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Cicone F, Sjögreen Gleisner K, Sarnelli A, Indovina L, Gear J, Gnesin S, Kraeber-Bodéré F, Bischof Delaloye A, Valentini V, Cremonesi M. The contest between internal and external-beam dosimetry: The Zeno's paradox of Achilles and the tortoise. Phys Med 2024; 117:103188. [PMID: 38042710 DOI: 10.1016/j.ejmp.2023.103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
Radionuclide therapy, also called molecular radiotherapy (MRT), has come of age, with several novel radiopharmaceuticals being approved for clinical use or under development in the last decade. External beam radiotherapy (EBRT) is a well-established treatment modality, with about half of all oncologic patients expected to receive at least one external radiation treatment over their disease course. The efficacy and the toxicity of both types of treatment rely on the interaction of radiation with biological tissues. Dosimetry played a fundamental role in the scientific and technological evolution of EBRT, and absorbed doses to the target and to the organs at risk are calculated on a routine basis. In contrast, in MRT the usefulness of internal dosimetry has long been questioned, and a structured path to include absorbed dose calculation is missing. However, following a similar route of development as EBRT, MRT treatments could probably be optimized in a significant proportion of patients, likely based on dosimetry and radiobiology. In the present paper we describe the differences and the similarities between internal and external-beam dosimetry in the context of radiation treatments, and we retrace the main stages of their development over the last decades.
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Affiliation(s)
- Francesco Cicone
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Nuclear Medicine Unit, "Mater Domini" University Hospital, Catanzaro, Italy.
| | | | - Anna Sarnelli
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Luca Indovina
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
| | - Françoise Kraeber-Bodéré
- Nantes Université, Université Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000 Nantes, France
| | | | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Léost F, Barbet J, Beyler M, Chérel M, Delpon G, Garcion E, Lacerda S, Lepareur N, Rbah-Vidal L, Vaugier L, Visvikis D. ["New Modalities in Cancer Imaging and Therapy" XVth edition of the workshop organized by the network "Tumor Targeting, Imaging, Radiotherapies" of the Cancéropôle Grand-Ouest, 5-8 October 2022, France]. Bull Cancer 2023; 110:1322-1331. [PMID: 37880044 DOI: 10.1016/j.bulcan.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 10/27/2023]
Abstract
The fifteenth edition of the international workshop organized by the "Tumour Targeting and Radiotherapies network" of the Cancéropôle Grand-Ouest focused on the latest advances in internal and external radiotherapy from different disciplinary angles: chemistry, biology, physics, and medicine. The workshop covered several deliberately diverse topics: the role of artificial intelligence, new tools for imaging and external radiotherapy, theranostic aspects, molecules and contrast agents, vectors for innovative combined therapies, and the use of alpha particles in therapy.
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Affiliation(s)
- Françoise Léost
- Cancéropôle Grand-Ouest, IRS-UN, 8, quai Moncousu, 44007 Nantes cedex 1, France.
| | | | - Maryline Beyler
- Université de Brest, UMR CNRS-UBO 6521 CEMCA, 6, avenue V.-Le-Gorgeu, 29200 Brest, France
| | - Michel Chérel
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI(2)NA, Nantes, France
| | - Grégory Delpon
- Institut de cancérologie de l'Ouest, département de physique médicale, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, 4, rue Alfred-Kastler, 44307 Nantes cedex 3, France
| | - Emmanuel Garcion
- Université d'Angers, Inserm, CNRS, Nantes Université, CRCI(2)NA, Angers, France
| | - Sara Lacerda
- Université d'Orléans, centre de biophysique moléculaire, CNRS UPR 4301, rue Charles-Sadron, 45071 Orléans cedex 2, France
| | - Nicolas Lepareur
- Université de Rennes, Inrae, Inserm, CLCC Eugène-Marquis, institut nutrition, métabolismes et cancer (NUMECAN), UMR 1317, Rennes, France
| | - Latifa Rbah-Vidal
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI(2)NA, Nantes, France
| | - Loïg Vaugier
- Institut de cancérologie de l'Ouest, département de physique médicale, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, 4, rue Alfred-Kastler, 44307 Nantes cedex 3, France
| | - Dimitris Visvikis
- Inserm, LaTIM, UMR 1101, IBSAM, UBO, UBL, 22, rue Camille-Desmoulins, 29238 Brest, France
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Davis L, Elmaraghi C, Buscombe JR, Gaze MN. Clinical perspectives on dosimetry in molecular radiotherapy. Phys Med 2023; 114:103154. [PMID: 37805342 DOI: 10.1016/j.ejmp.2023.103154] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Abstract
Molecular radiotherapy is the use of systemically administered unsealed radioactive sources to treat cancer. Theragnostics is the term used to describe paired radiopharmaceuticals localising to a specific target, one optimised for imaging, the other for therapy. For many decades, molecular radiotherapy has developed empirically. Standard administered activity schedules have been used without the prior estimation of the resulting tumour radiation absorbed dose by theragnostic imaging, or its subsequent measurement by serial scanning. This pragmatic approach has benefited many patients, however others who should have benefited have failed to do so as the radiation absorbed dose in the tumour was suboptimal. The accurate prediction and measurement of tumour and organ at risk radiation absorbed doses allows treatment to be personalised, and offers the prospect of improved clinical outcomes. To deliver this for all molecular radiotherapy patients would require not only a significant financial investment in equipment and skilled personnel, but also a change in attitude of those who believe that simple - or simplistic - schedules are easier to deliver, and that accurate dosimetry is too much trouble. Further clinical studies are required to demonstrate beyond doubt that the advantages of individualised treatment planning outweigh the inconvenience, and that the expense is justified by enhanced results.
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Affiliation(s)
- LauraMay Davis
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline Elmaraghi
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - John R Buscombe
- Department of Nuclear Medicine, Barts Health NHS Trust, London, UK
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
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Gear J, Stokke C, Terwinghe C, Gnesin S, Sandström M, Tran-Gia J, Cremonesi M, Cicone F, Verburg F, Hustinx R, Giovanella L, Herrmann K, Gabiña PM. EANM enabling guide: how to improve the accessibility of clinical dosimetry. Eur J Nucl Med Mol Imaging 2023; 50:1861-1868. [PMID: 37086275 PMCID: PMC10287783 DOI: 10.1007/s00259-023-06226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
Dosimetry can be a useful tool for personalization of molecular radiotherapy (MRT) procedures, enabling the continuous development of theranostic concepts. However, the additional resource requirements are often seen as a barrier to implementation. This guide discusses the requirements for dosimetry and demonstrates how a dosimetry regimen can be tailored to the available facilities of a centre. The aim is to help centres wishing to initiate a dosimetry service but may not have the experience or resources of some of the more established therapy and dosimetry centres. The multidisciplinary approach and different personnel requirements are discussed and key equipment reviewed example protocols demonstrating these factors are given in the supplementary material for the main therapies carried out in nuclear medicine, including [131I]-NaI for benign thyroid disorders, [177Lu]-DOTATATE and 131I-mIBG for neuroendocrine tumours and [90Y]-microspheres for unresectable hepatic carcinoma.
