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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.

Journal article
Authors Maria Larsson
Peter Bernhardt
Johanna Svensson
Bo Wängberg
Håkan Ahlman
Eva Forssell-Aronsson
Published in EJNMMI research
Volume 2
Issue 1
Pages 49
ISSN 2191-219X
Publication year 2012
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Oncology
Pages 49
Language en
Keywords Kidney, Dosimetry, Neuroendocrine tumor, 177Lu-octreotate, Scintigraphy, Conjugate-view method
Subject categories Radiological physics


ABSTRACT: BACKGROUND: Lu-[DOTA0, Tyr3]-octreotate (177Lu-octreotate) is used to treat neuroendocrine tumors with high somatostatin-receptor expression. 177Lu-octreotate is mainly excreted via the kidneys, but to some extent, accumulates in the kidney cortex due to, e.g., tubular reabsorption. Renal toxicity is one of the main limiting factors in 177Lu-octreotate treatment. Further knowledge of the biodistribution and dosimetry of 177Lu-octreotate in individual patients is needed. The aim of this study was to estimate the absorbed dose to the kidneys and compare the results obtained with planar imaging and different dosimetric methods: (1) conjugate-view (CV) method using patient-specific kidney sizes, (2) PA method, based on posterior images only, (3) CV method with reduced number of time points (CVreduced data), and (4) CV method using standard kidney sizes (CVstandard size). METHODS: Totally, 33 patients each received 3.4 to 8.2 GBq of 177Lu-octreotate up to five times, with infusion of lysine and arginine to block the renal uptake. Whole-body planar gamma camera images were acquired on days 0, 1, 2, and 7. The 177Lu concentration in the kidneys was determined by the CV method, and the absorbed dose was estimated with patient-specific organ sizes. Comparison to the CV method was made using posterior images only, together with the influence of the number of time points and with standard organ sizes. RESULTS: Large interindividual variations were found in the time-activity curve pattern and in the absorbed dose to the kidneys using the CV method: 0.33 to 2.4 Gy/GBq (mean 0.80 Gy/GBq, SD = 0.30). In the individual patient, the mean deviation of all subsequent kidney doses compared to that of the first administration was 1 % (SD 19 %) and 5 % (SD 23 %) for the right and left kidneys, respectively. Excluding data for day 7 resulted in large variations in the absorbed dose. CONCLUSION: Large interindividual variations in kidney dose were found, demonstrating the need for patient-specific dosimetry and treatment planning.

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