Demir Mustafa, Abuqbeitah Mohammad, Uslu-Beşli Lebriz, Yıldırım Özlem, Yeyin Nami, Çavdar İffet, Vatankulu Betül, Gündüz Hüseyin, Kabasakal Levent
Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Fatih, 34098 Istanbul, Turkey.
J Radiol Prot. 2016 Jun;36(2):269-78. doi: 10.1088/0952-4746/36/2/269. Epub 2016 Apr 18.
The aim of this study is to investigate the outpatient treatment protocol and radiation safety of a new-emerging lutetium-177 ((177)Lu) prostate specific membrane antigen (PSMA) therapy. This work analyzed the dose rate of 23 patients treated with 7400 MBq (177)Lu-PSMA at different distances (0, 0.25, 0.50, 1.0 and 2.0 m) and variable time marks (0, 1, 2, 4, 18, 24, 48 and 120 h) after the termination of infusion. Blood samples were withdrawn from 17 patients within the same group at 3, 10, 20, 40, 60 and 90 min and 2, 3, 24 h after termination of infusion. Seven different patients were asked to collect urine for 24 h and a gamma well counter was used for counting samples. Family members were invited to wear an optically stimulated luminescence dosimeter whenever they were in the proximity of the patients up to 4-5 d. The total dose of the medical team including the radiopharmacist, physicist, physician, nurse, and nuclear medicine technologist was estimated by an electronic personnel dosimeter. The finger dose was determined using a ring thermoluminescent dosimeter for the radiopharmacist and nurse. The mean dose rate at 1 m after 4 h and 6 h was 23 ± 6 μSv h(-1) and 15 ± 4 μSv h(-1) respectively. The mean total dose to 23 caregivers was 202.3 ± 42.7 μSv (range: 120-265 μSv). The radiation dose of the nurse and radiopharmacist was 6 and 4 μSv per patient, respectively, whereas the dose of the physicist and physician was 2 μSv. The effective half life of blood distribution and early elimination was 0.4 ± 0.1 h and 5 ± 1 h, respectively. Seven patients excreted a mean of 45% (range: 32%-65%) from the initial activity in 6 h. Our findings demonstrate that (177)Lu-PSMA is a safe treatment modality to be applied as an outpatient protocol, since the dose rate decreases below the determined threshold of <30 μSv h(-1) after approximately 5 h and degrades to 20 μSv h(-1) after 6 h.
本研究旨在探讨一种新兴的镥 - 177（¹⁷⁷Lu）前列腺特异性膜抗原（PSMA）疗法的门诊治疗方案及辐射安全性。这项工作分析了23例接受7400 MBq ¹⁷⁷Lu - PSMA治疗的患者在输液结束后不同距离（0、0.25、0.50、1.0和2.0 m）以及不同时间点（0、1、2、4、18、24、48和120小时）的剂量率。在同一组的17名患者中，于输液结束后3、10、20、40、60和90分钟以及2、3、24小时采集血样。另外选取7名不同的患者收集24小时尿液，并使用γ井型计数器对样本进行计数。只要家庭成员在患者附近长达4 - 5天，就邀请他们佩戴光激励发光剂量计。通过电子个人剂量计估算包括放射药剂师、物理学家、医生、护士和核医学技术人员在内的医疗团队的总剂量。使用环形热释光剂量计测定放射药剂师和护士的手指剂量。4小时和6小时后1米处的平均剂量率分别为23 ± 6 μSv h⁻¹和15 ± 4 μSv h⁻¹。23名护理人员的平均总剂量为202.3 ± 42.7 μSv（范围：120 - 265 μSv）。护士和放射药剂师每位患者的辐射剂量分别为6 μSv和4 μSv，而物理学家和医生的剂量为2 μSv。血液分布和早期消除的有效半衰期分别为0.4 ± 0.1小时和5 ± 1小时。7名患者在6小时内排出的初始活度平均为45%（范围：32% - 65%）。我们的研究结果表明，¹⁷⁷Lu - PSMA作为门诊治疗方案是一种安全的治疗方式，因为在大约5小时后剂量率降至低于确定的阈值<30 μSv h⁻¹，并在6小时后降至20 μSv h⁻¹。
