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Patient dosimetry of 177Lu-PSMA I&T in metastatic prostate cancer treatment: the experience in Thailand

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Abstract

Purpose

This study aimed to determine the radiation dosimetry for 177Lu-PSMA imaging and therapy (I&T) in Thai patients who were treated for metastatic prostate cancer.

Methods

Whole-body planar images acquired at immediately, 4 and 24 h after 177Lu-PSMA I&T injection (range 4.44–8.51 GBq) were collected from 12 treatment cycles of 8 prostate cancer patients. Region of interests (ROIs) were manually contoured on the whole-body, liver, spleen, urinary bladder, lacrimal glands, parotid, and submandibular glands to determine time-integrated activity (TIA) in source organs and fitted time-activity curves using mono-exponential extrapolation. The S values calculated utilizing non-uniform rational B-splines (NURBS) computational phantoms were extracted from the OLINDA/EXM v. 2.0 to calculate the absorbed dose coefficient in target organs according to the Medical Internal Radiation Dose (MIRD) scheme. The absorbed doses to bone marrow were estimated using the planar two-compartment image-based method by separating the high-uptake and low-uptake compartment. The spherical model was used to calculate the lacrimal gland absorbed doses.

Results

Mean absorbed dose coefficients to the kidneys, bone marrow, liver, urinary bladder, spleen, lacrimal glands, parotid, and submandibular glands were 0.81 ± 0.24, 0.02 ± 0.01, 0.13 ± 0.10, 0.27 ± 0.25, 0.16 ± 0.07, 3.62 ± 1.78, 0.21 ± 0.14, and 0.09 ± 0.07 Gy/GBq, respectively. Dose constraints for the kidneys (23 Gy) and bone marrow (2 Gy) were not reached in any patients. The absorbed dose in lacrimal glands calculated by the NURBS computational phantoms was slightly lower than the calculation based on the Cristy–Eckerman computational phantoms using OLINDA/EXM v. 1.0 by 6.37 ± 0.14%.

Conclusion

Dosimetry results in this study suggested that 177Lu-PSMA I&T treatment with higher activities and more cycles is possible without the risk of damaging normal organs in prostate cancer patients.

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Acknowledgements

The authors sincerely thank all staff at the Division of Nuclear Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand, for their kind support in this study. The authors also thanks Dr. Chanan Sukprakun, MD, for his valuable advice. Miss Kotchakorn Chatachot was supported by the graduate school scholarship, Faculty of Medicine, Chulalongkorn University.

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Authors and Affiliations

  1. Medical Physics Program, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Kotchakorn Chatachot & Kitiwat Khamwan

  2. Division of Nuclear Medicine, Department of Radiology, Buddhachinaraj Hospital, Phitsanulok, 65000, Thailand

    Kotchakorn Chatachot

  3. Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand

    Shuichi Shiratori, Tawatchai Chaiwatanarat & Kitiwat Khamwan

  4. Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand

    Shuichi Shiratori

  5. Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Kotchakorn Chatachot, Shuichi Shiratori, Tawatchai Chaiwatanarat & Kitiwat Khamwan

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  1. Kotchakorn Chatachot
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Correspondence to Kitiwat Khamwan.

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Chatachot, K., Shiratori, S., Chaiwatanarat, T. et al. Patient dosimetry of 177Lu-PSMA I&T in metastatic prostate cancer treatment: the experience in Thailand. Ann Nucl Med 35, 1193–1202 (2021). https://doi.org/10.1007/s12149-021-01659-8

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  • DOI: https://doi.org/10.1007/s12149-021-01659-8

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