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[111In]DOTATOC as a dosimetric substitute for kidney dosimetry during [90Y]DOTATOC therapy: results and evaluation of a combined gamma camera/probe approach

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

During [90Y]DOTATOC therapy, for determination of kidney doses a conventional approach using co-injected [111In]DOTATOC was evaluated for validity, reliability and reproducibility as well as for the influence of methodological variations and bremsstrahlung. Biologically effective doses were estimated by calculating the relative effectiveness (RE) of kidney doses.

Methods

Fractionated [90Y]DOTATOC therapy (n=20 patients, 3.1±0.7 GBq/therapy cycle, 45 therapy cycles) included co-injection of 157±37 MBq [111In]DOTATOC and a nephroprotective infusion regimen. From serial gamma camera/probe measurements, individual region of interest (ROI) sets were established and kidney doses were determined according to MIRDOSE3 (corrected for individual kidney mass) by use of three methodological variants: (1) correction for interfering organs (liver/spleen) and background activity, (2) correction for interfering organs alone and (3) no corrections. A phantom study was performed with 111 In alone and with 111In +90Y to estimate the influence of 90Y bremsstrahlung.

Results

Mean kidney dose (method 1, n=20 patients, 20 therapy cycles) was 1.51±0.60 Gy/GBq [90Y]DOTATOC (1.41±0.48 Gy/GBq for n=20 patients, 45 therapy cycles). With partial correction (method 2) or no correction (method 3) for interfering activity, kidney doses increased significantly, to 2.71±1.26 Gy/GBq and 3.15±1.22 Gy/GBq, respectively. The span of REs ranged from 1.02 to 1.24. Inter-observer variability was as high as ±32% (±2SD). 90Y bremsstrahlung accounted for a 4–11% underestimation of obtained target activity.

Conclusion

The obtained kidney doses are highly influenced by methodological variations. Full correction for interfering activity clearly underestimates kidney doses. By comparison, 90Y bremsstrahlung and variability in the relative effectiveness of kidney doses cause minor bias. Inter-observer variability must be considered when interpreting kidney doses.

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Correspondence to Alexander Stahl.

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Stahl, A., Schachoff, S., Beer, A. et al. [111In]DOTATOC as a dosimetric substitute for kidney dosimetry during [90Y]DOTATOC therapy: results and evaluation of a combined gamma camera/probe approach. Eur J Nucl Med Mol Imaging 33, 1328–1336 (2006). https://doi.org/10.1007/s00259-006-0078-6

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  • DOI: https://doi.org/10.1007/s00259-006-0078-6

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