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Affiliation(s)
- Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK.
| | - Caroline Stokke
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Christelle Terwinghe
- Department of Nuclear Medicine, Universitair Ziekenhuis Leuven, Louvain, Belgium
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mattias Sandström
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Sweden & Section of Medical Physics, Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Marta Cremonesi
- Radiation Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo Di Oncologia, IRCCS, Milan, Italy
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, Neuroscience Research Centre, PET/RM Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
- Nuclear Medicine Unit, University Hospital "Mater Domini, Catanzaro, Italy
| | - Fredrik Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
- GIGA-CRC in Vivo Imaging, University of Liège, Liège, Belgium
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Pablo Minguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
- Department of Applied Physics, Faculty of Engineering, UPV/EHU, Bilbao, Spain
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Di Domenico G, Di Biaso S, Longo L, Turra A, Tonini E, Longo M, Uccelli L, Bartolomei M. Validation of [Formula: see text]Tc and [Formula: see text]Lu quantification parameters for a Monte Carlo modelled gamma camera. EJNMMI Phys 2023; 10:27. [PMID: 37029829 PMCID: PMC10082889 DOI: 10.1186/s40658-023-00547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE Monte Carlo (MC) simulation in Nuclear Medicine is a powerful tool for modeling many physical phenomena which are difficult to track or measure directly. MC simulation in SPECT/CT imaging is particularly suitable for optimizing the quantification of activity in a patient, and, consequently, the absorbed dose to each organ. To do so, validating MC results with real data acquired with gamma camera is mandatory. The aim of this study was the validation of the calibration factor (CF) and the recovery coefficient (RC) obtained with SIMIND Monte Carlo code for modeling a Siemens Symbia Intevo Excel SPECT-CT gamma camera to ensure optimal [Formula: see text]Tc and [Formula: see text]Lu SPECT quantification. METHODS Phantom experiments using [Formula: see text]Tc and [Formula: see text]Lu have been performed to measure spatial resolution and sensitivity, as well as to evaluate the CF and RC from acquired data. The geometries used for 2D planar imaging were (1) Petri dish and (2) capillary source while for 3D volumetric imaging were (3) a uniform filled cylinder phantom and (4) a Jaszczack phantom with spheres of different volumes. The experimental results have been compared with the results obtained from Monte Carlo simulations performed in the same geometries. RESULTS Comparison shows good accordance between simulated and experimental data. The measured planar spatial resolution was 8.3[Formula: see text] mm for [Formula: see text]Tc and 11.8±0.6 mm for [Formula: see text]Lu. The corresponding data obtained by SIMIND for [Formula: see text]Tc was 7.8±0.1 mm, while for [Formula: see text]Lu was 12.4±0.4 mm. The CF was 110.1±5.5 cps/MBq for Technetium and 18.3±1.0 cps/MBq for Lutetium. The corresponding CF obtained by SIMIND for [Formula: see text]Tc was 107.3±0.3 cps/MBq, while for [Formula: see text]Lu 20.4±0.7 cps/MBq. Moreover, a complete curve RCs vs Volume (ml) both for Technetium and Lutetium was determined to correct the PVE for all volumes of clinical interest. In none of the cases, a RC coefficient equal to 100 was found. CONCLUSIONS The validation of quantification parameters shows that SIMIND can be used for simulating both gamma camera planar and SPECT images of Siemens Symbia Intevo using [Formula: see text]Tc and [Formula: see text]Lu radionuclides for different medical purposes and treatments.
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Affiliation(s)
- Giovanni Di Domenico
- Department of Physics and Earth Science, University of Ferrara, via Saragat 1, 44122 Ferrara, IT Italy
| | - Simona Di Biaso
- Department of Physics and Earth Science, University of Ferrara, via Saragat 1, 44122 Ferrara, IT Italy
| | - Lorenzo Longo
- Department of Physics and Earth Science, University of Ferrara, via Saragat 1, 44122 Ferrara, IT Italy
| | - Alessandro Turra
- Medical Physics Unit, University Hospital, 44124 Ferrara, IT Italy
| | - Eugenia Tonini
- Medical Physics Unit, University Hospital, 44124 Ferrara, IT Italy
| | | | - Licia Uccelli
- Nuclear Medicine Unit, University Hospital, 44124 Ferrara, IT Italy
- Department of Translational Medicine, University of Ferrara, via Fossato di Mortara, 70 c/o viale Eliporto, 44124 Ferrara, IT Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, University Hospital, 44124 Ferrara, IT Italy
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Salas-Ramirez M, Lassmann M, Tran-Gia J. Quantification of the volume fraction of fat, water and bone mineral in spongiosa for red marrow dosimetry in molecular radiotherapy by using a dual-energy (SPECT/)CT. Z Med Phys 2022; 32:428-37. [PMID: 35292186 DOI: 10.1016/j.zemedi.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 11/22/2022]
Abstract
A patient-specific absorbed dose calculation for red marrow dosimetry requires quantifying patient-specific volume fractions of the red marrow, yellow marrow, and trabecular bone in the spongiosa of several skeletal sites. This quantification allows selecting appropriate S values calculated from the parameterized radiation transport models for bone and bone marrow dosimetry. Currently, no comprehensive, individualized, and non-invasive procedure is available for quantifying the volume fractions of red marrow, yellow marrow, and trabecular bone in the spongiosa. This study aims to provide a new quantitative method based on dual-energy computed tomography to fill this gap in red marrow dosimetry using a (SPECT/)CT system. METHODS First, a method for parametrizing the photon attenuation coefficients relative to water was implemented. Next, a method to calculate the effective atomic number (Zeff) and effective mass density (ρeff) using dual-energy CT (DECT) was employed. Lastly, two- and three-material decomposition using a dual-energy quantitative CT method (DEQCT) was performed in an anthropomorphic spine phantom and two bone samples of a boar, respectively. The measurements of Zeff and ρeff were compared with the syngo.CT DE Rho/Z tool (Siemens Healthineers). Furthermore, the DEQCT method implemented in this study (DEQCT-I) was compared with a second DEQCT method based on the use of external material standards (DEQCT-II). DEQCT-II was used as reference method for calculating relative errors. RESULTS The two-material decomposition in the anthropomorphic spine phantom presented a maximum relative error of -10% for the bone mineral density quantification. Furthermore, Zeff and ρeff calculated by DEQCT-I differed from syngo.CT DE Rho/Z tool by less than 4.4% and 1.9%, respectively. The three-material decomposition in the two bone samples showed a maximum relative error of 21%, -17%, and 15% for the quantification of the volume fractions of fat, water, and bone mineral equivalent materials. Lastly, Zeff and ρeff calculated by DEQCT-I differed from syngo.CT DE Rho/Z tool by less than 8.2% and 7.0%, respectively. CONCLUSION This study shows that quantifying the volume fraction of fat, water, and bone mineral using a phantom-independent and post-reconstruction DEQCT method is feasible. DEQCT-I has the advantage of not requiring prior information about the X-ray spectra or the detector sensitivity function, as is the case with spectral-based DEQCT methods. Instead, DEQCT-I, similar to other DEQCT methods depends on the chemical description of reference materials and a beam hardening correction function. DEQCT-I method provides an individualized and non-invasive procedure using a (SPECT/)CT system to apply S values based on the patient-specific volume fractions of yellow marrow, red marrow, and bone mineral in red marrow dosimetry.
