Influence of dosimetry method on bone lesion absorbed dose estimates in PSMA therapy: application to mCRPC patients receiving Lu-177-PSMA-I&T.
Influence of dosimetry method on bone lesion absorbed dose estimates in PSMA therapy: application to mCRPC patients receiving Lu-177-PSMA-I&T.
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PSMA治疗中剂量测定方法对骨病变吸收剂量估计的影响：应用于接受Lu-177-PSMA-I &T的mCRPC患者。
DOI：
10.1186/s40658-021-00369-4
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发表时间：
2021-03-12
期刊：
影响因子：
4
通讯作者：
Böning G
中科院分区：
文献类型：
--
作者：
Brosch-Lenz J;Uribe C;Gosewisch A;Kaiser L;Todica A;Ilhan H;Gildehaus FJ;Bartenstein P;Rahmim A;Celler A;Ziegler S;Böning G
转移性、去势抵抗前列腺癌(MCRPC)患者骨骼中的肿瘤负担增加。对于这些患者，以前列腺特异性膜抗原(PSMA)为靶点的Lu-177(Lu-177)放射配基治疗获得了越来越多的兴趣，并获得了有希望的结果数据。患者个体化剂量测定能够提高治疗成功率，目的是最大限度地减少对危险器官的吸收剂量，同时最大限度地增加对肿瘤的吸收剂量。为此，存在具有不同复杂性和准确性的不同剂量测定方法。适用于肿瘤的医用内照射剂量公式假定在具有单位密度的球面上均匀分布活度，以求出肿瘤S值(TSV)。体素S值(VSV)方法可以解释异质活动，但模拟的是特定组织。完整的患者-个体蒙特卡罗(MC)吸收剂量模拟同时解决了不均匀的活动和密度分布。随后基于CT的密度加权有可能克服TSV和VSV方法中MIRD公式中密度均匀的假设，这可能是应用于密度不均匀的骨转移瘤的主要限制。本研究的目的是比较这些方法在接受Lu-177-PSMA治疗的mCRPC患者中的骨损伤剂量。总共分析了15例mCRPC患者的289个骨病变。与MC相比，TSV每个病灶的平均吸收剂量百分比差(PD)为+14±10%(最小：−21%；最大：+56%)。通过使用Hounsfield单位(HU)对患者CT图像进行病变个体密度加权，PD减少到−8±1%(最小：−10%；最大：−3%)。体素水平上的PD用于三维(3D)体素方向剂量学方法，每个病变平均显示软组织VSV方法与MC相比+18±11%(最小：−27%；最大：+58%)；在体素密度校正后，这降低到−5±1%(最小：−12%；最大：−2%)。患者-个体MC吸收剂量模拟能够解释骨病变中的不同密度。由于计算工作阻碍了其常规的临床应用，因此使用了TSV或VSV剂量学方法。本研究表明，在Lu-177-PSMA治疗骨损伤剂量学中，TSV或VSV的病灶个体密度加权是必要的。
Patients with metastatic, castration-resistant prostate cancer (mCRPC) present with an increased tumor burden in the skeleton. For these patients, Lutetium-177 (Lu-177) radioligand therapy targeting the prostate-specific membrane antigen (PSMA) has gained increasing interest with promising outcome data. Patient-individualized dosimetry enables improvement of therapy success with the aim of minimizing absorbed dose to organs at risk while maximizing absorbed dose to tumors. Different dosimetric approaches with varying complexity and accuracy exist for this purpose. The Medical Internal Radiation Dose (MIRD) formalism applied to tumors assumes a homogeneous activity distribution in a sphere with unit density for derivation of tumor S values (TSV). Voxel S value (VSV) approaches can account for heterogeneous activities but are simulated for a specific tissue. Full patient-individual Monte Carlo (MC) absorbed dose simulation addresses both, heterogeneous activity and density distributions. Subsequent CT-based density weighting has the potential to overcome the assumption of homogeneous density in the MIRD formalism with TSV and VSV methods, which could be a major limitation for the application in bone metastases with heterogeneous density. The aim of this investigation is a comparison of these methods for bone lesion dosimetry in mCRPC patients receiving Lu-177-PSMA therapy. In total, 289 bone lesions in 15 mCRPC patients were analyzed. Percentage difference (PD) of average absorbed dose per lesion compared to MC, averaged over all lesions, was + 14 ± 10% (min: − 21%; max: + 56%) for TSVs. With lesion-individual density weighting using Hounsfield Unit (HU)-to-density conversion on the patient’s CT image, PD was reduced to − 8 ± 1% (min: − 10%; max: − 3%). PD on a voxel level for three-dimensional (3D) voxel-wise dosimetry methods, averaged per lesion, revealed large PDs of + 18 ± 11% (min: − 27%; max: + 58%) for a soft tissue VSV approach compared to MC; after voxel-wise density correction, this was reduced to − 5 ± 1% (min: − 12%; max: − 2%). Patient-individual MC absorbed dose simulation is capable to account for heterogeneous densities in bone lesions. Since the computational effort prevents its routine clinical application, TSV or VSV dosimetry approaches are used. This study showed the necessity of lesion-individual density weighting for TSV or VSV in Lu-177-PSMA therapy bone lesion dosimetry.
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影响因子：
9.3
作者：
Lee, Min Sun;Kim, Joong Hyun;Lee, Jae Sung
通讯作者：
Lee, Jae Sung
DOI：
10.1007/s00259-010-1549-3
发表时间：
2011-01-01
影响因子：
9.1
作者：
Lassmann, M.;Chiesa, C.;Bardies, M.
通讯作者：
Bardies, M.
DOI：
10.2967/jnumed.111.100123
发表时间：
2012-08
期刊：
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
影响因子：
--
作者：
Dewaraja YK;Frey EC;Sgouros G;Brill AB;Roberson P;Zanzonico PB;Ljungberg M
通讯作者：
Ljungberg M
DOI：
10.1007/s00259-019-04485-3
发表时间：
2019-11-01
影响因子：
9.1
作者：
Kratochwil, Clemens;Fendler, Wolfgang Peter;Herrmann, Ken
通讯作者：
Herrmann, Ken
影响因子：
9.3
作者：
Kratochwil, Clemens;Giesel, Frederik L.;Haberkorn, Uwe
通讯作者：
Haberkorn, Uwe