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Individual voxelwise dosimetry of targeted (90)Y-labelled substance P radiotherapy for malignant gliomas.

Artikel i vetenskaplig tidskrift
Författare Stefan Kneifel
Peter Bernhardt
Helena Uusijärvi
Stephan Good
Ludwig Plasswilm
Carlos Buitrago-Téllez
Jan Müller-Brand
Helmut Mäcke
Adrian Merlo
Publicerad i European journal of nuclear medicine and molecular imaging
Volym 34
Nummer/häfte 9
Sidor 1388-95
ISSN 1619-7070
Publiceringsår 2007
Publicerad vid Institutionen för fysik (GU)
Institutionen för kliniska vetenskaper
Sidor 1388-95
Språk en
Länkar dx.doi.org/10.1007/s00259-006-0351-...
Ämneskategorier Medicin och Hälsovetenskap

Sammanfattning

PURPOSE: Substance P is the main ligand of neurokinin type 1 (NK-1) receptors, which are consistently overexpressed in malignant gliomas. The peptidic vector (111)In/(90)Y-DOTAGA-substance P binds to these receptors and can be used for local treatment of brain tumours. Dosimetry for this interstitial brachytherapy has mainly been done using geometrical models; however, they often do not faithfully reproduce the in vivo biodistribution of radiopharmaceuticals, which is indispensable to correlate the deposited energy with clinical response. The aim of this study was to establish a reproducible dosimetry protocol for intratumoural radiopeptide therapy. METHODS: For test and therapeutic injections, 2 MBq of (111)In-substance P and 370-3,330 MBq of (90)Y-substance P, respectively, were applied in 12 patients with malignant gliomas. Over a period of 24 h, serial SPECT scans were performed on a dual-head SPECT camera. The scans were acquired in a double-energy window technique together with (99m)Tc-ECD in order to co-register the dose distributions with a separately acquired, contrast-enhanced CT scan. Quantitative voxelwise dose distribution maps (in Gy/GBq) were computed from these data using a mono-exponential decay approach. Pre- and post-therapeutic values were compared. RESULTS: Agreement between pre- and post-therapeutic dosimetry was very good and delivered absolute dose values in Gy per injected GBq. In all patients, the pretherapeutic test injection together with the CT overlay technique could predict the precise localisation of dose deposition in an anatomical context. CONCLUSION: This protocol allows a precise pretherapeutic computation of the expected three-dimensional dose distribution and is clearly superior to the previously used dosimetry based on planar scintigraphic images. It has become an indispensable tool for planning intratumoural radiopeptide therapy in glioma patients.

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