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European Journal of Nuclear Medicine and Molecular Imaging

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01-06-2014 | Original Article

Individualized dosimetry-based activity reduction of ⁹⁰Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy

Authors: Sofie Van Binnebeek, Kristof Baete, Bert Vanbilloen, Christelle Terwinghe, Michel Koole, Felix M. Mottaghy, Paul M. Clement, Luc Mortelmans, Karin Haustermans, Eric Van Cutsem, Alfons Verbruggen, Kris Bogaerts, Chris Verslype, Christophe M. Deroose

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2014

Abstract

Purpose

Assessment of kidney function evolution after ⁹⁰Y-DOTATOC peptide receptor radionuclide therapy (PRRT) with capped activity administration based on a 37-Gy threshold of biological effective dose (BED) to the kidney.

Methods

In a prospective phase II study, patients with metastasized neuroendocrine tumours were evaluated for therapy using 185 MBq ¹¹¹In-pentetreotide with amino acid coinfusion. Planar whole-body images were acquired at four time-points after injection and kidney volumes were measured using CT/MRI. BED to the kidneys was estimated using an extended BED formula and biexponential renal clearance. Based on published BED dose–toxicity relationships, we allowed a maximal kidney BED of 37 Gy; if the calculated BED exceeded 37 Gy, treatment activity was reduced accordingly. Kidney function was assessed at baseline and at 18 months, predominantly using ⁵¹Cr-EDTA. The rate of renal function decline was expressed as annual glomerular filtration rate loss (aGFRL).

Results

Only 22 of 50 patients reached the 18-months time-point, with most missing patients having died due to disease progression. In the 22 patients who reached 18 months, no rapid kidney function deterioration was observed over the 18 months, aGFRL >33 % was not seen, and only three patients showed an increase of one toxicity grade and one patient an increase of two grades. No significant correlations between kidney volume (p = 0.35), baseline GFR (p = 0.18), risk factors for renal function loss (p = 0.74) and aGFRL were observed. Among the 28 patients who did not reach 18 months, one developed grade 4 kidney toxicity at 15 months after PRRT.

Conclusion

Prospective dosimetry using a 37 Gy BED as the threshold for kidney toxicity is a good guide for ⁹⁰Y-DOTATOC PRRT and is associated with a low risk of rapid renal function deterioration and evolution to severe nephrotoxicity.

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Title: Individualized dosimetry-based activity reduction of 90Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy
Authors: Sofie Van Binnebeek
Kristof Baete
Bert Vanbilloen
Christelle Terwinghe
Michel Koole
Felix M. Mottaghy
Paul M. Clement
Luc Mortelmans
Karin Haustermans
Eric Van Cutsem
Alfons Verbruggen
Kris Bogaerts
Chris Verslype
Christophe M. Deroose
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2670-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Individualized dosimetry-based activity reduction of ⁹⁰Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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