Cargando…

Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy

BACKGROUND: Patients with advanced neuroendocrine tumors (NETs) of the midgut are suitable candidates for (177)Lu-DOTATOC therapy. Integrated SPECT/CT systems have the potential to help improve the accuracy of patient-specific tumor dosimetry. Dose estimations to target organs are generally performe...

Descripción completa

Detalles Bibliográficos
Autores principales: Goetz, Th. I., Lang, E. W., Prante, O., Maier, A., Cordes, M., Kuwert, T., Ritt, P., Schmidkonz, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101301/
https://www.ncbi.nlm.nih.gov/pubmed/32114682
http://dx.doi.org/10.1007/s12149-020-01440-3
_version_ 1783511586402467840
author Goetz, Th. I.
Lang, E. W.
Prante, O.
Maier, A.
Cordes, M.
Kuwert, T.
Ritt, P.
Schmidkonz, Christian
author_facet Goetz, Th. I.
Lang, E. W.
Prante, O.
Maier, A.
Cordes, M.
Kuwert, T.
Ritt, P.
Schmidkonz, Christian
author_sort Goetz, Th. I.
collection PubMed
description BACKGROUND: Patients with advanced neuroendocrine tumors (NETs) of the midgut are suitable candidates for (177)Lu-DOTATOC therapy. Integrated SPECT/CT systems have the potential to help improve the accuracy of patient-specific tumor dosimetry. Dose estimations to target organs are generally performed using the Medical Internal Radiation Dose scheme. We present a novel Monte Carlo-based voxel-wise dosimetry approach to determine organ- and tumor-specific total tumor doses (TTD). METHODS: A cohort of 14 patients with histologically confirmed metastasized NETs of the midgut (11 men, 3 women, 62.3 ± 11.0 years of age) underwent a total of 39 cycles of (177)Lu-DOTATOC therapy (mean 2.8 cycles, SD ± 1 cycle). After the first cycle of therapy, regions of interest were defined manually on the SPECT/CT images for the kidneys, the spleen, and all 198 tracer-positive tumor lesions in the field of view. Four SPECT images, taken at 4 h, 24 h, 48 h and 72 h after injection of the radiopharmaceutical, were used to determine their effective half-lives in the structures of interest. The absorbed doses were calculated by a three-dimensional dosimetry method based on Monte Carlo simulations. TTD was calculated as the sum of all products of single tumor doses with single tumor volumes divided by the sum of all tumor volumes. RESULTS: The average dose values per cycle were 3.41 ± 1.28 Gy (1.91–6.22 Gy) for the kidneys, 4.40 ± 2.90 Gy (1.14–11.22 Gy) for the spleen, and 9.70 ± 8.96 Gy (1.47–39.49 Gy) for all (177)Lu-DOTATOC-positive tumor lesions. Low- and intermediate-grade tumors (G 1–2) absorbed a higher TTD compared to high-grade tumors (G 3) (signed-rank test, p =  < 0.05). The pre-therapeutic chromogranin A (CgA) value and the TTD correlated significantly (Pearson correlation:  = 0.67, p = 0.01). Higher TTD resulted in a significant decrease of CgA after therapy. CONCLUSION: These results suggest that Monte Carlo-based voxel-wise dosimetry is a very promising tool for predicting the absorbed TTD based on histological and clinical parameters.
format Online
Article
Text
id pubmed-7101301
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer Singapore
record_format MEDLINE/PubMed
spelling pubmed-71013012020-03-30 Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy Goetz, Th. I. Lang, E. W. Prante, O. Maier, A. Cordes, M. Kuwert, T. Ritt, P. Schmidkonz, Christian Ann Nucl Med Original Article BACKGROUND: Patients with advanced neuroendocrine tumors (NETs) of the midgut are suitable candidates for (177)Lu-DOTATOC therapy. Integrated SPECT/CT systems have the potential to help improve the accuracy of patient-specific tumor dosimetry. Dose estimations to target organs are generally performed using the Medical Internal Radiation Dose scheme. We present a novel Monte Carlo-based voxel-wise dosimetry approach to determine organ- and tumor-specific total tumor doses (TTD). METHODS: A cohort of 14 patients with histologically confirmed metastasized NETs of the midgut (11 men, 3 women, 62.3 ± 11.0 years of age) underwent a total of 39 cycles of (177)Lu-DOTATOC therapy (mean 2.8 cycles, SD ± 1 cycle). After the first cycle of therapy, regions of interest were defined manually on the SPECT/CT images for the kidneys, the spleen, and all 198 tracer-positive tumor lesions in the field of view. Four SPECT images, taken at 4 h, 24 h, 48 h and 72 h after injection of the radiopharmaceutical, were used to determine their effective half-lives in the structures of interest. The absorbed doses were calculated by a three-dimensional dosimetry method based on Monte Carlo simulations. TTD was calculated as the sum of all products of single tumor doses with single tumor volumes divided by the sum of all tumor volumes. RESULTS: The average dose values per cycle were 3.41 ± 1.28 Gy (1.91–6.22 Gy) for the kidneys, 4.40 ± 2.90 Gy (1.14–11.22 Gy) for the spleen, and 9.70 ± 8.96 Gy (1.47–39.49 Gy) for all (177)Lu-DOTATOC-positive tumor lesions. Low- and intermediate-grade tumors (G 1–2) absorbed a higher TTD compared to high-grade tumors (G 3) (signed-rank test, p =  < 0.05). The pre-therapeutic chromogranin A (CgA) value and the TTD correlated significantly (Pearson correlation:  = 0.67, p = 0.01). Higher TTD resulted in a significant decrease of CgA after therapy. CONCLUSION: These results suggest that Monte Carlo-based voxel-wise dosimetry is a very promising tool for predicting the absorbed TTD based on histological and clinical parameters. Springer Singapore 2020-02-29 2020 /pmc/articles/PMC7101301/ /pubmed/32114682 http://dx.doi.org/10.1007/s12149-020-01440-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Article
Goetz, Th. I.
Lang, E. W.
Prante, O.
Maier, A.
Cordes, M.
Kuwert, T.
Ritt, P.
Schmidkonz, Christian
Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy
title Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy
title_full Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy
title_fullStr Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy
title_full_unstemmed Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy
title_short Three-dimensional Monte Carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)Lu-DOTATOC therapy
title_sort three-dimensional monte carlo-based voxel-wise tumor dosimetry in patients with neuroendocrine tumors who underwent (177)lu-dotatoc therapy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101301/
https://www.ncbi.nlm.nih.gov/pubmed/32114682
http://dx.doi.org/10.1007/s12149-020-01440-3
work_keys_str_mv AT goetzthi threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT langew threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT pranteo threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT maiera threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT cordesm threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT kuwertt threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT rittp threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy
AT schmidkonzchristian threedimensionalmontecarlobasedvoxelwisetumordosimetryinpatientswithneuroendocrinetumorswhounderwent177ludotatoctherapy