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Bodei L, Michael Tuttle R, Grewal RK, Mauguen A, Augensen F, Abusamra M, Mahajan S, Jayaprakasam VS, Osborne JR, Haque S, Wong BZY, Ghossein RA, Fagin J, Schӧder H, Ho A, Humm JL, Larson SM. Toward individualized dosimetry for radiopharmaceutical therapy in day-to-day clinical practice of nuclear oncology: overcoming heterogeneity of radiation-absorbed dose to tumor and critical organs. Eur J Nucl Med Mol Imaging 2024; 51:325-329. [PMID: 37712994 PMCID: PMC10774147 DOI: 10.1007/s00259-023-06420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Lisa Bodei
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravinder K Grewal
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Audrey Mauguen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Finn Augensen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murad Abusamra
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Sonia Mahajan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Joseph R Osborne
- Division of Molecular Imaging and Therapeutics, Weill Cornell Medical College, New York, NY, USA
| | - Sofia Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Bernadette Z Y Wong
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Ronald A Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schӧder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA
| | - Alan Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John L Humm
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 77, New York, NY, 2C-21210065, USA.
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Mauguen A, Grewal RK, Augensen F, Abusamra M, Mahajan S, Jayaprakasam VS, Osborne J, Haque S, Wong BZY, Ghossein RA, Fagin J, Schӧder H, Tuttle RM, Ho A, Humm JL, Larson SM. The use of single-timepoint images to link administered radioiodine activity (MBq) to a prescribed lesion radiation-absorbed dose (cGy): a regression-based prediction interval tool for the management of well-differentiated thyroid cancer patients. Eur J Nucl Med Mol Imaging 2023; 50:2971-2983. [PMID: 37171634 PMCID: PMC10382352 DOI: 10.1007/s00259-023-06240-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To introduce a biomarker-based dosimetry method for the rational selection of a treatment activity for patients undergoing radioactive iodine 131I therapy (RAI) for metastatic differentiated thyroid cancer (mDTC) based on single-timepoint imaging of individual lesion uptake by 124I PET. METHODS Patients referred for RAI therapy of mDTC were enrolled in institutionally approved protocols. A total of 208 mDTC lesions (in 21 patients) with SUVmax > 1 underwent quantitative PET scans at 24, 48, 72, and 120 h post-administration of 222 MBq of theranostic NaI-124I to determine the individual lesion radiation-absorbed dose. Using a general estimating equation, a prediction curve for biomarker development was generated in the form of a best-fit regression line and 95% prediction interval, correlating individual predicted lesion radiation dose metrics, with candidate biomarkers ("predictors") such as SUVmax and activity in microcurie per gram, from a single imaging timepoint. RESULTS In the 169 lesions (in 15 patients) that received 131I therapy, individual lesion cGy varied over 3 logs with a median of 22,000 cGy, confirming wide heterogeneity of lesion radiation dose. Initial findings from the prediction curve on all 208 lesions confirmed that a 48-h SUVmax was the best predictor of lesion radiation dose and permitted calculation of the 131I activity required to achieve a lesional threshold radiation dose (2000 cGy) within defined confidence intervals. CONCLUSIONS Based on MIRD lesion-absorbed dose estimates and regression statistics, we report on the feasibility of a new single-timepoint 124I-PET-based dosimetry biomarker for RAI in patients with mDTC. The approach provides clinicians with a tool to select personalized (precision) therapeutic administration of radioactivity (MBq) to achieve a desired target lesion-absorbed dose (cGy) for selected index lesions based on a single 48-h measurement 124I-PET image, provided the selected activity does not exceed the maximum tolerated activity (MTA) of < 2 Gy to blood, as is standard of care at Memorial Sloan Kettering Cancer Center. TRIAL REGISTRATION NCT04462471, Registered July 8, 2020. NCT03647358, Registered Aug 27, 2018.
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Affiliation(s)
- Audrey Mauguen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravinder K Grewal
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - Finn Augensen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murad Abusamra
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - Sonia Mahajan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - Joseph Osborne
- Division of Molecular Imaging and Therapeutics, Weill Cornell Medical College, New York, NY, USA
| | - Sofia Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - Bernadette Z Y Wong
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - Ronald A Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Fagin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schӧder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alan Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John L Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 415 East 68th Street, Z-2064, New York, NY, 10065, USA.
