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Nautiyal A, Jha AK, Mithun S, Rangarajan V. Dosimetry in Lu-177-PSMA-617 prostate-specific membrane antigen targeted radioligand therapy: a systematic review. Nucl Med Commun 2022; 43:369-377. [PMID: 35045551 DOI: 10.1097/mnm.0000000000001535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND 177Lu-prostate-specific membrane antigen (PSMA) gained popularity as a choice of agent in the treatment of patients with advanced prostate cancer or metastatic castration-resistant stage of prostate carcinoma (mCRPC) diseases. However, this treatment may cause fatal effects, probably due to unintended irradiation of normal organs. We performed an extensive systematic review to assess the organs at risk and the absorbed dose received by tumor lesions in 177Lu-PSMA therapy. DESIGN In this review, published peer-reviewed articles that cover clinical dosimetry in patients following peptide radionuclide ligand therapy using 177Lu-PSMA have been included. Two senior researchers independently checked the articles for inclusion. A systematic search in the database was made using PubMed, Publons and DOAJ. All selected articles were categorized into three groups: (1) clinical studies with the technical description of dosimetry in 177Lu-PSMA therapy (2) organ dosimetry in 177Lu-PSMA therapy or (3) tumor dosimetry in 177Lu-PSMA therapy. RESULT In total, 182 citations were identified on PSMA therapy and 17 original articles on 177Lu-PSMA dosimetry were recognized as eligible for review. The median absorbed dose per unit of administered activity for kidneys, salivary, liver, spleen, lacrimal and bone marrow was 0.55, 0.81, 0.1, 0.1, 2.26 and 0.03 Gy/GBq, respectively. The median absorbed dose per unit of activity for tumor lesions was found in a range of 2.71-10.94 Gy/GBq. CONCLUSION 177Lu-PSMA systemic radiation therapy (SRT) is a well-tolerated and reliable treatment option against the management of the mCRPC stage of prostate carcinoma. Lacrimal glands and salivary glands are the major critical organs in 177Lu-PSMA SRT. Besides, tumors receive 3-6 times higher absorbed doses compared to organs at risk.
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Affiliation(s)
- Amit Nautiyal
- Department of Nuclear Medicine and Molecular Imaging, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Kharghar, Navi Mumbai
- Homi Bhabha National Institute
| | - Ashish K Jha
- Homi Bhabha National Institute
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sneha Mithun
- Homi Bhabha National Institute
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Homi Bhabha National Institute
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Chatachot K, Shiratori S, Chaiwatanarat T, Khamwan K. Patient dosimetry of 177Lu-PSMA I&T in metastatic prostate cancer treatment: the experience in Thailand. Ann Nucl Med 2021; 35:1193-1202. [PMID: 34309816 DOI: 10.1007/s12149-021-01659-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to determine the radiation dosimetry for 177Lu-PSMA imaging and therapy (I&T) in Thai patients who were treated for metastatic prostate cancer. METHODS Whole-body planar images acquired at immediately, 4 and 24 h after 177Lu-PSMA I&T injection (range 4.44-8.51 GBq) were collected from 12 treatment cycles of 8 prostate cancer patients. Region of interests (ROIs) were manually contoured on the whole-body, liver, spleen, urinary bladder, lacrimal glands, parotid, and submandibular glands to determine time-integrated activity (TIA) in source organs and fitted time-activity curves using mono-exponential extrapolation. The S values calculated utilizing non-uniform rational B-splines (NURBS) computational phantoms were extracted from the OLINDA/EXM v. 2.0 to calculate the absorbed dose coefficient in target organs according to the Medical Internal Radiation Dose (MIRD) scheme. The absorbed doses to bone marrow were estimated using the planar two-compartment image-based method by separating the high-uptake and low-uptake compartment. The spherical model was used to calculate the lacrimal gland absorbed doses. RESULTS Mean absorbed dose coefficients to the kidneys, bone marrow, liver, urinary bladder, spleen, lacrimal glands, parotid, and submandibular glands were 0.81 ± 0.24, 0.02 ± 0.01, 0.13 ± 0.10, 0.27 ± 0.25, 0.16 ± 0.07, 3.62 ± 1.78, 0.21 ± 0.14, and 0.09 ± 0.07 Gy/GBq, respectively. Dose constraints for the kidneys (23 Gy) and bone marrow (2 Gy) were not reached in any patients. The absorbed dose in lacrimal glands calculated by the NURBS computational phantoms was slightly lower than the calculation based on the Cristy-Eckerman computational phantoms using OLINDA/EXM v. 1.0 by 6.37 ± 0.14%. CONCLUSION Dosimetry results in this study suggested that 177Lu-PSMA I&T treatment with higher activities and more cycles is possible without the risk of damaging normal organs in prostate cancer patients.
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Affiliation(s)
- Kotchakorn Chatachot
- Medical Physics Program, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Division of Nuclear Medicine, Department of Radiology, Buddhachinaraj Hospital, Phitsanulok, 65000, Thailand
- Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Shuichi Shiratori
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
- Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Tawatchai Chaiwatanarat
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
- Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kitiwat Khamwan
- Medical Physics Program, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand.
- Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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