The comparison of serial SPECT-CT imaging to estimate absorbed dose to the organ at risk from peptide receptor radionuclide therapy dosimetry

Document Type: Original Article

Authors

1 Department of Nuclear Medicine, Institut Kanser Negara, Putrajaya, Malaysia

2 Departments of Radiology, Faculty Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

3 School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia

Abstract

Introduction: In Peptide Receptor Radionuclide Therapy (PRRT), the administration of radionuclide such as Lu-177 label with a pharmaceutical agent useful to destroy the lesion. The amount of Lu-177 radioactivity administered to the patients is still not standardize and generally not more than 7.4 GBq per session due to the patient’s safety issues. The first cycle of Lu-177 is an excellent technique to estimate radionuclide uptake for organs at risk. This study aims to simplify five SPECT-CT scanning points into less scanning points to estimate absorbed dose to the organ at risk.
Methods: Ten patients who have neuroendocrine tumors enrolled in 177Lu-Dotatate therapy dosimetry. The serial SPECT-CT done after 2, 4, 24, 48 and 72 hours to acquired time disintegration for organ at risk. Partik’s categorical grading criteria is relevantly used in this study to convert the numeric value of Lin’s concordance coefficient into an ordinal scale.
Results: Our current result demonstrated an excellent agreement between three and five scanning with LSA exponential fit method. These excellent results presented for kidney, liver and spleen. However, the bladder shows poor results due to the urinary system.
Conclusion: Three data point of SPECT-CT images is the best option to estimate absorbed dose to the lesion and organ at risk for 177Lu-Dotatate dosimetry technique.

