Radiation Dosimetry for (177)Lu-PSMA I&T in Metastatic Castration-Resistant Prostate Cancer: Absorbed Dose in Normal Organs and Tumor Lesions.

Okamoto, Shozo; Thieme, Anne; Allmann, Jakob; D'Alessandria, Calogero; Maurer, Tobias; Retz, Margitta; Tauber, Robert; Heck, Matthias M; Wester, Hans-Juergen; Tamaki, Nagara; Fendler, Wolfgang P; Herrmann, Ken; Pfob, Christian H; Scheidhauer, Klemens; Schwaiger, Markus; Ziegler, Sibylle; Eiber, Matthias

doi:10.2967/jnumed.116.178483

Benutzer: Gast

journal article

Titel:: Radiation Dosimetry for (177)Lu-PSMA I&T in Metastatic Castration-Resistant Prostate Cancer: Absorbed Dose in Normal Organs and Tumor Lesions.
Dokumenttyp:: Journal Article; Article
Autor(en):: Okamoto, Shozo; Thieme, Anne; Allmann, Jakob; D'Alessandria, Calogero; Maurer, Tobias; Retz, Margitta; Tauber, Robert; Heck, Matthias M; Wester, Hans-Juergen; Tamaki, Nagara; Fendler, Wolfgang P; Herrmann, Ken; Pfob, Christian H; Scheidhauer, Klemens; Schwaiger, Markus; Ziegler, Sibylle; Eiber, Matthias
Abstract:: Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy is increasingly used in metastatic castration-resistant prostate cancer. We aimed to estimate the absorbed doses for normal organs and tumor lesions using (177)Lu-PSMA I&T (I&T is imaging and therapy) in patients undergoing up to 4 cycles of radioligand therapy. Results were compared with pretherapeutic Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga(HBEDCC)] ((68)Ga-PSMA-HBED-CC) PET. Methods: A total of 34 cycles in 18 patients were analyzed retrospectively. In 15 patients the first, in 9 the second, in 5 the third, and in 5 the fourth cycle was analyzed, respectively. Whole-body scintigraphy was performed at least between 30-120 min, 24 h, and 6-8 d after administration. Regions of interest covering the whole body, organs, and up to 4 tumor lesions were drawn. Organ and tumor masses were derived from pretherapeutic (68)Ga-PSMA-HBED-CC PET/CT. Absorbed doses for individual cycles were calculated using OLINDA/EXM. SUVs from pretherapeutic PET were compared with absorbed doses and with change of SUV. Results: The mean whole-body effective dose for all cycles was 0.06 ± 0.03 Sv/GBq. The mean absorbed organ doses were 0.72 ± 0.21 Gy/GBq for the kidneys; 0.12 ± 0.06 Gy/GBq for the liver; and 0.55 ± 0.14 Gy/GBq for the parotid, 0.64 ± 0.40 Gy/GBq for the submandibular, and 3.8 ± 1.4 Gy/GBq for the lacrimal glands. Absorbed organ doses were relatively constant among the 4 different cycles. Tumor lesions received a mean absorbed dose per cycle of 3.2 ± 2.6 Gy/GBq (range, 0.22-12 Gy/GBq). Doses to tumor lesions gradually decreased, with 3.5 ± 2.9 Gy/GBq for the first, 3.3 ± 2.5 Gy/GBq for the second, 2.7 ± 2.3 Gy/GBq for the third, and 2.4 ± 2.2 Gy/GBq for the fourth cycle. SUVs of pretherapeutic PET moderately correlated with absorbed dose (r = 0.44, P < 0.001 for SUVmax; r = 0.43, P < 0.001 for SUVmean) and moderately correlated with the change of SUV (r = 0.478, P < 0.001 for SUVmax, and r = 0.50, P < 0.001 for SUVmean). Conclusion: Organ- and tumor-absorbed doses for (177)Lu-PSMA I&T are comparable to recent reports and complement these with information on an excellent correlation between the 4 therapy cycles. With the kidneys representing the critical organ, a cumulative activity of 40 GBq of (177)Lu-PSMA I&T appears to be safe and justifiable. The correlation between pretherapeutic SUV and absorbed tumor dose emphasizes the need for PSMA-ligand PET imaging for patient selection.
Zeitschriftentitel:: J Nucl Med
Jahr:: 2017
Band / Volume:: 58
Heft / Issue:: 3
Seitenangaben Beitrag:: 445-450
Sprache:: eng
Volltext / DOI:: doi:10.2967/jnumed.116.178483
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/27660138
Print-ISSN:: 0161-5505
TUM Einrichtung:: Klinik und Poliklinik für Nuklearmedizin; Urologische Klinik und Poliklinik
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