomas M. O'Dorisio,Richard A. Baum,Harshad R. Kulkarni,Martyn Caplin,Rachida Lebtahi,Timothy J. Hobday,Ebrahim S. Delpassand,E. Van Cutsem,Al B. Benson,Raj Srirajaskanthan,Marianne Pavel,J. Mora,Jordan Berlin,Enrique Grande,N. Reed,Ettore Seregni,Kjell Öberg,M. Lopera Sierra,P. Santoro,Thomas Thevenet,Jack L. Erion,Philippe Ruszniewski,Dirk Jan Kwekkeboom,E.P. Krenning +34 more
TL;DR: Treatment with lutetium‐177 (177Lu)–Dotatate resulted in markedly longer progression‐free survival and a significantly higher response rate than high‐dose octreotide LAR among patients with advanced midgut neuroendocrine tumors.
Journal ArticleDOI
Treatment With the Radiolabeled Somatostatin Analog [177Lu-DOTA0,Tyr3]Octreotate: Toxicity, Efficacy, and Survival
Dik J. Kwekkeboom,Wouter W. de Herder,Boen L. Kam,Casper H.J. van Eijck,Martijn van Essen,P. P. M. Kooij,Richard A Feelders,Maarten O. van Aken,Eric P. Krenning +8 more
TL;DR: Treatment with peptide receptor radionuclide therapy with the radiolabeled somatostatin analog [(177)Lu-DOTA(0),Tyr(3)]octreotate has few adverse effects and compares favorably to the limited number of alternative treatment modalities.
Specific absorbed fractions of energy at various ages from internal photon sources: 6, Newborn
M. Cristy,K.F. Eckerman +1 more
TL;DR: The dosimetry methods that Spiers and co-workers developed for beta-emitting radionuclides deposited in bone are applied to follow the transport of secondary electrons that were freed by photon interactions through the microscopic structure of the skeleton to estimate PHI in the endosteal cells.
Journal ArticleDOI
[177Lu-DOTA0, Tyr3]octreotate : comparison with [111In-DTPA0]octreotide in patients
Dik J. Kwekkeboom,Willem H. Bakker,P. P. M. Kooij,Mark Konijnenberg,Ananth Srinivasan,Jack L. Erion,Michelle A. Schmidt,Joe L. Bugaj,Marion de Jong,Eric P. Krenning +9 more
TL;DR: In this paper, the authors compared the radionuclide-coupled-somatostatin analogues of 177Lu-DOTA0,Tyr3] octreotate (177Lu-Octreotide) with 111In-DTPA0]octreotide (111In-CTPA0) for six patients with soma-positive tumours.
Journal ArticleDOI
Peptide receptor radionuclide therapy with 177Lu-DOTATATE: the IEO phase I-II study
Lisa Bodei,Marta Cremonesi,Chiara Maria Grana,Nicola Fazio,Simona Iodice,Silvia M. Baio,Mirco Bartolomei,Dario Lombardo,Mahila Ferrari,Maddalena Sansovini,Marco Chinol,Giovanni Paganelli +11 more
TL;DR: 177Lu-DOTATATE was well tolerated up to 29 GBq cumulative activity and the maximum tolerated dose/cycle was not reached, however, considering the individual bone marrow function and the presence of risk factors for kidney toxicity, it seems safer to divide cumulative activities into lower activity cycles.
Related Papers (5)
Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors
Jonathan R. Strosberg,Ghassan El-Haddad,Edward M. Wolin,Andrew Eugene Hendifar,James C. Yao,Beth Chasen,Erik Mittra,Pamela L. Kunz,Matthew H. Kulke,Heather A. Jacene,David L. Bushnell,Thomas M. O'Dorisio,Richard A. Baum,Harshad R. Kulkarni,Martyn Caplin,Rachida Lebtahi,Timothy J. Hobday,Ebrahim S. Delpassand,E. Van Cutsem,Al B. Benson,Raj Srirajaskanthan,Marianne Pavel,J. Mora,Jordan Berlin,Enrique Grande,N. Reed,Ettore Seregni,Kjell Öberg,M. Lopera Sierra,P. Santoro,Thomas Thevenet,Jack L. Erion,Philippe Ruszniewski,Dirk Jan Kwekkeboom,E.P. Krenning +34 more