Mair Christian, Warwitz Boris, Fink Katharina, Scarpa Lorenza, Nilica Bernhard, Maffey-Steffan Johanna, Buxbaum Sabine, Virgolini Irene J
Department of Nuclear Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Department of Radiation Therapy and Radiation Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Ann Nucl Med. 2018 Aug;32(7):499-502. doi: 10.1007/s12149-018-1264-x. Epub 2018 May 23.
As radionuclide therapy is gaining importance in palliative treatment of patients suffering from neuroendocrine tumour (NET) as well as castration resistant prostate cancer (CRPC), the radiation protection of patients, staff, family members and the general public is of increasing interest. Here, we determine patient discharge dates according to European guidelines.
In 40 patients with NET and 25 patients with CRPC organ and tumour doses based on the MIRD concept were calculated from data obtained during the first therapy cycle. Planar whole body images were recorded at 0.5, 4, 20, 68 und 92 h postinjection. Residence times were calculated from the respective time-activity-curves based on the conjugated view method. Residence times for critical organs were fitted into the commercially available OLINDA software to calculate the organ doses. The doses of tumours and salivary glands were calculated via their self-irradiation by approximation with spheres of equivalent volume. Kidney volumes were gained by organ segmentation, volumes of all other organs were estimated by means of OLINDA and hence were lean body mass corrected. Out of the whole body curves reference points for patient discharge were estimated.
In patients with NET discharge dates could be properly estimated from dosimetric data, which is not only crucial for radiation protection, but also makes therapy planning easier. For Lu-PSMA-617 ligand therapy it is difficult to seriously estimate a generalized discharge date due to large interpatient variation resulting from different tumor loads and heavy pre-treatment.
Patient release is predictable for Lu-DOTATATE therapy but not for Lu-PSMA ligand therapy.
由于放射性核素治疗在神经内分泌肿瘤（NET）以及去势抵抗性前列腺癌（CRPC）患者的姑息治疗中日益重要，患者、工作人员、家庭成员和公众的辐射防护受到越来越多的关注。在此，我们根据欧洲指南确定患者出院日期。
对40例NET患者和25例CRPC患者，根据第一个治疗周期获得的数据，基于MIRD概念计算器官和肿瘤剂量。在注射后0.5、4、20、68和92小时记录全身平面图像。根据共轭视图法从各自的时间-活度曲线计算停留时间。将关键器官的停留时间输入商用OLINDA软件以计算器官剂量。肿瘤和唾液腺的剂量通过用等效体积球体近似其自身辐射来计算。肾脏体积通过器官分割获得，所有其他器官的体积通过OLINDA估算，因此进行了瘦体重校正。从全身曲线中估计患者出院的参考点。
对于NET患者，可以根据剂量学数据正确估计出院日期，这不仅对辐射防护至关重要，而且使治疗计划更容易。对于Lu-PSMA-617配体治疗，由于不同肿瘤负荷和重度预处理导致患者间差异较大，难以准确估计通用的出院日期。
Lu-DOTATATE治疗的患者出院是可预测的，但Lu-PSMA配体治疗则不然。