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Takakusagi Y, Sugyo A, Tsuji AB, Sudo H, Yasunaga M, Matsumura Y, Sugawara F, Sakaguchi K, Higashi T. The natural sulfoglycolipid derivative SQAP improves the therapeutic efficacy of tissue factor-targeted radioimmunotherapy in the stroma-rich pancreatic cancer model BxPC-3. Transl Oncol 2021; 15:101285. [PMID: 34839108 PMCID: PMC8628266 DOI: 10.1016/j.tranon.2021.101285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/31/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Abstract
SQAP enhanced tumor uptake and the therapeutic efficacy of radiolabeled anti-tissue factor antibody 1849. SQAP allows for a reduction of the dose of the therapeutic agent 90Y-labeled 1849 to half. SQAP did not affect hematologic parameters, or gastrointestinal and respiratory systems in mice. 90Y-labeled 1849 with SQAP potentially increases exposure of tumors to radiation.
α-Sulfoquinovosylacyl-1,3-propanediol (SQAP) is a semi-synthetic derivative of natural sulfoglycolipid that sensitizes tumors to external-beam radiotherapy. How SQAP affects internal radiotherapy, however, is not known. Here, we investigated the effects of SQAP for radioimmunotherapy (RIT) targeting tissue factor (TF) in a stroma-rich refractory pancreatic cancer mouse model, BxPC-3. A low dose of SQAP (2 mg/kg) increased tumor uptake of the 111In-labeled anti-TF antibody 1849, indicating increased tumor perfusion. The addition of SQAP enhanced the growth-inhibitory effect of 90Y-labeled 1849 without leading to severe body weight changes, allowing for the dose of 90Y-labeled 1849 to be reduced to half that when used alone. Histologic analysis revealed few necrotic and apoptotic cells, but Ki-67–positive proliferating cells and increased vascular formation were detected. These results suggest that the addition of a low dose of SQAP may improve the therapeutic efficacy of TF-targeted RIT by increasing tumor perfusion, even for stroma-rich refractory pancreatic cancer.
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Affiliation(s)
- Yoichi Takakusagi
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology (QST-iQMS), 4-9-1 Inage, Chiba 263-8555, Japan; Institute for Quantum Life Science, National Institutes for Quantum and Radiological Science and Technology (QST-iQLS), 4-9-1 Inage, Chiba 263-8555, Japan
| | - Aya Sugyo
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology (QST-iQMS), 4-9-1 Inage, Chiba 263-8555, Japan
| | - Atsushi B Tsuji
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology (QST-iQMS), 4-9-1 Inage, Chiba 263-8555, Japan.
| | - Hitomi Sudo
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology (QST-iQMS), 4-9-1 Inage, Chiba 263-8555, Japan
| | - Masahiro Yasunaga
- Division of Developmental Therapeutics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Yasuhiro Matsumura
- Department of Immune Medicine, National Cancer Center Research Institute 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Fumio Sugawara
- pplied Biological Science, Faculty of Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan; Malignant Tumor Treatment Technologies (M.T.3) Inc., 3-20-2 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Kengo Sakaguchi
- pplied Biological Science, Faculty of Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan; Malignant Tumor Treatment Technologies (M.T.3) Inc., 3-20-2 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology (QST-iQMS), 4-9-1 Inage, Chiba 263-8555, Japan
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Gains JE, Moroz V, Aldridge MD, Wan S, Wheatley K, Laidler J, Peet C, Bomanji JB, Gaze MN. A phase IIa trial of molecular radiotherapy with 177-lutetium DOTATATE in children with primary refractory or relapsed high-risk neuroblastoma. Eur J Nucl Med Mol Imaging 2020; 47:2348-2357. [PMID: 32157433 DOI: 10.1007/s00259-020-04741-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/16/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this phase IIa, open-label, single-centre, single-arm, two-stage clinical trial was to evaluate the safety and activity of 177-lutetium DOTATATE (LuDO) molecular radiotherapy in neuroblastoma. METHODS Children with relapsed or refractory metastatic high-risk neuroblastoma were treated with up to four courses of LuDO. The administered activity was 75 to 100 MBq kg-1 per course, spaced at 8- to 12-week intervals. Outcomes were assessed by the International Neuroblastoma Response Criteria (primary outcome), progression-free survival (PFS), and overall survival (OS). RESULTS The trial recruited 21 patients; eight received the planned four courses. There was dose-limiting haematologic toxicity in one case, but no other significant haematologic or renal toxicities. None of 14 evaluable patients had an objective response at 1 month after completion of treatment (Wilson 90% CI 0.0, 0.16; and 95% CI is 0.0, 0.22). The trial did not therefore proceed to the second stage. The median PFS was 2.96 months (95% CI 1.71, 7.66), and the median OS was 13.0 months (95% CI 2.99, 21.52). CONCLUSION In the absence of any objective responses, the use of LuDO as a single agent at the dose schedule used in this study is not recommended for the treatment of neuroblastoma. There are several reasons why this treatment schedule may not have resulted in objective responses, and as other studies do show benefit, the treatment should not be regarded as being of no value. Further trials designed to overcome this schedule's limitations are required. TRIAL REGISTRATION ISRCTN98918118; URL: https://www.isrctn.com/search?q=98918118.
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Affiliation(s)
- Jennifer E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Veronica Moroz
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Matthew D Aldridge
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Simon Wan
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jennifer Laidler
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Connie Peet
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Jamshed B Bomanji
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
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Gear J, Chiesa C, Lassmann M, Gabiña PM, Tran-Gia J, Stokke C, Flux G. EANM Dosimetry Committee series on standard operational procedures for internal dosimetry for 131I mIBG treatment of neuroendocrine tumours. EJNMMI Phys 2020; 7:15. [PMID: 32144574 PMCID: PMC7060302 DOI: 10.1186/s40658-020-0282-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
The purpose of the EANM Dosimetry Committee Series on "Standard Operational Procedures for Dosimetry" (SOP) is to provide advice to scientists and clinicians on how to perform patient-specific absorbed dose assessments. This SOP describes image and data acquisition parameters and dosimetry calculations to determine the absorbed doses delivered to whole-body, tumour and normal organs following a therapeutic administration of 131I mIBG for the treatment of neuroblastoma or adult neuroendocrine tumours. Recommendations are based on evidence in recent literature where available and on expert opinion within the community. This SOP is intended to promote standardisation of practice within the community and as such is based on the facilities and expertise that should be available to any centre able to perform specialised treatments with radiopharmaceuticals and patient-specific dosimetry. A clinical example is given to demonstrate the application of the absorbed dose calculations.