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Beattie BJ, Akhurst TJ, Augensen F, Humm JL. SUVfdg: A standard-uptake-value (SUV) body habitus normalizer specific to fluorodeoxyglucose (FDG) in humans. PLoS One 2022; 17:e0266704. [PMID: 35446848 PMCID: PMC9022879 DOI: 10.1371/journal.pone.0266704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To devise a new body-habitus normalizer to be used in the calculation of an SUV that is specific to the PET tracer 18F-FDG.
Methods
A cohort of 481-patients was selected for analysis of 18F-FDG uptake into tissues unaffected by their disease. Among these, 65-patients had only brain concentrations measured and the remaining 416 were randomly divided into an 86-patient test set and a 330-patient training set. Within the test set, normal liver, spleen and blood measures were made. In the training set, only normal liver concentrations were measured. Using data from the training set, a simple polynomial function of height and weight was selected and optimized in a fitting procedure to predict each patient’s mean liver %ID/ml. This function, when used as a normalizer, defines a new SUV metric (SUVfdg) which we compared to SUV metrics normalized by body weight (SUVbw), lean-body mass (SUVlbm) and body surface-area (SUVbsa) in a five-fold cross-validation. SUVfdg was also evaluated in the independent brain-only and whole-body test sets.
Results
For patients of all sizes including pediatric patients, the normal range of liver 18F-FDG uptake at 60 minutes post injection in units of SUVfdg is 1.0 ± 0.16. Liver, blood, and spleen SUVfdg in all comparisons had lower coefficients of variation compared to SUVbw SUVlbm and SUVbsa. Blood had a mean SUVfdg of 0.8 ± 0.11 and showed no correlation with age, height, or weight. Brain SUVfdg measures were significantly higher (P<0.01) in pediatric patients (4.7 ± 0.9) compared to adults (3.1 ± 0.6).
Conclusion
A new SUV metric, SUVfdg, is proposed. It is hoped that SUVfdg will prove to be better at classifying tumor lesions compared to SUV metrics in current use. Other tracers may benefit from similarly tracer-specific body habitus normalizers.
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Affiliation(s)
- Bradley J. Beattie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
- * E-mail:
| | - Tim J. Akhurst
- Division of Radiation Oncology and Cancer Imaging, The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Finn Augensen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - John L. Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Levchenko A, Mehta BM, Lee JB, Humm JL, Augensen F, Squire O, Kothari PJ, Finn RD, Leonard EF, Larson SM. Evaluation of 11C-colchicine for PET imaging of multiple drug resistance. J Nucl Med 2000; 41:493-501. [PMID: 10716325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
UNLABELLED Overexpression of P-glycoprotein (P-gp) can confer multiple drug resistance (MDR) phenotype on cancer cells and tumors by reducing intracellular accumulation of various cytotoxic agents. Early diagnosis of MDR in the clinic will serve to improve the efficacy of chemotherapeutic intervention and the quality of life of patients. In this article we describe use of a positron-emitting MDR tracer, 11C-colchicine (CHC), to evaluate MDR by PET imaging. Unlike existing MDR tracers such as 99mTc-sestamibi, this compound is electroneutral, with biodistribution not affected by perturbations of membrane potential. METHODS In vitro studies showed that resistance to CHC is correlated to resistance to Taxol (paclitaxel). The results of biodistribution experiments were found to be consistent with previously reported experiments with CHC labeled with other isotopes. On the basis of in vitro experiments with a series of drug-resistant variants of the human neuroblastoma BE (2)-C cell line, a mathematic model of 11C-CHC distribution in tumors was formulated. Dynamic PET 11C-CHC imaging experiments were performed with nude rats xenografted with the BE (2)-C-sensitive and -resistant strains. Each scan was accompanied by a transmissions scan and a static FDG scan. These scans allowed improved image localization. RESULTS We observed an approximately 2-fold difference between 11C-CHC accumulation in sensitive and resistant tumors. Imaging data were analyzed using the mathematic model, and various parameters characterizing resistance could be identified and estimated. In particular, the parameter r, proportional to the level of resistance of the tumors, was obtained. We showed that the ratio of these r parameters determined from the sensitive and resistant tumors was identical to the ratio of CHC accumulation in the corresponding sensitive and resistant cell lines used for xenografting. CONCLUSION These in vivo experiments provided additional evidence for the indirect effect of P-gp action on CHC-to-tubulin binding, which in turn determines CHC uptake in tumors. The significance of these findings and future plans is discussed.
