A comparison of 2D and 3D kidney absorbed dose measures in patients receiving 177Lu-DOTATATE

Document Type: Original Article

Authors

1 Institute of Medical Physics, The University of Sydney

2 Faculty of Health Sciences, University of Sydney, Lidcombe 2141, Australia

3 Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne 3000, VIC, Australia

4 Institute of Medical Physics, School of Physics, University of Sydney, 2006 NSW, Australia

5 Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards 2065, NSW, Australia

6 Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards 2065, NSW, Australia Faculty of Health Sciences, University of Sydney, Lidcombe 2141, Australia

Abstract

Objective(s): To investigate and compare quantitative accuracy of kidney absorbed dose measures made from both 2D and 3D imaging in patients receiving 177LuDOTATATE (Lutate) for treatment of neuroendocrine tumours (NETs). Methods: Patients receiving Lutate therapy underwent both whole body planar imaging and SPECT/CT imaging over the kidneys at time points 0.5, 4, 24, and 96-120 hours after injection. Planar data were corrected for attenuation using transmission data, and were converted to units of absolute activity via two methods, using either a calibration standard in the field of view or relative to pre-voiding image total counts. Hand drawn regions of interest were used to generate time activity curves and kidney absorbed dose estimates in OLINDA-EXM. Fully quantitative SPECT data were generated using CT-derived corrections for both scatter and attenuation, before correction for dead time and application of a camera specific sensitivity factor to convert data to units of absolute activity. Volumes of interest were defined for kidney using the co-registered x-ray CT, before time activity curves and absorbed dose measures were generated in OLINDA-EXM, both with and without corrections made to the model for patient specific kidney volumes. Quantitative SPECT data were also used to derive dose maps through dose kernel convolution (DKC), which was treated as the gold standard. Results: A total of 50 studies were analysed, corresponding to various cycles of treatment from 21 patients. Planar absorbed dose estimates were consistently higher than SPECT derived estimates by, on average, a factor of 3. Conclusion: Quantitative SPECT is considered the gold standard approach for organ specific dosimetry however often relies on in house software. As such planar methods for estimating absorbed dose are much more widely available, and in particular, are often the only source of reference in previously published data. For the case of Lutate dosimetry, planar measures may lead to a three-fold increase in measures of kidney absorbed dose.

Keywords

Main Subjects

References

  1. Sandstrom M, Garske U, Granberg D, Sundin A, Lundqvist H. Individualized dosimetry in patients undergoing therapy with (177)Lu-DOTA-D-Phe(1)-Tyr(3)-octreotate. Eur J Nucl Med Mol Imaging. 2010;37(2):212-25.
  2. Valkema R, Pauwels SA, Kvols LK, Kwekkeboom DJ, Jamar F, de Jong M, et al. Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0),Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate. J Nucl Med. 2005;46:83S-91.
  3. Cremonesi M, Ferrari M, Bodei L, Tosi G, Paganelli G. Dosimetry in peptide radionuclide receptor therapy: a review. J Nucl Med. 2006;47(9):1467-75.
  4. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109-22.
  5. Bodel L, Cremonesi M, Ferrari M, Pacifici M, Grana CM, Bartolomei M, et al. Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors. Eur J Nucl Med Mol Imaging. 2008;35(10):1847-56.
  6. Kwekkeboom DJ, Bakker WH, Kooij PP, Konijnenberg MW, Srinivasan A, Erion JL, et al. [177Lu-DOTAOTyr3]octreotate: comparison with [111In-DTPAo]octreotide in patients. Eur J Nucl Med. 2001;28(9):1319-25.
  7. Wehrmann C, Senftleben S, Zachert C, Muller D, Baum RP. Results of individual patient dosimetry in peptide receptor radionuclide therapy with 177Lu DOTA-TATE and 177Lu DOTA-NOC. Cancer Biother Radiopharm. 2007;22(3):406-16.
  8. Garkavij M, Nickel M, Sjogreen-Gleisner K, Ljunberg M, Ohlsson T, Wingardh K, et al. 177Lu-[DOTA0,Tyr3] octreotate therapy in patients with disseminated neuroendocrine tumours: Analysis of dosimetry with impact on future therapeutic strategy. Cancer. 2010;116(4 Suppl):1084-92.
  9. Pauwels S, Barone R, Walrand S, Borson-Chazot F, Valkema R, Kvols LK, et al. Practical dosimetry of peptide receptor radionuclide therapy with (90)Y-labeled somatostatin analogs. J Nucl Med. 2005;46(Suppl 1):92S-8S.
10. Heikkonen J, Mäenpää H, Hippeläinen E, Reijonen V, Tenhunen M. Effect of calculation method on kidney dosimetry in 177Lu-octreotate treatment. Acta Oncol. 2016;55(9-10):1069-76.

11. Ljunberg M, Celler A, Konijnenberg MW, Eckerman K, Dewaraja YK, Sjogreen-Gleisner K. MIRD pamphlet No. 26: Joint EANM/MIRD guidelines for quantitative 177Lu SPECT applied for dosimetry of radiopharmaceutical therapy. J Nucl Med. 2016;57(1):151-62.

12. Bailey D, Hennessy T, Willowson K, Schembri G, Roach P, Snowdon G, et al. Quantitative biodistribution & kinetics of a new formulation of [Lu-177]-Octreotate. J Nucl Med. 2015;3:336.

13. Aslani A, Snowdon GM, Bailey DL, Schembri GP, Bailey EA, Pavlakis N, et al. Lutetium-177 DOTATATE Production with an Automated Radiopharmaceutical Synthesis System. Asia Ocean J Nucl Med Biol. 2015;3(2):107-15.

14. Siegel JA, Thomas SR, Stubbs JB, Stabin MG, Hays MT, Koral KF, et al. MIRD pamphlet no. 16: techniques for quantitative radiopharmaceutical biodistribution data acquisition and analysis for use in human radiation dose estimates. J Nucl Med. 1999;40(2):37S-61S.

15. Stabin MG, Sparks RB, Crowe E. OLINDA/EXM: the second-generation personal computer software for internal dose assessment in nuclear medicine. J Nucl Med. 2005;46(6):1023-7.

16. Willowson K, Bailey DL, Baldock C. Quantitative SPECT reconstruction using CT-derived corrections. Phys Med Biol. 2008;53(12):3099-112.

17. Jackson PA, Beauregard JM, Hofman MS, Kron T, Hogg A, Hicks RJ. An automated voxelized dosimetry tool for radionuclide therapy based on serial quantitative SPECT/CT imaging. Med Phys. 2013;40(11):112503.

Asia Oceania Journal of Nuclear Medicine and Biology

Volume 6, Issue 2
Summer and Autumn 2018
Pages 113-119

Files

Share

How to cite

Statistics