使用（90）Y-DOTA（0），Tyr（3）-奥曲肽和（177）Lu-DOTA（0），Tyr（3）-奥曲肽进行肽受体放射治疗后肾功能的长期随访
Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0),Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate.
作者信息
Valkema Roelf, Pauwels Stanislas A, Kvols Larry K, Kwekkeboom Dik J, Jamar Francois, de Jong Marion, Barone Raffaella, Walrand Stephan, Kooij Peter P M, Bakker Willem H, Lasher Janet, Krenning Eric P
机构信息
Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
出版信息
J Nucl Med. 2005 Jan;46 Suppl 1:83S-91S.
UNLABELLED
The kidneys are critical organs in peptide receptor radiation therapy (PRRT). Renal function loss may become apparent many years after PRRT. We analyzed the time course of decline in creatinine clearance (CLR) in patients during a follow-up of at least 18 mo after the start of PRRT with (90)Y-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA),Tyr(3)-octreotide ((90)Y-DOTATOC) or (177)Lu-DOTA(0),Tyr(3)-octreotate ((177)Lu-DOTATATE).
METHODS
Twenty-eight patients with metastasized neuroendocrine tumors received 1-5 cycles of (90)Y-DOTATOC, leading to renal radiation doses of 5.9-26.9 Gy per cycle and a total of 18.3-38.7 Gy. Median follow-up was 2.9 y (range, 1.5-5.4 y), with a median of 16 measurements (range, 5-53) per patient. Thirty-seven patients with metastasized neuroendocrine tumors received 3-7 cycles of (177)Lu-DOTATATE, leading to renal radiation doses of 1.8-7.8 Gy per cycle and a total of 7.3-26.7 Gy. Median follow-up was 2.4 y (range, 1.7-4.0 y), with a median of 10 (range, 6-27) measurements per patient. All renal dose estimates were calculated with the MIRDOSE3 model. All patients were infused with renoprotective amino acids during the administration of the radioactive peptides. The time trend of CLR was determined by fitting a monoexponential function through the data of individual patients, yielding the decline in CLR in terms of percentage change per year.
RESULTS
The median decline in CLR was 7.3% per y in patients treated with (90)Y-DOTATOC and 3.8% per y in patients treated with (177)Lu-DOTATATE (P = 0.06). The time trend of decline in CLR was sustained during the follow-up period. Eleven patients had a >15% per y decline in CLR. Cumulative renal radiation dose, per-cycle renal radiation dose, age, hypertension, and diabetes are probable contributing factors to the rate of decline in CLR after PRRT.
CONCLUSION
This study showed that the time course of CLR after PRRT was compatible with the pattern of sustained CLR loss in progressive chronic kidney disease.
未标注
肾脏是肽受体放射性核素治疗（PRRT）中的关键器官。肾功能丧失可能在PRRT多年后才变得明显。我们分析了接受（90）Y-1,4,7,10-四氮杂环十二烷-N,N',N'',N'''-四乙酸（DOTA）、酪胺酸（3）-奥曲肽（（90）Y-DOTATOC）或（177）镥-DOTA（0）、酪胺酸（3）-奥曲肽（（177）Lu-DOTATATE）进行PRRT治疗的患者，在开始治疗后至少18个月的随访期间，肌酐清除率（CLR）下降的时间进程。
方法
28例转移性神经内分泌肿瘤患者接受了1 - 5个周期的（90）Y-DOTATOC治疗，每个周期肾脏接受的辐射剂量为5.9 - 26.9 Gy，总剂量为18.3 - 38.7 Gy。中位随访时间为2.9年（范围1.5 - 5.4年），每位患者的测量次数中位数为16次（范围5 - 53次）。37例转移性神经内分泌肿瘤患者接受了3 - 7个周期的（177）Lu-DOTATATE治疗，每个周期肾脏接受的辐射剂量为1.8 - 7.8 Gy，总剂量为7.3 - 26.7 Gy。中位随访时间为2.4年（范围1.7 - 4.0年），每位患者的测量次数中位数为10次（范围6 - 27次）。所有肾脏剂量估计均采用MIRDOSE3模型计算。在给予放射性肽期间，所有患者均输注了肾脏保护氨基酸。通过对个体患者的数据拟合单指数函数来确定CLR的时间趋势，得出CLR每年下降的百分比变化。
结果
接受（90）Y-DOTATOC治疗的患者CLR的中位年下降率为7.3%，接受（177）Lu-DOTATATE治疗的患者为3.8%（P = 0.06）。在随访期间，CLR下降的时间趋势持续存在。11例患者的CLR年下降率>15%。累积肾脏辐射剂量、每个周期的肾脏辐射剂量、年龄、高血压和糖尿病可能是PRRT后CLR下降速率的影响因素。
结论
本研究表明，PRRT后CLR的时间进程与进行性慢性肾病中CLR持续丧失的模式相符。
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