Abstract
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Objectives To determine safety and efficacy of PRRNT in patients with a single kidney or high grade/terminal renal insufficiency in metastasized neuroendocrine tumors.
Methods 25 patients having only one kidney n=19), a functionally single kidney (n=4), or on dialysis (n=2) were treated with Y-90 (n=2), Lu-177 (n=21) DOTATATE, or a combination of Lu-177 and Y-90 (n=2) under maximum renal protection. Cumulative administered activity ranged from 3 to 21 GBq over 2-6 therapy cycles (per cycle activity ranged from 1 to 9 GBq). For assessment of glomerular renal function, Tc-99m DTPA was used and Tc-99m MAG3 for determining the tubular extraction rate (TER). Response assessment was performed using Ga-68 Somatostatin-Receptor PET/CT
Results For nephrotoxicity related to PRRNT, patients under dialysis were excluded. At baseline, 16 patients had kidney insufficiency (<20% n=2; 20-40% n=1; 40-60% n=9; 60-70% n=4); 55% showed improvement of more than 8% (range 8-35%), 35% no change while 18% had a fall of >10%. In patients who had normal baseline kidney function (n=9), 44% showed a fall of more than 10% (range 11-19% corresponding to grade 1 toxicity) while 1 patient (11%) showed 24% fall in renal function. PRRNT resulted in partial remission in 36% and disease stabilization in 36% of the patients. In the remaining 28% the disease remained progressive. 14 patients had grade 1 erythrocytopenia, three patients had grade 1 leucocytopenia and 3 had grade 1 thrombocytopenia. No significant hematotoxicity was observed in two dialysis patients treated with 2 cycles of PRRNT using Lu-177 DOTATATE (dose range 1-3 GBq)
Conclusions PRRNT, performed in patients with a single kidney or severly impaired renal function or even with end-stage renal insifficiency, appears effective without significant nephrotoxicity or hematological toxicity, if performed under maximum nephroprotection and as fractionated regim
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