Anna Sundlöv1, Katarina Sjögreen-Gleisner2, Jan Tennvall3, Ludvig Dahl4, Johanna Svensson5, Anna Åkesson6, Peter Bernhardt7, Ola Lindgren3,8. 1. Department of Clinical Sciences, Oncology, and Pathology, Skåne University Hospital, Lund University, Lund, Sweden, anna.sundlov@med.lu.se. 2. Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. 3. Department of Clinical Sciences, Oncology, and Pathology, Skåne University Hospital, Lund University, Lund, Sweden. 4. Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden. 5. Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden. 6. Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden. 7. Department of Radiation Physics, University of Gothenburg, Gothenburg, Sweden. 8. Department of Endocrinology, Skåne University Hospital, Lund University, Lund, Sweden.
Abstract
INTRODUCTION: The pituitary gland has a high expression of somatostatin receptors and is therefore a potential organ at risk for radiation-induced toxicity after 177Lu-DOTATATE treatment. OBJECTIVE: To study changes in pituitary function in patients with neuroendocrine tumors (NETs) treated with dosimetry-based 177Lu-DOTATATE to detect possible late toxicity. METHODS: 68 patients from a phase II clinical trial of dosimetry-based, individualized 177Lu-DOTATATE therapy were included in this analysis. Patients had received a median of 5 (range 3-9) treatment cycles of 7.4 GBq/cycle. Median follow-up was 30 months (range 11-89). The GH/IGF-1 axis, gonadotropins, and adrenal and thyroid axes were analyzed at baseline and on a yearly basis thereafter. Percent changes in hormonal levels over time were analyzed statistically using a linear mixed model and described graphically using box plots. The absorbed radiation dose to the pituitary was estimated based on post-therapeutic imaging, and the results analyzed versus percent change in IGF-1 levels over time. RESULTS: A statistically significant decrease in IGF-1 levels was found (p < 0.005), which correlated with the number of treatment cycles (p = 0.008) and the absorbed radiation dose (p = 0.03). A similar decrease, although non-significant, was seen in gonadotropins in postmenopausal women, while in men there was an increase during the first years after therapy, after which the levels returned to baseline. No change was observed in the adrenal or thyroid axes. CONCLUSIONS: No signs of severe endocrine disorders were detected, although a significant decrease in the GH/IGF-1 axis was found, where dosimetric analyses indicated radiation-induced damage to the pituitary gland as a probable cause.
INTRODUCTION: The pituitary gland has a high expression of somatostatin receptors and is therefore a potential organ at risk for radiation-induced toxicity after 177Lu-DOTATATE treatment. OBJECTIVE: To study changes in pituitary function in patients with neuroendocrine tumors (NETs) treated with dosimetry-based 177Lu-DOTATATE to detect possible late toxicity. METHODS: 68 patients from a phase II clinical trial of dosimetry-based, individualized 177Lu-DOTATATE therapy were included in this analysis. Patients had received a median of 5 (range 3-9) treatment cycles of 7.4 GBq/cycle. Median follow-up was 30 months (range 11-89). The GH/IGF-1 axis, gonadotropins, and adrenal and thyroid axes were analyzed at baseline and on a yearly basis thereafter. Percent changes in hormonal levels over time were analyzed statistically using a linear mixed model and described graphically using box plots. The absorbed radiation dose to the pituitary was estimated based on post-therapeutic imaging, and the results analyzed versus percent change in IGF-1 levels over time. RESULTS: A statistically significant decrease in IGF-1 levels was found (p < 0.005), which correlated with the number of treatment cycles (p = 0.008) and the absorbed radiation dose (p = 0.03). A similar decrease, although non-significant, was seen in gonadotropins in postmenopausal women, while in men there was an increase during the first years after therapy, after which the levels returned to baseline. No change was observed in the adrenal or thyroid axes. CONCLUSIONS: No signs of severe endocrine disorders were detected, although a significant decrease in the GH/IGF-1 axis was found, where dosimetric analyses indicated radiation-induced damage to the pituitary gland as a probable cause.
Authors: 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 Journal: Eur J Nucl Med Mol Imaging Date: 2022-03-14 Impact factor: 10.057
Authors: Marianne S Elston; Amanda Love; Dev Kevat; Richard Carroll; Zhen Rong Siow; Sharon Pattison; Veronica Boyle; Eva Segelov; Andrew H Strickland; David Wyld; Richard Gauci; Kim Kennedy; David Ransom Journal: Cancer Med Date: 2021-10-26 Impact factor: 4.452
Authors: Daniel Roth; Johan Gustafsson; Carl Fredrik Warfvinge; Anna Sundlöv; Anna Åkesson; Jan Tennvall; Katarina Sjögreen Gleisner Journal: J Nucl Med Date: 2021-07-16 Impact factor: 10.057