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High-Dose Radioimmunotherapy with ⁹⁰Y-Ibritumomab Tiuxetan: Comparative Dosimetric Study for Tailored Treatment

¹ Division of Medical Physics, European Institute of Oncology, Milan, Italy; ² Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy; ³ Division of Hematoncology, European Institute of Oncology, Milan, Italy; ⁴ Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; and ⁵ Melanomas and Sarcomas Division, European Institute of Oncology, Milan, Italy

View larger version (78K): [in this window] [in a new window]   FIGURE 1.  Whole-body acquisitions. (A) Transmission scan acquired before injection of radiocompound for possible attenuation correction. Energy window is centered on 57Co peak (122 keV, 20%). Flood source of 57Co was set over 1 of 2 detectors of double-head -camera facing patient. (B) From left to right, serial anterior views acquired with energy windows centered on the two 111In peaks (173 and 247 keV, 20%), with energy window centered on 140 keV (9%) for possible scatter correction, and with scatter correction.

View larger version (9K): [in this window] [in a new window]   FIGURE 2.  Clearance from blood. Time–activity curve for bloodstream of patient evaluated using method A with biexponential fit and using method C with standard blood mass and monoexponential fit. % IA = percentage injected activity; PtSpc = patient-specific.

View larger version (58K): [in this window] [in a new window]   FIGURE 3.  Biodistribution images with 111In-ibritumomab tiuxetan. Anterior (ant) and posterior (post) whole-body scintigraphic images (scatter-corrected) were obtained at 2, 18, 80, and 135 h after injection. Images show, in particular, uptake in testes persisting over time (1), bone marrow uptake at level of lumbar vertebrae (2), partially overlapping blood vessel activity in arteries well evident on anterior scans, and nonnegligible uptake in kidneys (3).

View larger version (13K): [in this window] [in a new window]   FIGURE 4.  Absorbed dose ratios comparing method A with methods B and C. Data are median values and ranges in normal organs. Dotted bar indicates variability in patient-specific/reference-mass dose ratio, with both patient-specific absorbed doses and reference-mass absorbed doses obtained using corrected images and OLINDA/EXM code including or excluding mass adjustment option. Black bar indicates variability in ratio of method A to method C, with patient-specific absorbed doses obtained using OLINDA/EXM code with actual mass adjustments and corrected images. Simplified absorbed doses were obtained using noncorrected images and ZevMIRD code (25) with reference phantom (male and female) masses. PtSpc = patient-specific; Ref = reference mass.