177Lu-[DOTA0,Tyr3] Octreotate Therapy in Patients With Disseminated Neuroendocrine Tumors: Analysis of Dosimetry With Impact on Future Therapeutic Strategy
177Lu-[DOTA0,Tyr3] Octreotate Therapy in Patients With Disseminated Neuroendocrine Tumors: Analysis of Dosimetry With Impact on Future Therapeutic Strategy
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DOI：
10.1002/cncr.24796
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发表时间：
2010-02-15
期刊：
影响因子：
6.2
通讯作者：
Tennvall, Jan
中科院分区：
文献类型：
--
作者：
Garkavij, Michael;Nickel, Mattias;Tennvall, Jan
背景：Lu-177-(DOTAO，Tyr3)octreotate是一种治疗播散性神经内分泌肿瘤的新方法。根据一项共识方案，计算出的肾脏最大耐受吸收剂量不应超过27Gy.在常用的剂量学方法中，平面成像用于确定滞留时间，而肾脏质量是通过计算机断层扫描(CT)确定的。方法：采用3种不同的量化方法评价肾脏的吸收剂量。第一种方法包括普通平面活动成像，使用医学内辐射剂量(MIRD)公式计算吸收剂量，使用基于CT扫描的肾脏肿块。在该方法中，对2个感兴趣区域进行了背景校正。第二种方法还包括单光子发射计算机断层扫描(SPECT)数据，这些数据被用来刻度从平面图像获得的时间-活动曲线的幅度。吸收剂量按平面法计算。第三种方法使用定量SPECT图像转换为吸收剂量率图像，其中肾脏的中位吸收剂量率是以肾皮质上定义的感兴趣体积计算的。结果：对于一些患者，根据剂量学方法的不同，计算的肾脏吸收剂量有很大的差异。这两种基于SPECT的方法给出的值基本一致，尽管计算基于不同的假设。使用基线平面法的剂量学在所有患者中都有较高的吸收剂量。通过将感兴趣的背景区域放置在肾脏附近的平面成像获得的值与包括SPECT在内的剂量学更一致。在累积的肿瘤吸收剂量方面，计划的4个治疗周期中的前2个周期做出了主要贡献。结论：结果表明，与其他方法相比，根据传统的平面剂量学方法评估的患者可能没有得到足够的治疗。血液学和肌酐并没有表明对更具侵袭性的治疗方法有任何限制，这对患有更具侵袭性的肿瘤的患者尤其有用，因为这些患者没有时间进行更长期的治疗。癌症2010；116(4补充)：1084-92。(C)2010年美国癌症协会。
BACKGROUND: Lu-177-(DOTAO,Tyr3) octreotate is a new treatment modality for disseminated neuroendocrine tumors. According to a consensus protocol, the calculated maximally tolerated absorbed dose to the kidney should not exceed 27 Gy. In commonly used dosimetry methods, planar imaging is used for determination of the residence time, whereas the kidney mass is determined from a computed tomography (CT) scan. METHODS: Three different quantification methods were used to evaluate the absorbed dose to the kidneys. The first method involved common planar activity imaging, and the absorbed dose was calculated using the medical internal radiation dose (MIRD) formalism, using CT scan-based kidney masses. For this method, 2 region of interest locations for the background correction were investigated. The second method also included single-photon emission computed tomography (SPECT) data, which were used to scale the amplitude of the time-activity curve obtained from planar images. The absorbed dose was calculated as in the planar method. The third method used quantitative SPECT images converted to absorbed dose rate images, where the median absorbed dose rate in the kidneys was calculated in a volume of interest defined over the renal cortex. RESULTS: For some patients, the results showed a large difference in calculated kidney-absorbed doses, depending on the dosimetry method. The 2 SPECT-based methods generally gave consistent values, although the calculations were based on different assumptions. Dosimetry using the baseline planar method gave higher absorbed doses in all patients. The values obtained from planar imaging with a background region of interest placed adjacent to the kidneys were more consistent with dosimetry also including SPECT. For the accumulated tumor absorbed dose, the first 2 of the 4 planned therapy cycles made the major contribution. CONCLUSIONS: The results suggested that patients evaluated according to the conventional planar-based dosimetry method may have been undertreated compared with the other methods. Hematology and creatinine did not indicate any restriction for a more aggressive approach, which would be especially useful in patients with more aggressive tumors where there is not time for more protracted therapy. Cancer 2010;116(4 suppl):1084-92. (C) 2010 American Cancer Society.