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Maughan NM, Kim H, Hao Y, Unangst S, Roach MC, Garcia-Ramirez JL, Amurao M, Luechtefeld D, Abdin K, Altman MB, Banks A, Riepe M, Bovard E, Jenkins S, Zoberi JE. Initial experience and lessons learned with implementing Lutetium-177-dotatate radiopharmaceutical therapy in a radiation oncology-based program. Brachytherapy 2020; 20:237-247. [PMID: 32819853 DOI: 10.1016/j.brachy.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assist radiation oncology centers in implementing Lutetium-177-dotatate (177Lu) radiopharmaceutical therapy for midgut neuroendocrine tumors. Here we describe our workflow and how it was revised based on our initial experience on an expanded access protocol (EAP). METHODS A treatment team/area was identified. An IV-pump-based infusion technique was implemented. Exposure-based techniques were implemented to determine completion of administration, administered activity, and patient releasability. Acute toxicities were assessed at each fraction. A workflow failure modes and effects analysis (FMEA) was performed. RESULTS A total of 22 patients were treated: 11 patients during EAP (36 administrations) and 11 patients after EAP (44 administrations). Mean 177Lu infusion time was 37 min (range 26-65 min). Mean administered activity was 97% (range 90-99%). Mean patient exposures at 1 m were 1.9 mR/h (range 1.0-4.1 mR/h) post-177Lu and 0.9 mR/h (range 0.4-1.8 mR/h) at discharge, rendering patients releasable with instructions. Treatment area was decontaminated and released same day. All patients in the EAP experienced nausea, and nearly half experienced emesis despite premedication with antiemetics. Peripheral IV-line complications occurred in six treatments (16.7%), halting administration in 2 cases (5.6%). We transitioned to peripherally inserted central catheter (PICC)-lines and revised amino acid formulary after the EAP. The second cohort of 11 patients after EAP were analyzed for PICC-line complications and acute toxicity. Nausea and emesis rates decreased (nausea G1+ 61%-27%; emesis G1+ 23%-7%), and no PICC complications were observed. FMEA revealed that a failure in amino acid preparation was the highest risk. CONCLUSION 177Lu-dotatate can be administered safely in an outpatient radiation oncology department.
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Affiliation(s)
- Nichole M Maughan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Michael C Roach
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jose L Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Max Amurao
- Radiation Safety Division, EH&S Department, Washington University in St. Louis, St Louis, MO
| | - David Luechtefeld
- Radiation Safety Division, EH&S Department, Washington University in St. Louis, St Louis, MO
| | - Kinda Abdin
- Radiation Safety Division, EH&S Department, Washington University in St. Louis, St Louis, MO
| | - Michael B Altman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Alexis Banks
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Mary Riepe
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Erica Bovard
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Samantha Jenkins
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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