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Affiliation(s)
- A Levchenko
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Tjuvajev JG, Avril N, Oku T, Sasajima T, Miyagawa T, Joshi R, Safer M, Beattie B, DiResta G, Daghighian F, Augensen F, Koutcher J, Zweit J, Humm J, Larson SM, Finn R, Blasberg R. Imaging herpes virus thymidine kinase gene transfer and expression by positron emission tomography. Cancer Res 1998; 58:4333-41. [PMID: 9766661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We report a series of studies that assess the feasibility and sensitivity of imaging of herpes virus type one thymidine kinase (HSV1-tk) gene transfer and expression with [124I]-5-iodo-2'-fluoro-1-beta-D-arabinofuranosyluracil ([124I]-FIAU) and positron emission tomography (PET) and the ability of [124I]-FIAU-PET imaging to discriminate different levels of HSV1-tk gene expression. Studies were performed in rats bearing multiple s.c. tumors derived from W256 rat carcinoma and RG2 rat glioma cells. In the first set, we tested the sensitivity of [124I]-FIAU-PET imaging to detect low levels of HSV1-tk gene expression after retroviral-mediated gene transfer. HSV1-tk gene transduction of one of preestablished wild-type W256 tumor in each animal was accomplished by direct intratumoral injection of retroviral vector-producer cells (W256-->W256TK* tumors). Tumors produced from W256 and W256TK+ cells served as the negative and positive control in each animal. Highly specific images of [124I]-FIAU-derived radioactivity were obtained in W256TK* tumors (that were transduced in vivo) and in W256TK+ tumors but not in nontransduced wild-type W256 tumors. The level of "specific" incorporated radioactivity in transduced portions of both W256TK* and W256TK+ tumors was relatively constant between 4 and 50 h. In the second set, we tested whether [124I]-FIAU and PET imaging can measure and discriminate between different levels of HSV1-tk gene expression. Multiple s.c. tumors were produced from wild-type RG2 cells and stably transduced RG2TK cell lines that express different levels of HSV1-tk. A highly significant relationship between the level of [124I]-FIAU accumulation [% injected dose/g and incorporation constant (Ki)] and an independent measure of HSV1-tk expression (sensitivity of the transduced tumor cells to ganciclovir, IC50) was demonstrated, and the slope of this relationship was defined as a sensitivity index. We have demonstrated for the first time that highly specific noninvasive images of HSV1-tk expression in experimental animal tumors can be obtained using radiolabeled 2'-fluoro-nucleoside [124I]-FIAU and a clinical PET system. The ability to image the location (distribution) of gene expression and the level of expression over time provides new and useful information for monitoring clinical gene therapy protocols in the future.
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MESH Headings
- Animals
- Antiviral Agents/therapeutic use
- Arabinofuranosyluracil/analogs & derivatives
- Carcinoma 256, Walker/diagnostic imaging
- Carcinoma 256, Walker/enzymology
- Carcinoma 256, Walker/pathology
- Female
- Ganciclovir/therapeutic use
- Gene Transfer Techniques
- Glioma/diagnostic imaging
- Glioma/enzymology
- Glioma/pathology
- Herpesvirus 1, Human/enzymology
- Herpesvirus 1, Human/genetics
- Iodine Radioisotopes
- Magnetic Resonance Imaging
- Mammary Neoplasms, Experimental/diagnostic imaging
- Mammary Neoplasms, Experimental/enzymology
- Mammary Neoplasms, Experimental/pathology
- Neoplasms, Experimental/diagnostic imaging
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/enzymology
- Neoplasms, Experimental/pathology
- Rats
- Rats, Nude
- Sensitivity and Specificity
- Thymidine Kinase/analysis
- Thymidine Kinase/biosynthesis
- Thymidine Kinase/genetics
- Tomography, Emission-Computed
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Affiliation(s)
- J G Tjuvajev
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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