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Radiation exposure of the kidneys affects haematological response during 177Lu-DOTATATE treatment

Konferensbidrag (offentliggjort, men ej förlagsutgivet)
Författare Johanna Svensson
Rebecka Hermann
Karin Holgersson
Bo Wängberg
A Sundlöv
G Tennvall
K Sjögren Gleisner
Peter Bernhardt
Publicerad i European Journal of Nuclear Medicine and Molecular Imaging
ISSN 1619-7070
Förlag Springer
Publiceringsår 2016
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för radiofysik
Institutionen för kliniska vetenskaper, Avdelningen för kirurgi
Institutionen för kliniska vetenskaper, Avdelningen för onkologi
Språk en
Länkar doi.org/10.1007/s00259-016-3484-4
Ämneskategorier Cancer och onkologi


Aim Radionuclide therapy with 177Lu-DOTATATE is a valuable treatment option in the management of patients with neuroendocrine tumours overexpressing somatostatin receptors. The amount of treatment is usually restricted by a fixed absorbed dose limit to the kidneys, or by persistent haematological toxicity. To better understand which patients will tolerate the treatment, and who should be considered for other treatment; clinical background information is important, including renal and bone marrow function, tumour burden and previous treatment. In this study, the impact of absorbed renal dose on the haematological response was investigated. Materials and methods This study analyses the results from 34 of the 80 patients included in the prospective ILUMINET study (EUDRACT 2011-000240-16), treated with 7.4 GBq of 177Lu-DOTATATE on one to eight occasions. Patients included in the study had a progressive disease according to RECIST criteria, tumours judged to overexpress somatostatin receptors by SSTR imaging and a GFR of > 50 ml/min. Treatment was given as a 30 min infusion together with kidney protecting amino acids, at 8 to 12 week intervals until a BED of 27 Gy (Stage 1 of the study) or 40 Gy (Stage 2) to the kidneys was reached. Some patients ended treatment earlier because of persisting haematological toxicity or disease progression. For dosimetry planar whole-body images were acquired at 1.5, 24, 48 and 168 h p.i. and a SPECT/CT at 24 h p.i. Dosimetry was based on a hybrid technique utilising both planar and SPECT activity data. Patient bone marrow function was monitored by blood sampling for haemoglobin, white blood cell and platelet counts weekly. Results The development of haematological toxicity was correlated to the total absorbed renal dose according to the decline in haemoglobin (r=−0.40, p=0.04) and platelet counts (r=−0.43, p=0.02)), but not to the activity amount given. Baseline GFR also affected the haematological toxicity according to haemoglobin values (r=0.49, p=0.01). Conclusion The correlation between radiation exposure of the kidneys and the decline in haemoglobin and platelet values during 177Lu-DOTATATE treatment can not be explained by the total amount of activity given. Instead renal function at baseline seems to be a risk factor, and possibly also the magnitude of the radiation of the kidneys, which may affect the ability to produce erythropoietin in response to the decline in haemoglobin.

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