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Meeting ReportOral - PhysicianPharm

Can absorbed radiation doses by organs and tumors after PRRT be estimated from a single SPECT/CT study?

Alexandre Chicheportiche, Moshe Sason, Yodphat Krausz, Jeremy Godefroy, Simona Grozinsky-Glasberg, Kira Oleinikov, Amichay Meirovitz, David Gross and Simona Ben-Haim
Journal of Nuclear Medicine May 2021, 62 (supplement 1) 18;
Alexandre Chicheportiche
1Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
2Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Moshe Sason
1Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
2Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Yodphat Krausz
3Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
1Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
2Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Jeremy Godefroy
1Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
2Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Simona Grozinsky-Glasberg
3Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
4ENETS Center of Excellence, Endocrinology and Metabolism Department Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Kira Oleinikov
4ENETS Center of Excellence, Endocrinology and Metabolism Department Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Amichay Meirovitz
5Oncology Department and Radiation Therapy Unit Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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David Gross
3Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
4ENETS Center of Excellence, Endocrinology and Metabolism Department Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
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Simona Ben-Haim
6Institute of Nuclear Medicine University College London and UCL Hospitals NHS Trust London United Kingdom
1Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
2Department of Nuclear Medicine & Biophysics Hadassah-Hebrew University Medical Center - Ein Kerem Jerusalem Israel
3Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
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Abstract

18

Objectives: After each cycle of [177Lu]-DOTA-TATE Peptide Receptor Radionuclide Therapy (PRRT), dosimetry is performed to enable calculation of the radiation absorbed dose to tumors and normal organs. In our center absorbed doses are typically calculated from three quantitative Single Photon Emission Computed Tomography (SPECT) studies corrected by Computed Tomography (CT) acquired at t1=24 h, t2=96 h, t3=168 h after the first cycle of treatment and from a single SPECT/CT study performed at t1 after the following cycles. The aim of the present study was to assess the feasibility of using a single quantitative SPECT/CT study after each PRRT cycle and a trained multiple linear regression (MLR) model for absorbed dose calculation, and to evaluate its impact on patient management.

Methods: Quantitative [177Lu]-DOTA-TATE SPECT/CT data after PRRT of seventy-two consecutive patients with metastatic neuroendocrine tumors were retrospectively evaluated. A set of 40 consecutive studies was used to train the MLR model. Independent variables included the time of imaging ts after administration of [177Lu]-DOTA-TATE (i.e., t1, t2 or t3), the volume and counts in a given tumor/organ VOI. The dependent variable was the dose absorbed by the organ/tumor of interest obtained with the standard protocol. For bone marrow dosimetry, the MLR model uses as independent variables the time of imaging ts, the blood activity concentration at ts and the volume and counts in the remainder of the body VOI. The model was evaluated in 32 consecutive patients. Management decisions (whether or not treatment was stopped due to dosimetry results) were compared to hypothetical patient management, based on the MLR model for absorbed dose calculation.

Results: There was no difference in management decisions in 32 patients of the test dataset, between the standard protocol with three SPECT/CT studies and MLR model-based protocol using a single SPECT/CT study at ts = t3 after the first cycle and at ts = t1 after the following cycles. The coefficients of determination r2test on the test population between the absorbed doses after the first cycle calculated using the standard protocol and those obtained from the MLR model at ts = t3 were 0.93, 0.97, 0.95, 0.99 and 0.98 for kidneys, bone marrow, liver, spleen and tumors, respectively. Cumulative doses were respectively obtained with a mean relative difference of -0.5% ± 5.4%, 1.6% ± 15.1%, -6.2% ± 7.3%, -5.5% ± 5.8% and 2.9% ± 12.7% and a coefficient of determination r2 of 0.94, 0.83, 0.96, 0.97 and 0.96.

Conclusions: Dosimetry calculations using a simple MLR model with a single quantitative SPECT/CT study are feasible and are in good agreement with the standard protocol with three SPECT/CT studies with no change in patient management decisions, while avoiding the use of dosimetry software and enabling improved patient comfort and reduced scanner and staff time.

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Journal of Nuclear Medicine
Vol. 62, Issue supplement 1
May 1, 2021
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Can absorbed radiation doses by organs and tumors after PRRT be estimated from a single SPECT/CT study?
Alexandre Chicheportiche, Moshe Sason, Yodphat Krausz, Jeremy Godefroy, Simona Grozinsky-Glasberg, Kira Oleinikov, Amichay Meirovitz, David Gross, Simona Ben-Haim
Journal of Nuclear Medicine May 2021, 62 (supplement 1) 18;

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Can absorbed radiation doses by organs and tumors after PRRT be estimated from a single SPECT/CT study?
Alexandre Chicheportiche, Moshe Sason, Yodphat Krausz, Jeremy Godefroy, Simona Grozinsky-Glasberg, Kira Oleinikov, Amichay Meirovitz, David Gross, Simona Ben-Haim
Journal of Nuclear Medicine May 2021, 62 (supplement 1) 18;
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