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

  • Lisa Bodei
  • Marta Cremonesi
  • Mahila Ferrari
  • Monica Pacifici
  • Chiara M. Grana
  • Mirco Bartolomei
  • Silvia M. Baio
  • Maddalena Sansovini
  • Giovanni Paganelli
Original Article

DOI: 10.1007/s00259-008-0778-1

Cite this article as:
Bodei, L., Cremonesi, M., Ferrari, M. et al. Eur J Nucl Med Mol Imaging (2008) 35: 1847. doi:10.1007/s00259-008-0778-1

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.

Keywords

Renal toxicity90Y-DOTATOC177Lu-DOTATATERadionuclide therapyDosimetry

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Lisa Bodei
    • 1
  • Marta Cremonesi
    • 2
  • Mahila Ferrari
    • 2
  • Monica Pacifici
    • 1
  • Chiara M. Grana
    • 1
  • Mirco Bartolomei
    • 1
  • Silvia M. Baio
    • 1
  • Maddalena Sansovini
    • 1
    • 3
  • Giovanni Paganelli
    • 1
  1. 1.Division of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  2. 2.Health Physics DivisionsEuropean Institute of OncologyMilanItaly
  3. 3.Department of Nuclear MedicineUniversity of BolognaBolognaItaly