Dosimetry in Lu-177-DOTATATE peptide receptor radionuclide therapy: a systematic review

Nautiyal, Amit, Michopoulou, Sofia and Guy, Matt (2023) Dosimetry in Lu-177-DOTATATE peptide receptor radionuclide therapy: a systematic review. Clinical and Translational Imaging. (doi:10.1007/s40336-023-00589-x).

Abstract

Purpose: ¹⁷⁷Lu- labelled somatostatin analog DOTATATE is an excellent vector for systemic radiation therapy in NETs. However, this treatment can affect organ functions or impact the quality of life of the patient, due to collateral irradiation of normal body organs. Here we conducted a comprehensive systematic review on organ and tumour dosimetry in ¹⁷⁷Lu-DOTATATE therapy.

Design: in this review, published peer-reviewed articles on organ dosimetry in patients following PRRT using ¹⁷⁷Lu-DOTATATE have been included. All the articles were screened for inclusion based on the title and abstract of the study. PubMed, Publons and DOAJ were used as search engines to conduct a systematic search in the database. Articles were categorized into three groups: (1) Clinical studies describing the technical parameter and method of dosimetry in ¹⁷⁷Lu-DOTATATE therapy or (2) Organ dosimetry in ¹⁷⁷Lu-DOTATATE treatment or (3) Tumour dosimetry in ¹⁷⁷Lu- DOTATATE treatment.

Result: in total, 694 studies were retrieved from database searching on NET and PRRT and 43 original articles on ¹⁷⁷Lu-DOTATATE dosimetry were included in this review. The median absorbed dose per unit of administered activity for kidneys, spleen, liver, bone marrow and tumour were 0.64 (0.47–0.90 Gy/GBq), 1.23 (0.53–1.59 Gy/GBq), 0.54 (0.23–0.62 Gy/GBq), 0.04 (0.02–0.06 Gy/GBq) and 4.6 (3.09–9.47 Gy/GBq), respectively.

Conclusion: according to the present dosimetric review, ¹⁷⁷Lu-DOTATATE PRRT appears to be a safe and reliable treatment option for advanced GEP-NETs. From the dosimetric point of view, kidneys are theoretically the major organs at risk in ¹⁷⁷Lu-DOTATATE treatment. The optimization of the number of treatment cycles beyond the prescribed limit of four and the maximum administered activity in each cycle must be determined by individual patient dosimetry in order to reduce the risk of organ toxicities whilst maximizing therapeutic efficacy.

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Contributors

Author: Matt Guy

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