177Lu-奥曲肽治疗后患者肾脏吸收剂量的估算：基于平面闪烁显像法的比较。
Estimation of absorbed dose to the kidneys in patients after treatment with 177Lu-octreotate: comparison between methods based on planar scintigraphy.
机构信息
Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, SE-413 45, Sweden.
出版信息
EJNMMI Res. 2012 Sep 24;2(1):49. doi: 10.1186/2191-219X-2-49.
BACKGROUND
Lu-[DOTA0, Tyr3]-octreotate (177Lu-octreotate) is used to treat neuroendocrine tumors with high somatostatin-receptor expression. 177Lu-octreotate is mainly excreted via the kidneys, but to some extent, accumulates in the kidney cortex due to, e.g., tubular reabsorption. Renal toxicity is one of the main limiting factors in 177Lu-octreotate treatment. Further knowledge of the biodistribution and dosimetry of 177Lu-octreotate in individual patients is needed. The aim of this study was to estimate the absorbed dose to the kidneys and compare the results obtained with planar imaging and different dosimetric methods: (1) conjugate-view (CV) method using patient-specific kidney sizes, (2) PA method, based on posterior images only, (3) CV method with reduced number of time points (CVreduced data), and (4) CV method using standard kidney sizes (CVstandard size).
METHODS
Totally, 33 patients each received 3.4 to 8.2 GBq of 177Lu-octreotate up to five times, with infusion of lysine and arginine to block the renal uptake. Whole-body planar gamma camera images were acquired on days 0, 1, 2, and 7. The 177Lu concentration in the kidneys was determined by the CV method, and the absorbed dose was estimated with patient-specific organ sizes. Comparison to the CV method was made using posterior images only, together with the influence of the number of time points and with standard organ sizes.
RESULTS
Large interindividual variations were found in the time-activity curve pattern and in the absorbed dose to the kidneys using the CV method: 0.33 to 2.4 Gy/GBq (mean = 0.80 Gy/GBq, SD = 0.30). In the individual patient, the mean deviation of all subsequent kidney doses compared to that of the first administration was 1% (SD = 19%) and 5% (SD = 23%) for the right and left kidneys, respectively. Excluding data for day 7 resulted in large variations in the absorbed dose.
CONCLUSION
Large interindividual variations in kidney dose were found, demonstrating the need for patient-specific dosimetry and treatment planning.
背景
Lu-[DOTA0, Tyr3]-octreotate（177Lu-octreotate）用于治疗高 somatostatin-receptor 表达的神经内分泌肿瘤。177Lu-octreotate 主要通过肾脏排泄，但由于肾小管重吸收等原因，在一定程度上会积聚在肾皮质中。肾毒性是 177Lu-octreotate 治疗的主要限制因素之一。需要进一步了解个体患者中 177Lu-octreotate 的生物分布和剂量学。本研究旨在估计肾脏的吸收剂量，并比较平面成像和不同剂量学方法的结果：（1）使用患者特定肾脏大小的共轭视图（CV）方法，（2）仅基于后图像的 PA 方法，（3）使用较少时间点的 CV 方法（CVreduced data），和（4）使用标准肾脏大小的 CV 方法（CVstandard size）。
方法
总共 33 名患者每次接受 3.4 至 8.2GBq 的 177Lu-octreotate 治疗，共 5 次，输注赖氨酸和精氨酸以阻断肾脏摄取。在第 0、1、2 和 7 天进行全身平面伽马相机图像采集。通过 CV 方法确定肾脏中的 177Lu 浓度，并使用患者特定的器官大小估算吸收剂量。与 CV 方法的比较是通过仅使用后图像进行的，同时还考虑了时间点数量和标准器官大小的影响。
结果
在使用 CV 方法时，发现个体间的时间-活性曲线模式和肾脏吸收剂量存在很大差异：0.33 至 2.4Gy/GBq（平均值=0.80Gy/GBq，SD=0.30）。在个体患者中，与第一次给药相比，所有后续肾脏剂量的平均偏差为 1%（SD=19%）和 5%（SD=23%），分别为右肾和左肾。排除第 7 天的数据会导致吸收剂量的大幅变化。
结论
发现肾脏剂量存在很大的个体间差异，这表明需要进行患者特异性剂量学和治疗计划。
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