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Dosimetry and Dose Calculation: Its Necessity in Radiopeptide Therapy

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Liver Intra-arterial PRRT with 111In-Octreotide

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Abstract

Target radionuclide therapy is an effective modality for treating a range of cancers. The therapeutic agent can be administered to patients in many ways such as intravenous (i.v.), oral, locoregional, intra-arterial (i.a.), or even more direct by intratumorally injection. Each method has certain advantages and restrictions in order to deliver lethal dose of radiation to tumors, by a variety of radionuclides attached to agents, such as peptides or even antibodies. Nowadays, this lethal or sublethal dose to cancer cells can be delivered directly, as, for example, by short-range beta, Auger, or alpha particles, or indirectly by the bystander effect. Personalized dosimetry is a useful tool from the patient-specific point of view enhancing therapeutic effectiveness, so as tumor may receive the highest absorbed dose providing favorable tumor-to-normal tissue ratios, sparing thus the critical organs from radiation burden.

Radiation dose calculations depend on the quantification imaging system (planar or tomographic), the quantification standardization procedures employing phantoms, the acquired patient images, or the simulated ones by Monte Carlo methods. Currently, the accuracy of personalized dosimetry is still limited by many uncertainties and limitations. Planar or SPECT quantification may improve patient outcomes as a result of dosimetry. It can assess the tumor response to radiation, healthy tissue toxicity, treatment planning, and decision to continue or modify the therapy.

The scope of this chapter is to develop an overview of [111In] In+ dosimetry with emphasis on conventional radionuclide imaging methods. The selection of [111In] In+ for infusion to an individual patient requires understanding of the strengths and potential limitations of this Auger emitter, in the field of PRRT therapy.

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Abbreviations

CSDA:

Continuous Slowing Down Approximation

CT:

Computed Tomography

D:

Dimensional

DPK:

Dose Point Kernels

DVH:

Dose Volume Histograms

EBRT:

External Beam Radiation Therapy

EGS:

Electron Gamma Shower

i.a:

Intra-arterial

i.v.:

Intravenous

IC:

Internal Conversion

ICRP:

International Commission on Radiological Protection

ICRU:

International Commission on Radiation Units

LET:

Linear Energy Transfer

MC:

Monte Carlo

MCNP:

Monte Carlo N-Particle Transport code

MIRD:

Medical Internal Radiation Dose

MRI:

Magnetic Resonance Imaging

OAR:

Organs at Risk

p.i.:

Post injection

PD:

Progression Death

PET:

Positron Emission Tomography

PR:

Partial Response

PRRT:

Peptide Receptor Radionuclide Therapy

R:

Range

RBE:

Relative Biological Effect

RECIST:

Response Evaluation Criteria in Solid Tumors

RILD:

Radiation-Induced Liver Disease

ROI:

Region of Interest

SD:

Stable Disease

SPECT:

Single Photon Emission Tomography

t1/2:

Half-Life

TAC:

Time-Activity Curves

TD:

Tolerance Doses

US:

Ultrasound

VOI:

Volume of Interest

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Author information

Authors and Affiliations

  1. National Health System, Athens, Greece

    Maria I. Paphiti

Authors
  1. Maria I. Paphiti
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Editor information

Editors and Affiliations

  1. Nuclear Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece

    Georgios S. Limouris

Appendix

Appendix

ICRP 89

 

ICRP 89 Adult Male

ICRP 89 15-year-old Male

ICRP 89 Adult Female

ICRP 89 15-year-old Female

RPI ICRP 89 9 month Pregnant Woman

 

RPI ICRP 89 6 month Pregnant Woman

 

RPI ICRP 89 3 month Pregnant Woman

 
 

ICRP 89 10-year-old Male

 

ICRP 89 10-year-old Female

 

ICRP 89 5-year-old Male

 

ICRP 89 5-year-old Female

ICRP 89 Newborn Male

 

ICRP 89 Newborn Female

 
Table 12.8 Decay data of [111In] In+ (from Fisher et al.) [52]
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Paphiti, M.I. (2021). Dosimetry and Dose Calculation: Its Necessity in Radiopeptide Therapy. In: Limouris, G.S. (eds) Liver Intra-arterial PRRT with 111In-Octreotide. Springer, Cham. https://doi.org/10.1007/978-3-030-70773-6_12

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  • DOI: https://doi.org/10.1007/978-3-030-70773-6_12

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