Abstract
The main target of this work is to examine blood clearance and external exposure for 177Lu-DOTATATE compared with new emerging 177Lu-PSMA therapy. Blood clearance and radiation exposure of 31 patients treated with 5.5 ± 1.1 GBq 177Lu-DOTATATE were compared to those of 23 patients treated with 7.4 GBq 177Lu-PSMA. Dose rates were measured at several distances and time points up to 120 h after treatment. Blood samples were collected conjunctively after infusion. Caregiver’s cumulative dose was measured by means of an OSL (optically stimulated luminescence) dosimeter for 4–5 days and medical staff’s dose was also estimated using electronic personal dosimeters. Finger dose was determined via ring TLD (Thermoluminescence Dosimeter) for radiopharmacists and nurses. Dose rates due to 177Lu-DOTATATE at a distance of 1 m, 4 h and 6 h after infusion, were 3.0 ± 2.8 and 2 ± 1.9 µSv/(h GBq), respectively, while those due to 177Lu-PSMA were 3.1 ± 0.8 and 2.2 ± 0.9 µSv/(h GBq). Total effective dose of 17 caregivers was 100–200 µSv for 177Lu-DOTATATE therapy. Mean effective doses to nurses and radiopharmacists were 5 and 4 µSv per patient, respectively, while those for physicists and physicians were 2 µSv per patient. For 177Lu-DOTATATE, effective half-life in blood and early elimination phase were 0.31 ± 0.13 and 4.5 ± 1 h, while they were found as 0.4 ± 0.1 and 5 ± 1 h, respectively, for 177Lu-PSMA. The first micturition time following 177Lu-DOTATATE infusion was noted after 36 ± 14 min, while the second and third voiding times were after 74 ± 9 and 128 ± 41 min, respectively. It is concluded that blood clearance and radiation exposure for 177Lu-DOTATATE are very similar to those for 177Lu-PSMA, and both treatment modalities are reasonably reliable for outpatient treatment, since the mean dose rate [2.1 µSv/(h GBq)] decreased below the dose rate that allows release of the patient from the hospital (20 µSv/h) after 6 h at 1 m distance.
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References
Bakker WH, Breeman WA, Kwekkeboom DJ, De Jong LC, Krenning EP (2006) Practical aspects of peptide receptor radionuclide therapy with [177Lu] [DOTA0, Tyr3] octreotate. Q J Nucl Med Mol Imaging 50:265–271
Bodei L, Mueller-Brand J, Baum RP, Pavel ME, Horsch D, O’Dorisio MS, O’Dorisio TM, Howe JR, Cremonesi M, Kwekkeboom DJ, Zaknun JJ (2013) The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumors. J Nucl Med Mol Imaging 40:800–816
Breeman W, De Blois E, Bakker W, Krenning E (2006) Radiolabeling DOTA-peptides with Y-90 and Lu-177 to a high specific activity. In: Chinol M, Paganelli G (eds) Radionuclide peptide cancer therapy. Taylor and Francis, New York, pp 19–26
Demir M, Demir B, Sayman H, Sager S, Sabbir Ahmed A, Uslu I (2011) Radiation protection for accompanying person and radiation workers in PET/CT. Radiat Prot Dosim 147:528–532
Demir M, Abuqbeitah M, Uslu-Besli L, Yildirim O, Yeyin N, Cavdar I, Vatankulu B, Gündüz H, Kabasakal L (2016) Evaluation of radiation safety in (177)Lu-PSMA therapy and development of outpatient treatment protocol. J Radiol Prot 36:269–278
Fleming JS (1979) A technique for the absolute measurement of activity using a gamma camera and computer. Phys Med Biol 24:176–80
International Commission on Radiological Protection (1990) Recommendations of the International Commission on Radiological Protection Annals of the ICRP. ICRP Publication 60 ed. Pergamon Press, Oxford, pp 1–201
Kabasakal L, AbuQbeitah M, Aygun A, Yeyin N, Ocak M, Demirci E, Toklu T (2015) Pre-therapeutic dosimetry of normal organs and tissues of Lu-PSMA-617 prostate-specific membrane antigen (PSMA) inhibitor in patients with castration-resistant prostate cancer. J Nucl Med Mol Imaging 42:1976–1983
Kwekkeboom DJ, Bakker WH, Kooij PP, Konijnenberg MW, Srinivasan A, Erion JL, Schmidt MA, Bugaj JL, de Jong M, Krenning EP (2001) [177Lu-DOTAOTyr3]octreotate: comparison with [111In-DTPAo]octreotide in patients. Eur J Nucl Med 28:1319–1325
Kwekkeboom DJ, Kam BL, van Essen M, Teunissen JJ, van Eijck CH, Valkema R, de Jong M, de Herder WW, Krenning EP (2010) Somatostatin-receptor-based imaging and therapy of gastroenteropancreatic neuroendocrine tumors. Endocr Rel Cancer 17:R53–R73
Marriott CJ, Webber CE, Gulenchyn KY (2007) Radiation exposure for ‘caregivers’ during high-dose outpatient radioiodine therapy. Radiat Prot Dosim 123:62–67
Melis M, Krenning EP, Bernard BF, Barone R, Visser TJ, de Jong M (2005) Localisation and mechanism of renal retention of radiolabeled somatostatin analogues. J Nucl Med Mol Imaging 32:1136–1143
Pool SE, Krenning EP, Koning GA, van Eijck CH, Teunissen JJ, Kam B, Valkema R, Kwekkeboom DJ, de Jong M (2010) Preclinical and clinical studies of peptide receptor radionuclide therapy. Sem Nucl Med 40:209–218
Sward C, Bernhardt P, Ahlman H, Wangberg B, Forssell-Aronsson E, Larsson M, Svensson J, Rossi-Norrlund R, Kölby L (2010) [177Lu-DOTA 0-Tyr 3]-octreotate treatment in patients with disseminated gastroenteropancreatic neuroendocrine tumors: the value of measuring absorbed dose to the kidney. World J Surg 34:1368–1372
Turner JH (2012) Outpatient therapeutic nuclear oncology. Ann Nucl Med 26:289–97
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The authors would like to express their sincere gratitude to the Head of Nuclear Medicine Department in Cerrahpaşa Medical Faculty for his cordial support, and to all colleagues who provided insight and professional advice to achieve this work.
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This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by Istanbul University Cerrahpaşa Medical Faculty Clinical Research Ethics Committee (document number: 83045809/604/5855).
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Abuqbeitah, M., Demir, M., Uslu-Beşli, L. et al. Blood clearance and occupational exposure for 177Lu-DOTATATE compared to 177Lu-PSMA radionuclide therapy. Radiat Environ Biophys 57, 55–61 (2018). https://doi.org/10.1007/s00411-017-0721-6
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DOI: https://doi.org/10.1007/s00411-017-0721-6