Radiation Dosimetry for 177 Lu-PSMA I&T in Metastatic Castration-Resistant Prostate Cancer: Absorbed Dose in Normal Organs and Tumor Lesions
Open accessAbstract
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 177Lu-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)-[68Ga(HBEDCC)] (68Ga-PSMA-HBED-CC) PET. Methods: 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 68Ga-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. Results: 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 (r = 0.44, P < 0.001 for SUVmax; r = 0.43, P < 0.001 for SUVmean) and moderately correlated with the change of SUV (r = 0.478, P < 0.001 for SUVmax, and r = 0.50, P < 0.001 for SUVmean). Conclusion: Organ- and tumor-absorbed doses for 177Lu-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 177Lu-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.
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Dosimetry studies of small molecules targeting PSMA have shown that salivary glands commonly receive the highest radiation-absorbed dose among normal organs.
“The dosimetry studies of small molecules targeting PSMA such as 124 I/ 131 I-MIP-1095, or 177 Lu-PSMA-617 or 177 Lu-PSMA I&T have shown salivary glands commonly receive the highest radiation-absorbed dose among normal organs ( 69 , 74 ).”
From Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns (2021) · cites this paper as [74]
The Dosimetry for Normal Organs section reports mean doses of 0.55 and 0.64 Gy/GBq for the salivary glands, versus 0.72 Gy/GBq for the kidneys and 3.8 Gy/GBq for the lacrimal glands. Thus, in this study of ¹⁷⁷Lu-PSMA I&T, the salivary glands did not receive the highest absorbed dose among the normal organs measured. (LLM, conf=0.88)
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Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT
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- Authors
- Okamoto, S., Thieme, A., Allmann, J., D’Alessandria, C., Maurer, T., Retz, M., Tauber, R., Heck, M. M., Wester, H.-J., Tamaki, N., Fendler, W. P., Herrmann, K., Pfob, C. H., Scheidhauer, K., Schwaiger, M., Ziegler, S., & Eiber, M.
- Affiliations
- Hokkaido University (JP)
- TUM Klinikum (DE)
- Technical University of Munich (DE)
- University of California, Los Angeles (US)
- ORCID
- Venue
- Journal of Nuclear Medicine
- Publisher
- Society of Nuclear Medicine
- Published
- 2016-09-22
- Volume
- 58
- Issue
- 3
- Pages
- 445-450
- ISSN
- 0161-5505 (ISSN-L)
- 2159-662X
- OpenAlex
- W2523192478
- Cited by
- 213
- References
- 33
- Citations by year
- 2026: 10 · 2025: 26 · 2024: 31 · 2023: 21 · 2022: 27 · 2021: 36 · 2020: 13 · 2019: 22 · 2018: 15 · 2017: 12
- FWCI
- 14.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Nuclear Medicine (publishedVersion)
- PubMed (publishedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Keywords
- 177Lu-PSMA-I&T, radioligand therapy, metastatic castration-resistant prostate cancer, absorbed dose, tumor dose, OLINDA/EXM, dosimetry, parotid gland, lacrimal gland, kidney dose, liver dose
- MeSH terms
- Aged, Dipeptides, Heterocyclic Compounds, 1-Ring, Humans, Lutetium, Male, Metabolic Clearance Rate, Neoplasm Metastasis, Organ Specificity, Radiotherapy Dosage, Retrospective Studies, Tissue Distribution, Whole-Body Counting, Treatment Outcome, Prostate-Specific Antigen, Radiopharmaceuticals, Positron-Emission Tomography, Organ Sparing Treatments, Prostatic Neoplasms, Castration-Resistant, Absorption, Radiation
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