Mattias Sandström1,2, Ulrike Garske-Román1, Silvia Johansson3, Dan Granberg4, Anders Sundin1, Nanette Freedman5,6. 1. a Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala University , Uppsala , Sweden. 2. b Department of Immunology, Genetics and Pathology, Section of Medical Physics , Uppsala University , Uppsala , Sweden. 3. c Department of Immunology, Section of Oncology, Genetics and Pathology , Uppsala University , Uppsala , Sweden. 4. d Department of Medical Sciences, Division of Endocrine Oncology , Uppsala University Hospital , Uppsala , Sweden. 5. e Department of Medical Biophysics and Nuclear Medicine , Hadassah-Hebrew University Medical Center , Jerusalem , Israel. 6. f Department of Imaging, Institute of Nuclear Medicine , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.
Abstract
BACKGROUND: Fractionated therapy with 177Lu-DOTATATE has been reported to be an effective treatment for patients with metastasized neuroendocrine tumors. To optimize the treatment, absorbed doses to risk organs are calculated for the individual patient. For each organ, absorbed dose due to activity in the organ itself (self-dose) and that originating from other organs (cross-dose) are calculated from serial measurements to obtain the activity distribution following treatment. The main aim of the present work were to calculate the cross-dose contribution to the total absorbed kidney dose. METHODS: Five hundred patients with neuroendocrine tumors undergoing therapy with 177Lu-DOTATATE were included. Scintigraphic planar whole body images and single photon emission computed tomography/computed tomography (SPECT/CT) over the abdomen were acquired at 1, 4 and 7 days after treatment. Kidney self-dose was calculated based on radioactivity distribution obtained from SPECT/CT. Cross-dose to kidneys was estimated using organ-based analysis of planar whole body images and cross-fire dose factors from Olinda/EXM 1.1. RESULTS: Cross-dose to kidneys in the majority of patients were less than 2% and almost all cross-doses were less than 10%. Cross-dose exceeded 10% only in rare cases of patients with high tumor burden and low absorbed doses to kidneys. CONCLUSIONS: The absorbed dose from 177Lu-octreotate to solid organs due to cross-fire is generally low and can usually be neglected.
BACKGROUND: Fractionated therapy with 177Lu-DOTATATE has been reported to be an effective treatment for patients with metastasized neuroendocrine tumors. To optimize the treatment, absorbed doses to risk organs are calculated for the individual patient. For each organ, absorbed dose due to activity in the organ itself (self-dose) and that originating from other organs (cross-dose) are calculated from serial measurements to obtain the activity distribution following treatment. The main aim of the present work were to calculate the cross-dose contribution to the total absorbed kidney dose. METHODS: Five hundred patients with neuroendocrine tumors undergoing therapy with 177Lu-DOTATATE were included. Scintigraphic planar whole body images and single photon emission computed tomography/computed tomography (SPECT/CT) over the abdomen were acquired at 1, 4 and 7 days after treatment. Kidney self-dose was calculated based on radioactivity distribution obtained from SPECT/CT. Cross-dose to kidneys was estimated using organ-based analysis of planar whole body images and cross-fire dose factors from Olinda/EXM 1.1. RESULTS: Cross-dose to kidneys in the majority of patients were less than 2% and almost all cross-doses were less than 10%. Cross-dose exceeded 10% only in rare cases of patients with high tumor burden and low absorbed doses to kidneys. CONCLUSIONS: The absorbed dose from 177Lu-octreotate to solid organs due to cross-fire is generally low and can usually be neglected.
Authors: Amanda Kristiansson; Jonas Ahlstedt; Bo Holmqvist; Anders Brinte; Thuy A Tran; Eva Forssell-Aronsson; Sven-Erik Strand; Magnus Gram; Bo Åkerström Journal: Antioxid Redox Signal Date: 2018-08-14 Impact factor: 8.401