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Affiliation(s)
- Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK.
| | - Carlo Chiesa
- Nuclear Medicine, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, 97080, Würzburg, Germany
| | - Pablo Mínguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, 97080, Würzburg, Germany
| | - Caroline Stokke
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
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10
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D'Arienzo M, Pimpinella M, De Coste V, Capogni M, Ferrari P, Mariotti F, Iaccarino G, Ungania S, Strigari L. Absorbed dose measurements from a 90Y radionuclide liquid solution using LiF:Mg,Cu,P thermoluminescent dosimeters. Phys Med 2020; 69:127-133. [PMID: 31901837 DOI: 10.1016/j.ejmp.2019.11.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022] Open
Abstract
In the last few years there has been an increasing interest in the measurement of the absorbed dose from radionuclides, with special attention devoted to molecular radiotherapy treatments. In particular, the determination of the absorbed dose from beta emitting radionuclides in liquid solution poses a number of issues when dose measurements are performed using thermoluminescent dosimeters (TLD). Finite volume effect, i.e. the exclusion of radioactivity from the volume occupied by the TLD is one of these. Furthermore, TLDs need to be encapsulated into some kind of waterproof envelope that unavoidably contributes to beta particle attenuation during the measurement. The purpose of this study is twofold: I) to measure the absorbed dose to water, Dw, using LiF:Mg,Cu,P chips inside a PMMA cylindrical phantom filled with a homogenous 90YCl3 aqueous solution II) to assess the uncertainty budget related to Dw measurements. To this purpose, six cylindrical PMMA phantoms were manufactured at ENEA. Each phantom can host a waterproof PMMA stick containing 3 TLD chips encapsulated by a polystyrene envelope. The cylindrical phantoms were manufactured so that the radioactive liquid environment surrounds the whole stick. Finally, Dw measurements were compared with Monte Carlo (MC) calculations. The measurement of absorbed dose to water from 90YCl3 radionuclide solution using LiF:Mg,Cu,P TLDs turned out to be a viable technique, provided that all necessary correction factors are applied. Using this method, a relative combined standard uncertainty in the range 3.1-3.7% was obtained on each Dw measurement. The major source of uncertainty was shown to be TLDs calibration, with associated uncertainties in the range 0.7-2.2%. Comparison of measured and MC-calculated absorbed dose per emitted beta particle provided good results, with the two quantities being in the ratio 1.08.
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Affiliation(s)
- Marco D'Arienzo
- ENEA, National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123 Rome, Italy.
| | - Maria Pimpinella
- ENEA, National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123 Rome, Italy
| | - Vanessa De Coste
- ENEA, National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123 Rome, Italy
| | - Marco Capogni
- ENEA, National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123 Rome, Italy
| | - Paolo Ferrari
- ENEA, Radiation Protection Institute, Bologna Via Martiri di Monte Sole 4, 40129 Bologna, Italy
| | - Francesca Mariotti
- ENEA, Radiation Protection Institute, Bologna Via Martiri di Monte Sole 4, 40129 Bologna, Italy
| | | | - Sara Ungania
- Istituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Lidia Strigari
- Istituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy
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11
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Othman MFB, Verger E, Costa I, Tanapirakgul M, Cooper MS, Imberti C, Lewington VJ, Blower PJ, Terry SYA. In vitro cytotoxicity of Auger electron-emitting [ 67Ga]Ga-trastuzumab. Nucl Med Biol 2019; 80-81:57-64. [PMID: 31889612 PMCID: PMC7099941 DOI: 10.1016/j.nucmedbio.2019.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
Abstract
Introduction Molecular radiotherapy exploiting short-range Auger electron-emitting radionuclides has potential for targeted cancer treatment and, in particular, is an attractive option for managing micrometastatic disease. Here, an approach using chelator-trastuzumab conjugates to target radioactivity to breast cancer cells was evaluated as a proof-of-concept to assess the suitability of 67Ga as a therapeutic radionuclide. Methods THP-trastuzumab and DOTA-trastuzumab were synthesised and radiolabelled with Auger electron-emitters 67Ga and 111In, respectively. Radiopharmaceuticals were tested for HER2-specific binding and internalisation, and their effects on viability (dye exclusion) and clonogenicity of HER2-positive HCC1954 and HER2–negative MDA-MB-231 cell lines was measured. Labelled cell populations were studied by microautoradiography. Results Labelling efficiencies for [67Ga]Ga-THP-trastuzumab and [111In]In-DOTA-trastuzumab were 90% and 98%, respectively, giving specific activities 0.52 ± 0.16 and 0.61 ± 0.11 MBq/μg (78–92 GBq/μmol). At 4 nM total antibody concentration and 200 × 103 cells/mL, [67Ga]Ga-THP-trastuzumab showed higher percentage of cell association (10.7 ± 1.3%) than [111In]In-DOTA-trastuzumab (6.2 ± 1.6%; p = 0.01). The proportion of bound activity that was internalised did not differ significantly for the two tracers (62.1 ± 1.4% and 60.8 ± 15.5%, respectively). At 100 nM, percentage cell binding of both radiopharmaceuticals was greatly reduced compared to 4 nM and did not differ significantly between the two (1.2 ± 1.0% [67Ga]Ga-THP-trastuzumab and 0.8 ± 0.9% for [111In]In-DOTA-trastuzumab). Viability and clonogenicity of HER2-positive cells decreased when each radionuclide was incorporated into cells by conjugation with trastuzumab, but not when the same level of radioactivity was confined to the medium by omitting the antibody conjugation, suggesting that 67Ga needs to be cell-bound or internalised for a therapeutic effect. Microautoradiography showed that radioactivity bound to individual cells varied considerably within the population. Conclusions [67Ga]Ga-THP-trastuzumab reduced cell viability and clonogenicity only when cell-bound, suggesting 67Ga holds promise as a therapeutic radionuclide as part of a targeted radiopharmaceutical. The causes and consequences of non-homogeneous uptake among the cell population should be explored.
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Affiliation(s)
- Muhamad Faiz Bin Othman
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Elise Verger
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Ines Costa
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Meena Tanapirakgul
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Margaret S Cooper
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Cinzia Imberti
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Valerie J Lewington
- Guy's & St Thomas' NHS Foundation Trust, Kings College London, London SE1 9RT, UK
| | - Philip J Blower
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Samantha Y A Terry
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, SE1 7EH, United Kingdom.
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12
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Bobin C, Bouchard J, Chisté V, Collins SM, Dryák P, Fenwick A, Keightley J, Lépy MC, Lourenço V, Robinson AP, Sochorová J, Šolc J, Thiam C. Activity measurements and determination of nuclear decay data of 166Ho in the MRTDosimetry project. Appl Radiat Isot 2019; 153:108826. [PMID: 31525708 DOI: 10.1016/j.apradiso.2019.108826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
Holmium-166 is a high-energy β--emitter radionuclide (~ 1.8 MeV) with a short half-life (~26.8h) that offers great potential as an alternative to 90Y for the treatment of liver cancer based on radioembolization. The possibility of quantitative Single Photon Emission Computed Tomography (SPECT) imaging of the main γ-ray emission at 80.6 keV, in addition to strong paramagnetic properties suitable for Magnetic Resonance Imaging (MRI), complement this therapeutic potential. The present paper describes the measurements carried out in three European radionuclide metrology laboratories for primary standardization of 166Ho and new determinations of X- and γ-ray photon-emission intensities in the framework of the European EMPIR project MRTDosimetry. New half-life measurements were also performed.
