, Volume 34, Issue 6, pp 1368-1372
Date: 12 Jan 2010

[177Lu-DOTA0-Tyr3]-Octreotate Treatment in Patients with Disseminated Gastroenteropancreatic Neuroendocrine Tumors: The Value of Measuring Absorbed Dose to the Kidney

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Abstract

Background

Peptide receptor radiation therapy (PRRT) using [177Lu-DOTA0-Tyr3]-octreotate is a new, promising option for treatment of disseminated gastroenteropancreatic neuroendocrine tumors (GEPNETs).

Methods

During 2006-2008, 26 patients with disseminated GEPNETs were treated with 177Lu-octreotate. Radiologic response (RECIST), biochemical response [plasma chromogranin-A (P-CgA)], hematologic toxicity [Common Toxicity Criteria (CTC)], absorbed dose to the kidneys (conjugate view method), and glomerular filtration rate (GFR) were analyzed.

Results

177Lu-octreotate (8 GBq) was given one to five times (median = 3) with a 6-week interval between each. Sixteen of the 26 patients were evaluated radiologically; 6 (38%) had partial response (PR), 8 (50%) had stable disease (SD), and 2 (13%) had progressive disease (PD). Seventeen of the 26 patients were evaluated biochemically; 6 (35%) showed a ≥30% decrease, 8 (47%) showed a ≥20% increase, and 3 (18%) showed neither a ≥30% decrease nor a ≥20% increase. The mean absorbed dose to the kidneys was 24 Gy. With a dose limit of 27 Gy to the kidneys, 10 patients did not receive the planned four treatments, while four patients had the potential to receive additional treatment. A significant reduction (p = 0.0013) of GFR was observed at follow-up. Three patients experienced CTC grade 3 hematologic toxicity.

Conclusions

By using the absorbed dose to the kidneys as a limiting factor, treatment with 177Lu-octreotate can be individualized, e.g., overtreatment can be avoided and patients with the potential to receive additional treatment can be identified. Further studies are needed to define tolerance doses to the kidneys so that treatment can be optimized.

This article is based on work that was presented at the ISW 2009 IAES free paper session, Adelaide, Australia, 6–10 September 2009.