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Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors

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

An Erratum to this article was published on 09 August 2008

Abstract

Purpose

Peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumours with 90Y-DOTATOC and 177Lu-DOTATATE is promising. The kidney is the critical organ and despite renal protection, function loss may become evident years later. The aim of this study was to analyse renal parameters in patients who had undergone dosimetry before PRRT.

Methods

Among those in protocols at our institution, 28 patients were considered: 23 received 90Y-DOTATOC (3.8–29.2 GBq, median 12.2) and five received 177Lu-DOTATATE (20.7–29.2 GBq, median 23.2). Patients were followed up after therapy for creatinine and creatinine clearance loss (CCL) for 3–97 months (median 30). Renal doses and bio-effective doses (BED) were calculated (MIRD, LQ model).

Results

After 90Y-DOTATOC toxicity on creatinine according to NCI criteria occurred in nine cases (seven grade 1, one grade 2, one grade 3), CCL at 1 year was >5% in 12 cases and >10% in eight. A 28-Gy BED threshold was observed in patients with risk factors (mainly hypertension and diabetes), while it was 40 Gy in patients without risk factors. Probably due to the low number of patients, despite the absence of severe toxicity after hyper-fractionated PRRT, clear correlations between fractionation and toxicity could not be found. After 177Lu-DOTATATE, no toxicity occurred in 1–2 year follow-up; CCL at 1 year >5% occurred in three patients and >10% in two.

Conclusions

Our results indicate the importance of clinical screening for risk factors: In this case, a BED <28 Gy is recommended. Fractionation of therapy is important in order to decrease toxicity, and further studies are needed to evaluate its clinical impact.

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Acknowledgement

The authors thank William Russell-Edu for his kind assistance in revising the English of this manuscript.

Conflict of interest statement

None of the authors have any duality or conflict of interests.

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Authors and Affiliations

  1. Division of Nuclear Medicine, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy

    Lisa Bodei, Monica Pacifici, Chiara M. Grana, Mirco Bartolomei, Silvia M. Baio, Maddalena Sansovini & Giovanni Paganelli

  2. Health Physics Divisions, European Institute of Oncology, Milan, Italy

    Marta Cremonesi & Mahila Ferrari

  3. Department of Nuclear Medicine, University of Bologna, Bologna, Italy

    Maddalena Sansovini

Authors
  1. Lisa Bodei
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  2. Marta Cremonesi
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  3. Mahila Ferrari
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Correspondence to Lisa Bodei.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00259-008-0914-y

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Bodei, L., Cremonesi, M., Ferrari, M. et al. Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors. Eur J Nucl Med Mol Imaging 35, 1847–1856 (2008). https://doi.org/10.1007/s00259-008-0778-1

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