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Affiliation(s)
- C Bobin
- CEA, LIST, Laboratoire National Henri Becquerel, (LNE-LNHB), 91191, Gif-sur-Yvette Cedex, France.
| | - J Bouchard
- CEA, LIST, Laboratoire National Henri Becquerel, (LNE-LNHB), 91191, Gif-sur-Yvette Cedex, France
| | - V Chisté
- CEA, LIST, Laboratoire National Henri Becquerel, (LNE-LNHB), 91191, Gif-sur-Yvette Cedex, France
| | - S M Collins
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom
| | - P Dryák
- Czech Metrology Institute, Okruzni 31, 638 00, Brno, Czech Republic
| | - A Fenwick
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom
| | - J Keightley
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom
| | - M-C Lépy
- CEA, LIST, Laboratoire National Henri Becquerel, (LNE-LNHB), 91191, Gif-sur-Yvette Cedex, France
| | - V Lourenço
- CEA, LIST, Laboratoire National Henri Becquerel, (LNE-LNHB), 91191, Gif-sur-Yvette Cedex, France
| | - A P Robinson
- National Physical Laboratory, Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom; University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom; Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, United Kingdom
| | - J Sochorová
- Czech Metrology Institute, Okruzni 31, 638 00, Brno, Czech Republic
| | - J Šolc
- Czech Metrology Institute, Okruzni 31, 638 00, Brno, Czech Republic
| | - C Thiam
- CEA, LIST, Laboratoire National Henri Becquerel, (LNE-LNHB), 91191, Gif-sur-Yvette Cedex, France
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13
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Wevrett J, Fenwick A, Scuffham J, Johansson L, Gear J, Schlögl S, Segbers M, Sjögreen-Gleisner K, Solný P, Lassmann M, Tipping J, Nisbet A. Inter-comparison of quantitative imaging of lutetium-177 ( 177Lu) in European hospitals. EJNMMI Phys 2018; 5:17. [PMID: 30069805 PMCID: PMC6070453 DOI: 10.1186/s40658-018-0213-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/13/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This inter-comparison exercise was performed to demonstrate the variability of quantitative SPECT/CT imaging for lutetium-177 (177Lu) in current clinical practice. Our aim was to assess the feasibility of using international inter-comparison exercises as a means to ensure consistency between clinical sites whilst enabling the sites to use their own choice of quantitative imaging protocols, specific to their systems. Dual-compartment concentric spherical sources of accurately known activity concentrations were prepared and sent to seven European clinical sites. The site staff were not aware of the true volumes or activity within the sources-they performed SPECT/CT imaging of the source, positioned within a water-filled phantom, using their own choice of parameters and reported their estimate of the activities within the source. RESULTS The volumes reported by the participants for the inner section of the source were all within 29% of the true value and within 60% of the true value for the outer section. The activities reported by the participants for the inner section of the source were all within 20% of the true value, whilst those reported for the outer section were up to 83% different to the true value. CONCLUSIONS A variety of calibration and segmentation methods were used by the participants for this exercise which demonstrated the variability of quantitative imaging across clinical sites. This paper presents a method to assess consistency between sites using different calibration and segmentation methods.
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Affiliation(s)
- Jill Wevrett
- University of Surrey, Guildford, UK.
- National Physical Laboratory, Teddington, UK.
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
| | | | - James Scuffham
- University of Surrey, Guildford, UK
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | | | | | - Marcel Segbers
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Pavel Solný
- Motol University Hospital, Prague, Czech Republic
| | | | - Jill Tipping
- The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew Nisbet
- University of Surrey, Guildford, UK
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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14
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Stokke C, Blakkisrud J, Løndalen A, Dahle J, Martinsen ACT, Holte H, Kolstad A. Pre-dosing with lilotomab prior to therapy with 177Lu-lilotomab satetraxetan significantly increases the ratio of tumor to red marrow absorbed dose in non-Hodgkin lymphoma patients. Eur J Nucl Med Mol Imaging 2018; 45:1233-1241. [PMID: 29470615 PMCID: PMC5953993 DOI: 10.1007/s00259-018-3964-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE 177Lu-lilotomab satetraxetan is a novel anti-CD37 antibody radionuclide conjugate for the treatment of non-Hodgkin lymphoma (NHL). Four arms with different combinations of pre-dosing and pre-treatment have been investigated in a first-in-human phase 1/2a study for relapsed CD37+ indolent NHL. The aim of this work was to determine the tumor and normal tissue absorbed doses for all four arms, and investigate possible variations in the ratios of tumor to organs-at-risk absorbed doses. METHODS Two of the phase 1 arms included cold lilotomab pre-dosing (arm 1 and 4; 40 mg fixed and 100 mg/m2 BSA dosage, respectively) and two did not (arms 2 and 3). All patients were pre-treated with different regimens of rituximab. The patients received either 10, 15, or 20 MBq 177Lu-lilotomab satetraxetan per kg body weight. Nineteen patients were included for dosimetry, and a total of 47 lesions were included. The absorbed doses were calculated from multiple SPECT/CT-images and normalized by administered activity for each patient. Two-sided Student's t tests were used for all statistical analyses. RESULTS Organs with distinct uptake of 177Lu-lilotomab satetraxetan, in addition to tumors, were red marrow (RM), liver, spleen, and kidneys. The mean RM absorbed doses were 0.94, 1.55, 1.44, and 0.89 mGy/MBq for arms 1-4, respectively. For the patients not pre-dosed with lilotomab (arms 2 and 3 combined) the mean RM absorbed dose was 1.48 mGy/MBq, which was significantly higher than for both arm 1 (p = 0.04) and arm 4 (p = 0.02). Of the other organs, the highest uptake was found in the spleen, and there was a significantly lower spleen absorbed dose for arm-4 patients than for the patient group without lilotomab pre-dosing (1.13 vs. 3.20 mGy/MBq; p < 0.01). Mean tumor absorbed doses were 2.15, 2.31, 1.33, and 2.67 mGy/MBq for arms 1-4, respectively. After averaging the tumor absorbed dose for each patient, the patient mean tumor absorbed dose to RM absorbed dose ratios were obtained, given mean values of 1.07 for the patient group not pre-dosed with lilotomab, of 2.16 for arm 1, and of 4.62 for arm 4. The ratios were significantly higher in both arms 1 and 4 compared to the group without pre-dosing (p = 0.05 and p = 0.02). No statistically significant difference between arms 1 and 4 was found. CONCLUSIONS RM is the primary dose-limiting organ for 177Lu-lilotomab satetraxetan treatment, and pre-dosing with lilotomab has a mitigating effect on RM absorbed dose. Increasing the amount of lilotomab from 40 mg to 100 mg/m2 was found to slightly decrease the RM absorbed dose and increase the ratio of tumor to RM absorbed dose. Still, both pre-dosing amounts resulted in significantly higher tumor to RM absorbed dose ratios. The findings encourage continued use of pre-dosing with lilotomab.
