Groener Daniel, Wichert Jennifer, Adams Magdalena, Mader Nicolai, Klimek Konrad, Nguyen Ngoc Christina, Baumgarten Justus, Happel Christian, Mandel Philipp, Chun Felix K H, Tselis Nikolaos, Grünwald Frank, Sabet Amir
Department of Nuclear Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
Department of Urology, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
Cancers (Basel). 2023 Jul 30;15(15):3878. doi: 10.3390/cancers15153878.
This study aims to assess the change in uptake to reference organs, including the liver, parotid and salivary glands after radioligand therapy (RLT) with [Lu]Lu-PSMA-617 in relation to pretreatment imaging metrics. Eighty-five patients with mCRPC underwent [Ga]Ga-PSMA-11 PET/CT imaging prior to (pre RLT PET) and after (post RLT PET) a median of 3 (IQR 2-6) RLT cycles with [Lu]Lu-PSMA-617. PSMA-positive tumor burden was stratified into 4 groups based on modified PROMISE criteria (oligofocal, multifocal, disseminated, diffuse). Uptake (SUV, SUV) in liver tissue, parotid and submandibular glands was measured. A control group was established with 54 patients who had received two separate PET acquisitions following the same protocol (PET1, PET2) within 12 months for localized or oligofocal prostate cancer without RLT in the interim. Baseline uptake values (SUV, SUV) in parotid (10.8 ± 3.2, 16.8 ± 5.4) and submandibular glands (11.3 ± 2.8, 18.1 ± 4.7) are 2-fold compared to liver uptake (4.9 ± 1.4, 7.7 ± 2.0), with no significant change between PET 1 and PET 2 in the control group. In the RLT group, increasing tumor burden class is significantly associated with decreasing uptake in the liver ( = 0.013), parotid ( < 0.001) and submandibular glands ( < 0.001); this tumor sink effect by respective tumor burden is widely maintained after RLT ( = 0.011, < 0.001, < 0.001). RLT has a significant impact on salivary gland uptake with decreasing values per patient in all groups of disease burden change (up to -30.4% in submandibular glands, < 0.001), while liver tissue shows rising values in patients with declining tumor burden throughout RLT (+18.6%, = 0.020). Uptake in liver tissue and salivary glands on [Ga]Ga-PSMA-11 PET/CT imaging is inversely related to tumor burden prior to and following RLT with [Lu]Lu-PSMA-617. Per patient, salivary gland uptake is further reduced throughout RLT independently from tumor burden, while changes in liver uptake remain burden-dependent. Liver and salivary gland uptake-derived metrics and segmentation thresholds may thus be of limited value when used as reference for response assessment to RLT.
本研究旨在评估[Lu]Lu - PSMA - 617放射性配体治疗（RLT）后，肝脏、腮腺和唾液腺等参考器官的摄取变化与治疗前成像指标的关系。85例转移性去势抵抗性前列腺癌（mCRPC）患者在接受[Lu]Lu - PSMA - 617进行中位3次（四分位间距2 - 6次）RLT周期治疗之前（RLT前PET）和之后（RLT后PET）接受了[Ga]Ga - PSMA - 11 PET/CT成像。根据改良的PROMISE标准（寡灶性、多灶性、播散性、弥漫性），将PSMA阳性肿瘤负荷分为4组。测量肝脏组织、腮腺和颌下腺的摄取情况（SUV、SUV）。建立了一个对照组，54例患者在12个月内按照相同方案接受了两次单独的PET采集（PET1、PET2），期间未接受RLT，用于局部或寡灶性前列腺癌。腮腺（10.8±3.2，16.8±5.4）和颌下腺（11.3±2.8，18.1±4.7）的基线摄取值是肝脏摄取值（4.9±1.4，7.7±2.0）的2倍，对照组中PET1和PET2之间无显著变化。在RLT组中，肿瘤负荷分级增加与肝脏（P = 0.013）、腮腺（P < 0.001）和颌下腺（P < 0.001）摄取减少显著相关；RLT后，各肿瘤负荷导致的这种肿瘤摄取“汇聚效应”广泛存在（P = 0.011，P < 0.001，P < 0.
