Journal article
90Y-DOTATOC Dosimetry-Based Personalized Peptide Receptor Radionuclide Therapy
The Journal of nuclear medicine (1978), Vol.59(11), pp.1692-1698
11/2018
DOI: 10.2967/jnumed.117.202903
PMCID: PMC6225542
PMID: 29523629
Abstract
Pretherapy PET with 86Y-DOTATOC is considered the ideal dosimetry protocol for 90Y-DOTATOC therapy; however, its cost, limited availability, and need for infusion of amino acids to mimic the therapy administration limit its use in the clinical setting. The goal of this study was to develop a dosimetric method for 90Y-DOTATOC using 90Y-DOTATOC PET/CT and bremsstrahlung SPECT/CT and to determine whether dosimetry-based administered activities differ significantly from standard administered activities. Methods: This was a prospective phase 2 trial of 90Y-DOTATOC therapy in patients with somatostatin receptor–positive tumors. 90Y-DOTATOC was given in 3 cycles 6–8 wk apart. In the first cycle of therapy, adults received 4.4 GBq and children received 1.85 GBq/m2; the subsequent administered activities were adjusted according to the dosimetry of the preceding cycle so as not to exceed a total kidney dose of 23 Gy and bone marrow dose of 2 Gy. The radiation dose to the kidneys was determined from serial imaging sessions consisting of time-of-flight 90Y-DOTATOC PET/CT at 5 h after therapy and 90Y-DOTATOC bremsstrahlung SPECT/CT at 6, 24, 48, and 72 h. The PET/CT data were used to measure the absolute concentration of 90Y-DOTATOC and to calibrate the bremsstrahlung SPECT kidney clearance data. The radiation dose to the kidneys was determined by multiplying the time-integrated activity (from the fitted biexponential curve of renal clearance of 90Y-DOTATOC) with the energy emitted per decay, divided by the mass of the kidneys. Results: The radiation dose to the kidneys per cycle of 90Y-DOTATOC therapy was highly variable among patients, ranging from 0.32 to 3.0 mGy/MBq. In 17 (85%) of the 20 adult patients who received the second and the third treatment cycles of 90Y-DOTATOC, the administered activity was modified by at least 20% from the starting administered activity. Conclusion: Renal dosimetry of 90Y-DOTATOC is feasible using 90Y-DOTATOC time-of-flight PET/CT and bremsstrahlung SPECT/CT and has a significant impact on the administered activity in treatment cycles.
Details
- Title: Subtitle
- 90Y-DOTATOC Dosimetry-Based Personalized Peptide Receptor Radionuclide Therapy
- Creators
- Yusuf Menda - Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa yusuf-menda@uiowa.eduMark T Madsen - Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaThomas M O'Dorisio - Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaJohn J Sunderland - Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaG Leonard Watkins - Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaJoseph S Dillon - Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaSarah L Mott - Holden Comprehensive Cancer Center, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaMichael K Schultz - Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaGideon K D Zamba - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa; andDavid L Bushnell - Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IowaM Sue O'Dorisio - Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of nuclear medicine (1978), Vol.59(11), pp.1692-1698
- DOI
- 10.2967/jnumed.117.202903
- PMID
- 29523629
- PMCID
- PMC6225542
- NLM abbreviation
- J Nucl Med
- ISSN
- 0161-5505
- eISSN
- 1535-5667
- Publisher
- United States
- Grant note
- R01 CA167632 / NCI NIH HHS P30 CA086862 / NCI NIH HHS P50 CA174521 / NCI NIH HHS
- Language
- English
- Date published
- 11/2018
- Academic Unit
- Radiology; Stead Family Department of Pediatrics; Biostatistics; Physics and Astronomy; Radiation Oncology; Internal Medicine
- Record Identifier
- 9983997322002771
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