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Affiliation(s)
- Caroline Stokke
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway.
| | - Johan Blakkisrud
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ayca Løndalen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Anne C T Martinsen
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- The Department of Physics, University of Oslo, Oslo, Norway
| | - Harald Holte
- Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Arne Kolstad
- Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
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15
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Gains JE, Sebire NJ, Moroz V, Wheatley K, Gaze MN. Immunohistochemical evaluation of molecular radiotherapy target expression in neuroblastoma tissue. Eur J Nucl Med Mol Imaging 2018; 45:402-411. [PMID: 29043399 DOI: 10.1007/s00259-017-3856-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/23/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Neuroblastoma may be treated with molecular radiotherapy, 131I meta-Iodobenzylguanidine and 177Lu Lutetium DOTATATE, directed at distinct molecular targets: Noradrenaline Transporter Molecule (NAT) and Somatostatin Receptor (SSTR2), respectively. This study used immunohistochemistry to evaluate target expression in archival neuroblastoma tissue, to determine whether it might facilitate clinical use of molecular radiotherapy. METHODS Tissue bank samples of formalin fixed paraffin embedded neuroblastoma tissue from patients for whom clinical outcome data were available were sectioned and stained with haematoxylin and eosin, and monoclonal antibodies directed against NAT and SSTR2. Sections were examined blinded to clinical information and scored for the percentage and intensity of tumour cells stained. These data were analysed in conjunction with clinical data. RESULTS Tissue from 75 patients was examined. Target expression scores varied widely between patients: NAT median 45%, inter-quartile range 25% - 65%; and SSTR2 median 55%, interquartile range 30% - 80%; and in some cases heterogeneity of expression between different parts of a tumour was observed. A weak positive correlation was observed between the expression scores of the different targets: correlation coefficient = 0.23, p = 0.05. MYCN amplified tumours had lower SSTR2 scores: mean difference 23% confidence interval 8% - 39%, p < 0.01. Survival did not differ by scores. CONCLUSIONS As expression of both targets is variable and heterogeneous, imaging assessment of both may yield more clinical information than either alone. The clinical value of immunohistochemical assessment of target expression requires prospective evaluation. Variable target expression within a patient may contribute to treatment failure.
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Affiliation(s)
- Jennifer E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Neil J Sebire
- Department of Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Veronica Moroz
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
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16
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Sjögreen Gleisner K, Spezi E, Solny P, Gabina PM, Cicone F, Stokke C, Chiesa C, Paphiti M, Brans B, Sandström M, Tipping J, Konijnenberg M, Flux G. Variations in the practice of molecular radiotherapy and implementation of dosimetry: results from a European survey. EJNMMI Phys 2017; 4:28. [PMID: 29199391 PMCID: PMC5712507 DOI: 10.1186/s40658-017-0193-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, the implementation of dosimetry in molecular radiotherapy (MRT) is not well investigated, and in view of the Council Directive (2013/59/Euratom), there is a need to understand the current availability of dosimetry-based MRT in clinical practice and research studies. The aim of this study was to assess the current practice of MRT and dosimetry across European countries. METHODS An electronic questionnaire was distributed to European countries. This addressed 18 explicitly considered therapies, and for each therapy, a similar set of questions were included. Questions covered the number of patients and treatments during 2015, involvement of medical specialties and medical physicists, implementation of absorbed dose planning, post-therapy imaging and dosimetry, and the basis of therapy prescription. RESULTS Responses were obtained from 26 countries and 208 hospitals, administering in total 42,853 treatments. The most common therapies were 131I-NaI for benign thyroid diseases and thyroid ablation of adults. The involvement of a medical physicist (mean over all 18 therapies) was reported to be either minority or never by 32% of the responders. The percentage of responders that reported that dosimetry was included on an always/majority basis differed between the therapies and showed a median value of 36%. The highest percentages were obtained for 177Lu-PSMA therapy (100%), 90Y microspheres of glass (84%) and resin (82%), 131I-mIBG for neuroblastoma (59%), and 131I-NaI for benign thyroid diseases (54%). The majority of therapies were prescribed based on fixed-activity protocols. The highest number of absorbed-dose based prescriptions were reported for 90Y microsphere treatments in the liver (64% and 96% of responses for resin and glass, respectively), 131I-NaI treatment of benign thyroid diseases (38% of responses), and for 131I-mIBG treatment of neuroblastoma (18% of responses). CONCLUSIONS There is a wide variation in MRT practice across Europe and for different therapies, including the extent of medical-physicist involvement and the implementation of dosimetry-guided treatments.
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Affiliation(s)
| | | | - Pavel Solny
- Department of Nuclear Medicine and Endocrinology, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Francesco Cicone
- Nuclear Medicine, Sant’Andrea Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Carlo Chiesa
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Paphiti
- Department of Medical Physics, Pammakaristos Hospital, Athens, Greece
| | - Boudewijn Brans
- Department of Nuclear Medicine and PET Center, University Hospital, Ghent, Belgium
| | - Mattias Sandström
- Department of Surgical Sciences, Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Jill Tipping
- The Christie NHS Foundation Trust, Nuclear Medicine, Manchester, UK
| | - Mark Konijnenberg
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
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17
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D'Arienzo M, Pimpinella M, Capogni M, De Coste V, Filippi L, Spezi E, Patterson N, Mariotti F, Ferrari P, Chiaramida P, Tapner M, Fischer A, Paulus T, Pani R, Iaccarino G, D'Andrea M, Strigari L, Bagni O. Phantom validation of quantitative Y-90 PET/CT-based dosimetry in liver radioembolization. EJNMMI Res 2017; 7:94. [PMID: 29185067 PMCID: PMC5705539 DOI: 10.1186/s13550-017-0341-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/29/2017] [Indexed: 12/20/2022] Open
Abstract
Background PET/CT has recently been shown to be a viable alternative to traditional post-infusion imaging methods providing good quality images of 90Y-laden microspheres after selective internal radiation therapy (SIRT). In the present paper, first we assessed the quantitative accuracy of 90Y-PET using an anthropomorphic phantom provided with lungs, liver, spine, and a cylindrical homemade lesion located into the hepatic compartment. Then, we explored the accuracy of different computational approaches on dose calculation, including (I) direct Monte Carlo radiation transport using Raydose, (II) Kernel convolution using Philips Stratos, (III) local deposition algorithm, (IV) Monte Carlo technique (MCNP) considering a uniform activity distribution, and (V) MIRD (Medical Internal Radiation Dose) analytical approach. Finally, calculated absorbed doses were compared with those obtained performing measurements with LiF:Mg,Cu,P TLD chips in a liquid environment. Results Our results indicate that despite 90Y-PET being likely to provide high-resolution images, the 90Y low branch ratio, along with other image-degrading factors, may produce non-uniform activity maps, even in the presence of uniform activity. A systematic underestimation of the recovered activity, both for the tumor insert and for the liver background, was found. This is particularly true if no partial volume correction is applied through recovery coefficients. All dose algorithms performed well, the worst case scenario providing an agreement between absorbed dose evaluations within 20%. Average absorbed doses determined with the local deposition method are in excellent agreement with those obtained using the MIRD and the kernel-convolution dose calculation approach. Finally, absorbed dose assessed with MC codes are in good agreement with those obtained using TLD in liquid solution, thus confirming the soundness of both calculation approaches. This is especially true for Raydose, which provided an absorbed dose value within 3% of the measured dose, well within the stated uncertainties. Conclusions Patient-specific dosimetry is possible even in a scenario with low true coincidences and high random fraction, as in 90Y–PET imaging, granted that accurate absolute PET calibration is performed and acquisition times are sufficiently long. Despite Monte Carlo calculations seeming to outperform all dose estimation algorithms, our data provide a strong argument for encouraging the use of the local deposition algorithm for routine 90Y dosimetry based on PET/CT imaging, due to its simplicity of implementation.
