Abstract
241447
Introduction: The recent ZIRCON trial entailed the use of 89Zr-girentuximab PET/CT imaging for patients with clear cell renal carcinoma. 89Zr is emerging as a popular radionuclide for imaging; however, safety procedures for healthcare providers working with the radionuclide have not been well established. We took quantitative radiation dose rate measurements from the drug vial, a controlled spill, and from a patient to guide assessment of the radiation risk and necessary control procedures.
Methods: A single site took dose rate measurements 0.05, 0.5, and 1 metres from the 89Zr-girentuximab vial and 1 metre from a 1 mL-controlled spill on an absorbent surface. A patient enrolled in the ZIRCON study was administered 37MBq 89Zr-girentuximab, and dose rate measurements were taken at 3 distances from the patient’s anterior (surface, 1 and 2 metres) at 5 timepoints: immediately following infusion (defined as Day 0), Hour 2 on Day 0, Day 3, Day 4 before surgery, and Day 4 after surgery. The patient underwent a radical nephrectomy on Day 4, and the radiation dose rates from the surgically removed kidney, surgical equipment, and waste were measured.
Results: The dose rate from the 89Zr-girentuximab vial at 1 metre was 0.2 µSv/hr/MBq and from a controlled spill at 1 meter was 0.52 µSv/hr/MBq (Table 1). The dose rate at the patient surface immediately following infusion was 85 µSv/hr, and at 1 and 2 metres from the patient the dose rate was 4.0 and 1.5 µSv/hr, respectively. After 2 hours, the dose rate at the patient surface, 1, and 2 metres from the patient was 55, 3.1, and 1.9 µSv/hr, respectively. On Day 3, the dose rate at the patient surface, 1, and 2 metres from the patient was 34.0, 3.1, and 1.0 µSv/hr, respectively. On Day 4 before surgery, the dose rate at the patient surface and 1 metre from the patient was 15, and 3.0 µSv/hr, respectively. The dose rate from the removed kidney on Day 4 was measured at 6 µSv/hr at 5 cm. After surgery on Day 4, the dose rate at the patient surface, 1, and 2 metres from the patient was 12, 2.5, and 0.6 µSv/hr (Table 2). Surgical equipment had a low level of contamination, and surgical waste did not measure above background.
Conclusions: Our results demonstrate low radiation exposure levels associated with 89Zr-girentuximab PET/CT and subsequent surgery. Given that the patient studied underwent radical nephrectomy only 4 days after 89Zr-girentuximab administration, with patient surgery occurring 20.5±20.1 days (mean ± SD) after administration in the ZIRCON study, our on-site measurements represent the upper end of the range of expected dose to theatre staff. With recent positive Phase 3 trial results and potential integration of 89Zr-girentuximab into clinical practice, appropriate radiation protection procedures are needed. Dose rate measurements such as those presented here can help guide development of best practices.
Disclosures: The ZIRCON trial was sponsored by Telix Pharmaceuticals. Medical writing support provided by Stefanie Martina and Jess Roetman, Telix Pharmaceuticals.
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