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Estimation of absorbed dose to the kidneys in patients after treatment with 177Lu-octreotate comparison between methods based on planar scintigraphy.doc

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Estimation of absorbed dose to the kidneys in patients after treatment with 177Lu-octreotate comparison between methods based on planar scintigraphy

Larssonetal.EJNMMIResearch2012,2:49 /content/2/1/49 ORIGINAL RESEARCH OpenAccess Estimationofabsorbeddosetothekidneysin 177 patientsaftertreatmentwith Lu-octreotate: comparisonbetweenmethodsbasedon planarscintigraphy MariaLarsson1*,PeterBernhardt1,JohannaBSvensson2,BoW?ngberg3,H?kanAhlman3 andEvaForssell-Aronsson1 Abstract Background:Lu-[DOTA0,Tyr3]-octreotate(177Lu-octreotate)isusedtotreatneuroendocrinetumorswithhigh somatostatin-receptorexpression. 177Lu-octreotateismainlyexcretedviathekidneys,buttosomeextent, accumulatesinthekidneycortexdueto,e.g.,tubularreabsorption.Renaltoxicityisoneofthemainlimitingfactors in 177Lu-octreotatetreatment.Furtherknowledgeofthebiodistributionanddosimetryof 177Lu-octreotatein individualpatientsisneeded.Theaimofthisstudywastoestimatetheabsorbeddosetothekidneysandcompare theresultsobtainedwithplanarimaginganddifferentdosimetricmethods:(1)conjugate-view(CV)methodusing patient-specifickidneysizes,(2)PAmethod,basedonposteriorimagesonly,(3)CVmethodwithreducednumber oftimepoints(CVreduced data),and(4)CVmethodusingstandardkidneysizes(CVstandard size ). Methods:Totally,33patientseachreceived3.4to8.2GBqof 177Lu-octreotateuptofivetimes,withinfusionof lysineandargininetoblocktherenaluptake.Whole-bodyplanargammacameraimageswereacquiredondays0, 1,2,and7.The 177LuconcentrationinthekidneyswasdeterminedbytheCVmethod,andtheabsorbeddosewas estimatedwithpatient-specificorgansizes.ComparisontotheCVmethodwasmadeusingposteriorimagesonly, togetherwiththeinfluenceofthenumberoftimepointsandwithstandardorgansizes. Results:Largeinterindividualvariationswerefoundinthetime-activitycurvepatternandintheabsorbeddoseto thekidneysusingtheCVmethod:0.33to2.4Gy/GBq(mean= 0.80Gy/GBq,SD=0.30).Intheindividualpatient,the meandeviationofallsubsequentkidneydosescomparedtothatofthefirstadministrationwas1%(SD=19%)and 5%(SD=23%)fortherightandleftkidneys,respectively.Excludingdataforday7resultedinlargevariationsinthe absorbeddose. Conclusion:Lar