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Affiliation(s)
- Marco D'Arienzo
- ENEA, Italian National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123, Rome, Italy. .,Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University, Rome, Italy.
| | - Maria Pimpinella
- ENEA, Italian National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123, Rome, Italy
| | - Marco Capogni
- ENEA, Italian National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123, Rome, Italy
| | - Vanessa De Coste
- ENEA, Italian National Institute of Ionizing Radiation Metrology, Via Anguillarese 301, 00123, Rome, Italy
| | - Luca Filippi
- Nuclear Medicine Department, Santa Maria Goretti Hospital, Latina, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, CF24 3AA, United Kingdom.,Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | - Nick Patterson
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | - Francesca Mariotti
- ENEA, Radiation Protection Institute, Bologna Via Martiri di Monte Sole 4, 40129, Bologna, Italy
| | - Paolo Ferrari
- ENEA, Radiation Protection Institute, Bologna Via Martiri di Monte Sole 4, 40129, Bologna, Italy
| | | | | | - Alexander Fischer
- Philips Technologie GmbH Innovative Technologies, Research Laboratories Pauwelsstr, 17, 52074, Aachen, Germany
| | - Timo Paulus
- Philips Technologie GmbH Innovative Technologies, Research Laboratories Pauwelsstr, 17, 52074, Aachen, Germany
| | - Roberto Pani
- Depertment of Medico-surgical Sciences and Biotecnologies, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Iaccarino
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Marco D'Andrea
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Oreste Bagni
- Nuclear Medicine Department, Santa Maria Goretti Hospital, Latina, Italy
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18
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Stokke C, Gabiña PM, Solný P, Cicone F, Sandström M, Gleisner KS, Chiesa C, Spezi E, Paphiti M, Konijnenberg M, Aldridge M, Tipping J, Wissmeyer M, Brans B, Bacher K, Kobe C, Flux G. Dosimetry-based treatment planning for molecular radiotherapy: a summary of the 2017 report from the Internal Dosimetry Task Force. EJNMMI Phys 2017; 4:27. [PMID: 29164483 PMCID: PMC5698234 DOI: 10.1186/s40658-017-0194-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The European directive on basic safety standards (Council directive 2013/59 Euratom) mandates dosimetry-based treatment planning for radiopharmaceutical therapies. The directive comes into operation February 2018, and the aim of a report produced by the Internal Dosimetry Task Force of the European Association of Nuclear Medicine is to address this aspect of the directive. A summary of the report is presented. RESULTS A brief review of five of the most common therapy procedures is included in the current text, focused on the potential to perform patient-specific dosimetry. In the full report, 11 different therapeutic procedures are included, allowing additional considerations of effectiveness, references to specific literature on quantitative imaging and dosimetry, and existing evidence for absorbed dose-effect correlations for each treatment. Individualized treatment planning with tracer diagnostics and verification of the absorbed doses delivered following therapy is found to be scientifically feasible for almost all procedures investigated, using quantitative imaging and/or external monitoring. Translation of this directive into clinical practice will have significant implications for resource requirements. CONCLUSIONS Molecular radiotherapy is undergoing a significant expansion, and the groundwork for dosimetry-based treatment planning is already in place. The mandated individualization is likely to improve the effectiveness of the treatments, although must be adequately resourced.
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Affiliation(s)
- Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.
| | - Pablo Minguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Pavel Solný
- Department of Dosimetry and Application of Ionizing Radiation, Czech Technical University in Prague, Prague, Czech Republic
| | - Francesco Cicone
- Nuclear Medicine, Sant'Andrea Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Mattias Sandström
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Carlo Chiesa
- Nuclear Medicine Division, Foundation IRCCS istituto nazionale Tumori, Milan, Italy
| | | | - Maria Paphiti
- Department of Medical Physics, Pammakaristos Hospital, Athens, Greece
| | - Mark Konijnenberg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Matt Aldridge
- Nuclear Medicine/Radiotherapy Physics, UCL Institute of Nuclear Medicine and UCL Hospitals NHS Foundation Trust, London, UK
| | - Jill Tipping
- The Christie NHS Foundation Trust, Nuclear Medicine, Manchester, UK
| | - Michael Wissmeyer
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Boudewijn Brans
- Department of Nuclear Medicine and PET Center, University Hospital, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, Division of Medical Physics, Ghent University, Ghent, Belgium
| | - Carsten Kobe
- Department for Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
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19
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Denis-Bacelar AM, Chittenden SJ, Dearnaley DP, Divoli A, O'Sullivan JM, McCready VR, Johnson B, Du Y, Flux GD. Phase I/II trials of 186Re-HEDP in metastatic castration-resistant prostate cancer: post-hoc analysis of the impact of administered activity and dosimetry on survival. Eur J Nucl Med Mol Imaging 2017; 44:620-629. [PMID: 27770145 PMCID: PMC5323472 DOI: 10.1007/s00259-016-3543-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/30/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the role of patient-specific dosimetry as a predictive marker of survival and as a potential tool for individualised molecular radiotherapy treatment planning of bone metastases from castration-resistant prostate cancer, and to assess whether higher administered levels of activity are associated with a survival benefit. METHODS Clinical data from 57 patients who received 2.5-5.1 GBq of 186Re-HEDP as part of NIH-funded phase I/II clinical trials were analysed. Whole-body and SPECT-based absorbed doses to the whole body and bone lesions were calculated for 22 patients receiving 5 GBq. The patient mean absorbed dose was defined as the mean of all bone lesion-absorbed doses in any given patient. Kaplan-Meier curves, log-rank tests, Cox's proportional hazards model and Pearson's correlation coefficients were used for overall survival (OS) and correlation analyses. RESULTS A statistically significantly longer OS was associated with administered activities above 3.5 GBq in the 57 patients (20.1 vs 7.1 months, hazard ratio: 0.39, 95 % CI: 0.10-0.58, P = 0.002). A total of 379 bone lesions were identified in 22 patients. The mean of the patient mean absorbed dose was 19 (±6) Gy and the mean of the whole-body absorbed dose was 0.33 (±0.11) Gy for the 22 patients. The patient mean absorbed dose (r = 0.65, P = 0.001) and the whole-body absorbed dose (r = 0.63, P = 0.002) showed a positive correlation with disease volume. Significant differences in OS were observed for the univariate group analyses according to disease volume as measured from SPECT imaging of 186Re-HEDP (P = 0.03) and patient mean absorbed dose (P = 0.01), whilst only the disease volume remained significant in a multivariable analysis (P = 0.004). CONCLUSION This study demonstrated that higher administered activities led to prolonged survival and that for a fixed administered activity, the whole-body and patient mean absorbed doses correlated with the extent of disease, which, in turn, correlated with survival. This study shows the importance of patient stratification to establish absorbed dose-response correlations and indicates the potential to individualise treatment of bone metastases with radiopharmaceuticals according to patient-specific imaging and dosimetry.
