Personalized radiation dosimetry for PRRT—how many scans are really required?

• Published in: EJNMMI physics 2020-05, Vol.7 (1), p.26-26, Article 26
• Main Authors: Freedman, Nanette, Sandström, Mattias, Kuten, Jonathan, Shtraus, Natan, Ospovat, Inna, Schlocker, Albert, Even-Sapir, Einat
• Format: Article
• Language: English
• Subjects: 177Lu-DOTATATE; Applied and Technical Physics; Bone marrow; Computational Mathematics and Numerical Analysis; Computed tomography; Curve fitting; Data points; Dosimeters; Dosimetry; Engineering; Estimates; Half-life; Imaging; Lutetium isotopes; Mathematical analysis; Medical imaging; Medicine; Medicine & Public Health; Metastasis; Method dependence; Methods; Neuroendocrine tumors; Nuclear Medicine; Numerical integration; Numerical methods; Organs; Peptides; Radiation therapy; Radiology; Receptors; Short Communication; Tumors
• ISSN: 2197-7364; 2197-7364
• DOI: 10.1186/s40658-020-00293-z

Purpose Over recent years, peptide receptor radiotherapy (PRRT) has been recognized as an effective treatment for patients with metastatic neuroendocrine tumors (NETs). Personalized dosimetry can contribute to improve the outcome of peptide receptor radiotherapy (PRRT) in patients with metastatic NETs. Dosimetry can aid treatment planning, ensuring that absorbed dose to vulnerable normal organs (kidneys and bone marrow) does not exceed safe limits over serial treatments, and that absorbed dose to tumor is sufficient. Absorbed dose is estimated from a series of post-treatment SPECT/CT images. Total self-dose is proportional to the integral under the time activity concentration curve (TACC). Method dependence of image-based absorbed dose calculations has been previously investigated, and we set out here to extend previous work by examining implications of number of data points in the TACC and the numerical integration methods used in estimating absorbed dose. Methods In this retrospective study, absorbed dose estimates and effective half-lives were calculated by fitting curves to TACCs for normal organs and tumors in 30 consecutive patients who underwent a series of 4 post-treatment SPECT/CT scans at 4 h, 24 h, 4–5 days, and 1 week following 177 Lu-DOTATATE PRRT. We examined the effects of including only 2 or 3 rather than all 4 data points in the TACC, and the effect of numerical integration method (mono-exponential alone or in combination with trapezoidal rule) on the absorbed dose and half-life estimates. Our current method is the combination of trapezoidal rule over the first 24 h, with mono-exponential fit thereafter extrapolated to infinity. The other methods were compared to this current method. Results Differences in absorbed dose and effective half-life between the current method and estimates based only on the second, third, and fourth scans were very small (mean differences < 2.5%), whereas differences between the current method and 4-point mono-exponential fit were higher (mean differences < 5%) with a larger range. It appears that in a 4-point mono-exponential fit the early (4 h) time point may skew results, causing some large errors. Differences between the current method and values based on only 2 time points were relatively small (mean differences < 3.5%) when the 24 h and 1 week scans were used, but when the 24 h and 4–5 days scans, or the 4–5 days and 1 week scans were used, differences were greater. Conclusion This study indicates that for