Keywords

Main Subjects


  1. Sandström M, Garske-Román U, Granberg D, Johansson S, Widström C, Eriksson B, Sundin A, Lundqvist H, Lubberink M. Individualized dosimetry of kidney and bone marrow in patients undergoing 177Lu-DOTA-octreotate treatment. J Nucl Med. 2013 Jan;54(1):33-41.
  2. Gabriel M, Andergassen U, Putzer D, Kroiss A, Waitz D, Von Guggenberg E, Kendler D, Virgolini IJ. Individualized peptide-related-radionuclide-therapy concept using different radiolabelled somatostatin analogs in advanced cancer patients. Q J Nucl Med Mol Imaging. 2010 Feb;54(1):92-9.
  3. Grimes J, Celler A. Comparison of internal dose estimates obtained using organ-level, voxel S value, and Monte Carlo techniques. Med Phys. 2014 Sep;41(9):092501.
  4. Pacilio M, Amato E, Lanconelli N, Basile C, Torres LA, Botta F, Ferrari M, Diaz NC, Perez MC, Fernández M, Lassmann M, Gil AV, Cremonesi M. Differences in 3D dose distributions due to calculation method of voxel S-values and the influence of image blurring in SPECT. Phys Med Biol. 2015 Mar 7;60(5):1945-64.
  5. Grassi E, Fioroni F, Berenato S, Patterson N, Ferri V, Braglia L, Filice A, Versari A, Iori M, Spezi E. Effect of image registration on 3D absorbed dose calculations in 177Lu-DOTATOC peptide receptor radionuclide therapy. Phys Med. 2018 Jan;45:177-185.
  6. Heikkonen J, Mäenpää H, Tenhunen M. Methodological effects in kidney dosimetry in Lu-177 radionuclide therap. Eur J Nucl Med Mol Imaging. 2013;40: S265.
  7. Sandström M, Garske-Román U, Granberg D, Johansson S, Widström C, Eriksson B, Sundin A, Lundqvist H, Lubberink M. Individualized dosimetry of kidney and bone marrow in patients undergoing 177Lu-DOTA-octreotate treatment. J Nucl Med. 2013 Jan;54(1):33-41.  
  8. Weber DA. The MIRD method of estimating absorbed dose. International conference on medical and biological engineering and 9th international conference on medical physics, Kyoto (Japan), 7-12 Jul 1991.
  9. Sanders JC, Kuwert T, Hornegger J, Ritt P. Quantitative SPECT/CT imaging of (177)Lu with in vivo validation in patients undergoing peptide receptor radionuclide therapy. Mol Imaging Biol. 2015 Aug;17(4):585-93.
  10. Bodei L, Mueller-Brand J, Baum RP, Pavel ME, Hörsch D, O'Dorisio MS, O'Dorisio TM, Howe JR, Cremonesi M, Kwekkeboom DJ, Zaknun JJ. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2013 May;40(5):800-16.
  11. Siegel JA, Thomas SR, Stubbs JB, Stabin MG, Hays MT, Koral KF, Robertson JS, Howell RW, Wessels BW, Fisher DR, Weber DA, Brill AB. MIRD pamphlet no. 16: Techniques for quantitative radiopharmaceutical biodistribution data acquisition and analysis for use in human radiation dose estimates. J Nucl Med. 1999 Feb;40(2):37S-61S.
  12. Said MA, Masud MA, Abdul Razak HR. Quantitative imaging with commercial SPECT. J Phys Conf Ser. 2020 Mar;1497:012025.
  13. Partik BL, Stadler A, Schamp S, Koller A, Voracek M, Heinz G, Helbich TH. 3D versus 2D ultrasound: accuracy of volume measurement in human cadaver kidneys. Invest Radiol. 2002 Sep;37(9):489-95.
  14. McBride GB. A proposal for strength-of-agreement criteria for Lin’s Concordance Correlation Coefficient. NIWA Client Report: HAM 2005 – 062. National Institute of Water & Atmospheric Research Ltd: Hamilton, New Zealand, May 2005.
  15. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, Mittra E, Kunz PL, Kulke MH, Jacene H, Bushnell D, O'Dorisio TM, Baum RP, Kulkarni HR, Caplin M, Lebtahi R, Hobday T, Delpassand E, Van Cutsem E, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Öberg K, Lopera Sierra M, Santoro P, Thevenet T, Erion JL, Ruszniewski P, Kwekkeboom D, Krenning E; NETTER-1 Trial Investigators. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017 Jan 12;376(2):125-135.
  16. Kupitz D, Wetz C, Wissel H, Wedel F, Apostolova I, Wallbaum T, Ricke J, Amthauer H, Grosser OS. Software-assisted dosimetry in peptide receptor radionuclide therapy with 177Lutetium-DOTATATE for various imaging scenarios. PLoS One. 2017 Nov 6;12(11):e0187570.
  17. Howell RW, Wessels BW, Loevinger R, Watson EE, Bolch WE, Brill AB, Charkes ND, Fisher DR, Hays MT, Robertson JS, Siegel JA, Thomas SR. The MIRD perspective 1999. Medical Internal Radiation Dose Committee. J Nucl Med. 1999 Jan;40(1):3S-10S.
  18. Watson EE, Stabin MG, Siegel JA. MIRD formulation. Med Phys. 1993 Mar-Apr;20(2 Pt 2):511-4.
  19. Zhao W, Esquinas PL, Frezza A, Hou X, Beauregard JM, Celler A. Accuracy of kidney dosimetry performed using simplified time activity curve modelling methods: a 177Lu-DOTATATE patient study. Phys Med Biol. 2019 Aug 28;64(17):175006.  
  20. Jentzen W, Bockisch A, Ruhlmann M. Assessment of Simplified Blood Dose Protocols for the Estimation of the Maximum Tolerable Activity in Thyroid Cancer Patients Undergoing Radioiodine Therapy Using 124I. J Nucl Med. 2015 Jun;56(6):832-8.
  21. Jackson PA, Hofman MS, Hicks RJ, Scalzo M, Violet J. Radiation dosimetry in 177 Lu-PSMA-617 therapy using a single posttreatment SPECT/CT scan: A novel methodology to generate time- and tissue-specific dose factors. J Nucl Med . 2019 Dec; 61(7):1030-1036.
  22. Guerriero F, Ferrari ME, Botta F, Fioroni F, Grassi E, Versari A, Sarnelli A, Pacilio M, Amato E, Strigari L, Bodei L, Paganelli G, Iori M, Pedroli G, Cremonesi M. Kidney dosimetry in 177Lu and 90Y peptide receptor radionuclide therapy: Influence of image timing, time-activity integration method, and risk factors. Biomed Res Int. 2013;2013: 935351.