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Affiliation(s)
- Ana M Denis-Bacelar
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK.
| | - Sarah J Chittenden
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - David P Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Antigoni Divoli
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - V Ralph McCready
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Bernadette Johnson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Yong Du
- Department of Nuclear Medicine and PET/CT, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Glenn D Flux
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
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20
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Robinson AP, Tipping J, Cullen DM, Hamilton D, Brown R, Flynn A, Oldfield C, Page E, Price E, Smith A, Snee R. Organ-specific SPECT activity calibration using 3D printed phantoms for molecular radiotherapy dosimetry. EJNMMI Phys 2016; 3:12. [PMID: 27411356 PMCID: PMC4943909 DOI: 10.1186/s40658-016-0148-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/28/2016] [Indexed: 01/09/2023] Open
Abstract
Background Patient-specific absorbed dose calculations for molecular radiotherapy require accurate activity quantification. This is commonly derived from Single-Photon Emission Computed Tomography (SPECT) imaging using a calibration factor relating detected counts to known activity in a phantom insert. Methods A series of phantom inserts, based on the mathematical models underlying many clinical dosimetry calculations, have been produced using 3D printing techniques. SPECT/CT data for the phantom inserts has been used to calculate new organ-specific calibration factors for 99mTc and 177Lu. The measured calibration factors are compared to predicted values from calculations using a Gaussian kernel. Results Measured SPECT calibration factors for 3D printed organs display a clear dependence on organ shape for 99mTc and 177Lu. The observed variation in calibration factor is reproduced using Gaussian kernel-based calculation over two orders of magnitude change in insert volume for 99mTc and 177Lu. These new organ-specific calibration factors show a 24, 11 and 8 % reduction in absorbed dose for the liver, spleen and kidneys, respectively. Conclusions Non-spherical calibration factors from 3D printed phantom inserts can significantly improve the accuracy of whole organ activity quantification for molecular radiotherapy, providing a crucial step towards individualised activity quantification and patient-specific dosimetry. 3D printed inserts are found to provide a cost effective and efficient way for clinical centres to access more realistic phantom data.
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Affiliation(s)
- Andrew P Robinson
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK.
| | - Jill Tipping
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - David M Cullen
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - David Hamilton
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Richard Brown
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - Alex Flynn
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - Christopher Oldfield
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - Emma Page
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK.,Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Emlyn Price
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - Andrew Smith
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - Richard Snee
- Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
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21
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Kletting P, Schimmel S, Hänscheid H, Luster M, Fernández M, Nosske D, Lassmann M, Glatting G. The NUKDOS software for treatment planning in molecular radiotherapy. Z Med Phys 2015; 25:264-74. [PMID: 25791740 DOI: 10.1016/j.zemedi.2015.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 09/12/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 02/04/2023]
Abstract
The aim of this work was the development of a software tool for treatment planning prior to molecular radiotherapy, which comprises all functionality to objectively determine the activity to administer and the pertaining absorbed doses (including the corresponding error) based on a series of gamma camera images and one SPECT/CT or probe data. NUKDOS was developed in MATLAB. The workflow is based on the MIRD formalism For determination of the tissue or organ pharmacokinetics, gamma camera images as well as probe, urine, serum and blood activity data can be processed. To estimate the time-integrated activity coefficients (TIAC), sums of exponentials are fitted to the time activity data and integrated analytically. To obtain the TIAC on the voxel level, the voxel activity distribution from the quantitative 3D SPECT/CT (or PET/CT) is used for scaling and weighting the TIAC derived from the 2D organ data. The voxel S-values are automatically calculated based on the voxel-size of the image and the therapeutic nuclide ((90)Y, (131)I or (177)Lu). The absorbed dose coefficients are computed by convolution of the voxel TIAC and the voxel S-values. The activity to administer and the pertaining absorbed doses are determined by entering the absorbed dose for the organ at risk. The overall error of the calculated absorbed doses is determined by Gaussian error propagation. NUKDOS was tested for the operation systems Windows(®) 7 (64 Bit) and 8 (64 Bit). The results of each working step were compared to commercially available (SAAMII, OLINDA/EXM) and in-house (UlmDOS) software. The application of the software is demonstrated using examples form peptide receptor radionuclide therapy (PRRT) and from radioiodine therapy of benign thyroid diseases. For the example from PRRT, the calculated activity to administer differed by 4% comparing NUKDOS and the final result using UlmDos, SAAMII and OLINDA/EXM sequentially. The absorbed dose for the spleen and tumour differed by 7% and 8%, respectively. The results from the example from radioiodine therapy of benign thyroid diseases and the example given in the latest corresponding SOP were identical. The implemented, objective methods facilitate accurate and reproducible results. The software is freely available.
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Affiliation(s)
- Peter Kletting
- Klinik für Nuklearmedizin, Universität Ulm, Ulm, Germany.
| | | | | | - Markus Luster
- Klinik für Nuklearmedizin, Universität Marburg, Marburg, Germany
| | - Maria Fernández
- Klinik für Nuklearmedizin, Universität Würzburg, Würzburg, Germany
| | - Dietmar Nosske
- Bundesamt für Strahlenschutz, Fachbereich Strahlenschutz und Gesundheit, Oberschleißheim, Germany
| | - Michael Lassmann
- Klinik für Nuklearmedizin, Universität Würzburg, Würzburg, Germany
| | - Gerhard Glatting
- Medical Radiation Physics/Radiation Protection, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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22
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Wilson JS, Gains JE, Moroz V, Wheatley K, Gaze MN. A systematic review of 131I-meta iodobenzylguanidine molecular radiotherapy for neuroblastoma. Eur J Cancer 2014; 50:801-15. [PMID: 24333097 DOI: 10.1016/j.ejca.2013.11.016] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [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: 02/27/2013] [Revised: 09/22/2013] [Accepted: 11/13/2013] [Indexed: 11/19/2022]
Abstract
The optimal use and effectiveness of (131)I-meta iodobenzylguanidine ((131)I-mIBG) molecular radiotherapy for neuroblastoma remain unclear despite extensive clinical experience. This systematic review aimed to improve understanding of the current data and define uncertainties for future clinical trials. Bibliographic databases were searched for neuroblastoma and (131)I-mIBG. Clinical trials and non-comparative case series of (131)I-mIBG therapy for neuroblastoma were included. Two reviewers assessed papers for inclusion using the title and abstract with consensus achieved by discussion. Data were extracted by one reviewer and checked by a second. Studies with multiple publications were reported as a single study. The searches yielded 1216 citations, of which 51 publications reporting 30 studies met our inclusion criteria. No randomised controlled trials (RCTs) were identified. In two studies (131)I-mIBG had been used as induction therapy and in one study it had been used as consolidation therapy. Twenty-seven studies for relapsed and refractory disease were identified. Publication dates ranged from 1987 to 2012. Total number of patients was 1121 with study sizes ranging from 10 to 164. There was a large amount of heterogeneity between the studies with regard to patient population, treatment schedule and response assessment. Study quality was highly variable. The objective tumour response rate reported in 25 studies ranged from 0% to 75%, mean 32%. We conclude that (131)I-mIBG is an active treatment for neuroblastoma, but its place in the management of neuroblastoma remains unclear. Prospective randomised trials are essential to strengthen the evidence base.
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Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Jennifer E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom
| | - Veronica Moroz
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, United Kingdom.
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