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The use of molecular volumetric parameters for the evaluation of Lu-177 PSMA I&T therapy response and survival

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Abstract

Purpose

The primary aim of this study was to evaluate the volumetric therapy response via Ga-68 PSMA I&T PET/CT in patients treated with Lu-177 PSMA I&T therapy. The secondary purpose was to determine the impact of volumetric parameter responses to overall survival.

Methods

PSMA tumor volumes (PSMA-TV) and tumor lesion PSMA expressions (TL-PSMA) were calculated with a semi-automatic program on Ga-68 PSMA I&T PET/CT images that were obtained before and after Lu-177 PSMA I&T therapies with 19 patients. The median overall survival was compared with PSMA-TV, TL-PSMA, SUVmax, PSA, and alteration in PERCIST criteria.

Results

PSMA-TV values were decreased in 12 patients (63%), and TL-PSMA values were decreased in 15 patients (79%) following the therapy. The SUVmax and the PSA values were also decreased in 14 (74%) and 10 (53%) patients, respectively. The complete remission (CR) was observed in two patients (10%). The partial response (PR) and progressive disease were observed in 6 (32%) and 11 (58%) patients, respectively, according to PRECIST criteria. The survival rates were statistically significant in patients with a decrease in PSMA-TV and TL-PSMA values than patients without any decrease (p 0.001, p < 0.001, respectively). However, the survival rates did not differ in responders (PR or CR) and non-responders according to the PERCIST criteria (p 0.232). The survival rates did not also differ in responders and non-responders according to the SUVmax and PSA values (p 0.140, p 0.206, respectively).

Conclusions

Molecular and volumetric parameters are beneficial in the assessment of Lu-177 PSMA I&T therapy response. Although the number of patients is small, TL-PSMA response, which includes both the tumor volume and PSMA expression in tumor, may be considered as the most valuable parameter for the evaluation of the therapy response and the prediction of survival rate.

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The authors received no financial support for the research and/or authorship of this article.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Ataturk Training and Research Hospital, İzmir Kâtip Çelebi University, Karabağlar, Izmir, Turkey

    Emine Acar

  2. Department of Translational Oncology, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey

    Emine Acar

  3. Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey

    Özhan Özdoğan, Ayşegül Aksu, Erkan Derebek, Recep Bekiş & Gamze Çapa Kaya

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  1. Emine Acar
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  2. Özhan Özdoğan
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Acar, E., Özdoğan, Ö., Aksu, A. et al. The use of molecular volumetric parameters for the evaluation of Lu-177 PSMA I&T therapy response and survival. Ann Nucl Med 33, 681–688 (2019). https://doi.org/10.1007/s12149-019-01376-3

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  • DOI: https://doi.org/10.1007/s12149-019-01376-3

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