Cited by 213Radiopharmaceutical Chemistry and ApplicationsMedical Imaging Techniques and ApplicationsProstate Cancer Diagnosis and Treatment

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Radiation Dosimetry for 177 Lu-PSMA I&T in Metastatic Castration-Resistant Prostate Cancer: Absorbed Dose in Normal Organs and Tumor Lesions

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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·2017·Journal of Nuclear Medicine

DOI 10.2967/jnumed.116.178483

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Abstract

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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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: Okamoto, Shozo
D’Alessandria, Calogero
Maurer, Tobias
Tauber, Robert
Heck, Matthias M.
Tamaki, Nagara
Fendler, Wolfgang P.
Herrmann, Ken
Pfob, Christian H.
Schwaiger, Markus
Ziegler, Sibylle
Eiber, Matthias
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
DOI: 10.2967/jnumed.116.178483
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 › Urology › 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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Radiation Dosimetry for 177 Lu-PSMA I&T in Metastatic Castration-Resistant Prostate Cancer: Absorbed Dose in Normal Organs and Tumor Lesions

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