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68GaGa-PSMA-11 PET imaging as a predictor for absorbed doses in organs at risk and small lesions in 177LuLu-PSMA-617 treatment
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68GaGa-PSMA-11 PET imaging as a predictor for absorbed doses in organs at risk and small lesions in 177LuLu-PSMA-617 treatment
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68GaGa-PSMA-11 PET imaging as a predictor for absorbed doses in organs at risk and small lesions in 177LuLu-PSMA-617 treatment
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Journal Article
68GaGa-PSMA-11 PET imaging as a predictor for absorbed doses in organs at risk and small lesions in 177LuLu-PSMA-617 treatment
2022
Overview
Introduction
Patient eligibility for [
177
Lu]Lu-PSMA therapy remains a challenge, with only 40–60% response rate when patient selection is done based on the lesion uptake (SUV) on [
68
Ga]Ga-PSMA-PET/CT. Prediction of absorbed dose based on this pre-treatment scan could improve patient selection and help to individualize treatment by maximizing the absorbed dose to target lesions while adhering to the threshold doses for the organs at risk (kidneys, salivary glands, and liver).
Methods
Ten patients with low-volume hormone-sensitive prostate cancer received a pre-therapeutic [
68
Ga]Ga-PSMA-11 PET/CT, followed by 3 GBq [
177
Lu]Lu-PSMA-617 therapy. Intra-therapeutically, SPECT/CT was acquired at 1, 24, 48, 72, and 168 h. Absorbed dose in organs and lesions (
n
= 22) was determined according to the MIRD scheme. Absorbed dose prediction based on [
68
Ga]Ga-PSMA-PET/CT was performed using tracer uptake at 1 h post-injection and the mean tissue effective half-life on SPECT. Predicted PET/actual SPECT absorbed dose ratios were determined for each target volume.
Results
PET/SPECT absorbed dose ratio was 1.01 ± 0.21, 1.10 ± 0.15, 1.20 ± 0.34, and 1.11 ± 0.29 for kidneys (using a 2.2 scaling factor), liver, submandibular, and parotid glands, respectively. While a large inter-patient variation in lesion kinetics was observed, PET/SPECT absorbed dose ratio was 1.3 ± 0.7 (range: 0.4–2.7, correlation coefficient
r
= 0.69,
p
< 0.01).
Conclusion
A single time point [
68
Ga]Ga-PSMA-PET scan can be used to predict the absorbed dose of [
177
Lu]Lu-PSMA therapy to organs, and (to a limited extent) to lesions. This strategy facilitates in treatment management and could increase the personalization of [
177
Lu]Lu-PSMA therapy.
Publisher
Springer Berlin Heidelberg,Springer Nature B.V
Subject
/ Heterocyclic Compounds, 1-Ring
/ Humans
/ Imaging
/ Kidneys
/ Lesions
/ Liver
/ Lutetium
/ Male
/ Medicine
/ Oncology
/ Organs
/ Original
/ Patients
/ Positron Emission Tomography Computed Tomography - methods
/ Positron-Emission Tomography
/ Prostatic Neoplasms, Castration-Resistant - pathology
/ Radiopharmaceuticals - therapeutic use
/ Single photon emission computed tomography
/ Therapy
