Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT
Abstract Background Bone marrow toxicity in advanced prostate cancer patients who receive [177Lu]Lu-PSMA-617 is a well-known concern. In early stage patients; e.g. low volume metastatic hormone sensitive prostate cancer (mHSPC) patients, prevention of late bone marrow toxicity is even more crucial d...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-04-01
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| Series: | EJNMMI Physics |
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| Online Access: | https://doi.org/10.1186/s40658-024-00636-0 |
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| author | Dagmar Grob Bastiaan M. Privé Constantijn H. J. Muselaers Niven Mehra James Nagarajah Mark W. Konijnenberg Steffie M. B. Peters |
| author_facet | Dagmar Grob Bastiaan M. Privé Constantijn H. J. Muselaers Niven Mehra James Nagarajah Mark W. Konijnenberg Steffie M. B. Peters |
| author_sort | Dagmar Grob |
| collection | DOAJ |
| description | Abstract Background Bone marrow toxicity in advanced prostate cancer patients who receive [177Lu]Lu-PSMA-617 is a well-known concern. In early stage patients; e.g. low volume metastatic hormone sensitive prostate cancer (mHSPC) patients, prevention of late bone marrow toxicity is even more crucial due to longer life expectancy. To date, bone marrow dosimetry is primarily performed using blood sampling. This method is time consuming and does not account for possible active bone marrow uptake. Therefore other methodologies are investigated. We calculated the bone marrow absorbed dose for [177Lu]Lu-PSMA-617 in mHSPC patients using SPECT/CT imaging and compared it to the blood sampling method as reference. Methods Eight mHSPC patients underwent two cycles (3 and 6 GBq) of [177Lu]Lu-PSMA-617 therapy. After each cycle, five time point (1 h, 1 day, 2 days, 3 days, 7 days) SPECT/CT was performed at kidney level. Bone marrow dosimetry was performed using commercial software by drawing ten 1.5 cm diameter spheres in the lowest ten vertebrae to determine the time-integrated activity. Simplified protocols using only 2 imaging time points and 3 vertebrae were also compared. Blood-based dosimetry was based on the blood sampling method according to the EANM guideline. Results Mean bone marrow absorbed dose was significantly different (p < 0.01) for the imaging based method (25.4 ± 8.7 mGy/GBq) and the blood based method (17.2 ± 3.4 mGy/GBq), with an increasing absorbed dose ratio between both methods over time. Bland Altman analysis of both simplification steps showed that differences in absorbed dose were all within the 95% limits of agreement. Conclusion This study showed that bone marrow absorbed dose after [177Lu]Lu-PSMA-617 can be determined using an imaging-based method of the lower vertebrae, and simplified using 2 time points (1 and 7 days) and 3 vertebrae. An increasing absorbed dose ratio over time between the imaging-based method and blood-based method suggests that there might be specific bone marrow binding of [177Lu]Lu-PSMA-617. |
| first_indexed | 2024-04-24T12:35:07Z |
| format | Article |
| id | doaj.art-6dbce80e4d6b49a5afe0d91156498091 |
| institution | Directory Open Access Journal |
| issn | 2197-7364 |
| language | English |
| last_indexed | 2024-04-24T12:35:07Z |
| publishDate | 2024-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | EJNMMI Physics |
| spelling | doaj.art-6dbce80e4d6b49a5afe0d911564980912024-04-07T11:31:29ZengSpringerOpenEJNMMI Physics2197-73642024-04-0111111210.1186/s40658-024-00636-0Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CTDagmar Grob0Bastiaan M. Privé1Constantijn H. J. Muselaers2Niven Mehra3James Nagarajah4Mark W. Konijnenberg5Steffie M. B. Peters6Department of Medical Imaging, Radboud University Medical CenterDepartment of Medical Imaging, Radboud University Medical CenterDepartment of Urology, Radboud University Medical CenterDepartment of Medical Oncology, Radboud University Medical CenterDepartment of Medical Imaging, Radboud University Medical CenterDepartment of Medical Imaging, Radboud University Medical CenterDepartment of Medical Imaging, Radboud University Medical CenterAbstract Background Bone marrow toxicity in advanced prostate cancer patients who receive [177Lu]Lu-PSMA-617 is a well-known concern. In early stage patients; e.g. low volume metastatic hormone sensitive prostate cancer (mHSPC) patients, prevention of late bone marrow toxicity is even more crucial due to longer life expectancy. To date, bone marrow dosimetry is primarily performed using blood sampling. This method is time consuming and does not account for possible active bone marrow uptake. Therefore other methodologies are investigated. We calculated the bone marrow absorbed dose for [177Lu]Lu-PSMA-617 in mHSPC patients using SPECT/CT imaging and compared it to the blood sampling method as reference. Methods Eight mHSPC patients underwent two cycles (3 and 6 GBq) of [177Lu]Lu-PSMA-617 therapy. After each cycle, five time point (1 h, 1 day, 2 days, 3 days, 7 days) SPECT/CT was performed at kidney level. Bone marrow dosimetry was performed using commercial software by drawing ten 1.5 cm diameter spheres in the lowest ten vertebrae to determine the time-integrated activity. Simplified protocols using only 2 imaging time points and 3 vertebrae were also compared. Blood-based dosimetry was based on the blood sampling method according to the EANM guideline. Results Mean bone marrow absorbed dose was significantly different (p < 0.01) for the imaging based method (25.4 ± 8.7 mGy/GBq) and the blood based method (17.2 ± 3.4 mGy/GBq), with an increasing absorbed dose ratio between both methods over time. Bland Altman analysis of both simplification steps showed that differences in absorbed dose were all within the 95% limits of agreement. Conclusion This study showed that bone marrow absorbed dose after [177Lu]Lu-PSMA-617 can be determined using an imaging-based method of the lower vertebrae, and simplified using 2 time points (1 and 7 days) and 3 vertebrae. An increasing absorbed dose ratio over time between the imaging-based method and blood-based method suggests that there might be specific bone marrow binding of [177Lu]Lu-PSMA-617.https://doi.org/10.1186/s40658-024-00636-0Bone marrow dosimetryAbsorbed doseRadionuclide therapy177-Lu-PSMA |
| spellingShingle | Dagmar Grob Bastiaan M. Privé Constantijn H. J. Muselaers Niven Mehra James Nagarajah Mark W. Konijnenberg Steffie M. B. Peters Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT EJNMMI Physics Bone marrow dosimetry Absorbed dose Radionuclide therapy 177-Lu-PSMA |
| title | Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT |
| title_full | Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT |
| title_fullStr | Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT |
| title_full_unstemmed | Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT |
| title_short | Bone marrow dosimetry in low volume mHSPC patients receiving Lu-177-PSMA therapy using SPECT/CT |
| title_sort | bone marrow dosimetry in low volume mhspc patients receiving lu 177 psma therapy using spect ct |
| topic | Bone marrow dosimetry Absorbed dose Radionuclide therapy 177-Lu-PSMA |
| url | https://doi.org/10.1186/s40658-024-00636-0 |
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