Okamoto Shozo, Thieme Anne, Allmann Jakob, D'Alessandria Calogero, Maurer Tobias, Retz Margitta, Tauber Robert, Heck Matthias M, Wester Hans-Juergen, Tamaki Nagara, Fendler Wolfgang P, Herrmann Ken, Pfob Christian H, Scheidhauer Klemens, Schwaiger Markus, Ziegler Sibylle, Eiber Matthias
Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Nucl Med. 2017 Mar;58(3):445-450. doi: 10.2967/jnumed.116.178483. Epub 2016 Sep 22.
Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy is increasingly used in metastatic castration-resistant prostate cancer. We aimed to estimate the absorbed doses for normal organs and tumor lesions using Lu-PSMA I&T (I&T is imaging and therapy) in patients undergoing up to 4 cycles of radioligand therapy. Results were compared with pretherapeutic Glu-NH-CO-NH-Lys-(Ahx)-[Ga(HBEDCC)] (Ga-PSMA-HBED-CC) PET. A total of 34 cycles in 18 patients were analyzed retrospectively. In 15 patients the first, in 9 the second, in 5 the third, and in 5 the fourth cycle was analyzed, respectively. Whole-body scintigraphy was performed at least between 30-120 min, 24 h, and 6-8 d after administration. Regions of interest covering the whole body, organs, and up to 4 tumor lesions were drawn. Organ and tumor masses were derived from pretherapeutic Ga-PSMA-HBED-CC PET/CT. Absorbed doses for individual cycles were calculated using OLINDA/EXM. SUVs from pretherapeutic PET were compared with absorbed doses and with change of SUV. The mean whole-body effective dose for all cycles was 0.06 ± 0.03 Sv/GBq. The mean absorbed organ doses were 0.72 ± 0.21 Gy/GBq for the kidneys; 0.12 ± 0.06 Gy/GBq for the liver; and 0.55 ± 0.14 Gy/GBq for the parotid, 0.64 ± 0.40 Gy/GBq for the submandibular, and 3.8 ± 1.4 Gy/GBq for the lacrimal glands. Absorbed organ doses were relatively constant among the 4 different cycles. Tumor lesions received a mean absorbed dose per cycle of 3.2 ± 2.6 Gy/GBq (range, 0.22-12 Gy/GBq). Doses to tumor lesions gradually decreased, with 3.5 ± 2.9 Gy/GBq for the first, 3.3 ± 2.5 Gy/GBq for the second, 2.7 ± 2.3 Gy/GBq for the third, and 2.4 ± 2.2 Gy/GBq for the fourth cycle. SUVs of pretherapeutic PET moderately correlated with absorbed dose ( = 0.44, < 0.001 for SUV; = 0.43, < 0.001 for SUV) and moderately correlated with the change of SUV ( = 0.478, < 0.001 for SUV, and = 0.50, < 0.001 for SUV). Organ- and tumor-absorbed doses for Lu-PSMA I&T are comparable to recent reports and complement these with information on an excellent correlation between the 4 therapy cycles. With the kidneys representing the critical organ, a cumulative activity of 40 GBq of Lu-PSMA I&T appears to be safe and justifiable. The correlation between pretherapeutic SUV and absorbed tumor dose emphasizes the need for PSMA-ligand PET imaging for patient selection.
前列腺特异性膜抗原(PSMA)靶向放射性配体疗法越来越多地用于转移性去势抵抗性前列腺癌。我们旨在估算接受多达4个周期放射性配体治疗的患者使用Lu-PSMA I&T(I&T即成像和治疗)时正常器官和肿瘤病灶的吸收剂量。将结果与治疗前的Glu-NH-CO-NH-Lys-(Ahx)-[Ga(HBEDCC)](Ga-PSMA-HBED-CC)PET进行比较。对18例患者的34个周期进行了回顾性分析。分别分析了15例患者的第1周期、9例患者的第2周期、5例患者的第3周期和5例患者的第4周期。给药后至少在30 - 120分钟、24小时和6 - 8天进行全身闪烁扫描。绘制覆盖全身、器官以及多达4个肿瘤病灶的感兴趣区域。器官和肿瘤体积来自治疗前的Ga-PSMA-HBED-CC PET/CT。使用OLINDA/EXM计算各个周期的吸收剂量。将治疗前PET的SUV与吸收剂量以及SUV的变化进行比较。所有周期的平均全身有效剂量为0.06±0.03 Sv/GBq。肾脏的平均吸收器官剂量为0.7