Impact of Single-Time-Point Estimates of 177Lu-PRRT Absorbed Doses on Patient Management: Validation of a Trained Multiple-Linear-Regression Model in 159 Patients and 477 Therapy Cycles.

IF 9.1 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Nuclear Medicine Pub Date : 2023-10-01 Epub Date: 2023-07-27 DOI:10.2967/jnumed.122.264923
Alexandre Chicheportiche, Moshe Sason, Mahmoud Zidan, Jeremy Godefroy, Yodphat Krausz, David J Gross, Simona Grozinsky-Glasberg, Simona Ben-Haim
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引用次数: 0

Abstract

Dosimetry after 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) enables estimation of radiation doses absorbed by normal organs and target lesions. This process is time-consuming and requires multiple posttreatment studies on several subsequent days. In a previous study, we described a newly developed multiple-linear-regression model to predict absorbed doses (ADs) from a single-time-point (STP) posttreatment study acquired 168 h after the first infusion and 24 h after the following ones, with similar results to the standard multiple-time-point (MTP) protocol. The present study aimed to validate this model in a large patient cohort and to assess whether STP dosimetry affects patient management decisions compared with our MTP protocol. Methods: Quantitative 177Lu-DOTATATE SPECT/CT post-PRRT data from 159 consecutive patients (172 therapies, 477 therapy cycles) were retrospectively analyzed. ADs obtained from an STP model were compared with those obtained using an MTP model. We evaluated the impact of the STP model on the decision on whether PRRT should be stopped because of an expected kidney AD exceeding the safety threshold. We hypothesized that patient management based on the STP model does not differ from that based on the MTP model in at least 90% of the cases. Results: There was no difference in management decisions between the MTP and STP models in 170 of 172 therapies (98.8%). A Fisher χ2 test for combined probabilities produced a composite P value of 0.0003. Mean cumulative AD relative differences between the STP and MTP models were 0.8% ± 8.0%, -7.7% ± 4.8%, 0.0% ± 11.4%, -2.8% ± 6.3%, and -2.1% ± 18.4% for kidneys, bone marrow, liver, spleen, and tumors, respectively (Pearson r = 0.99 for all), for patients who underwent 4 therapy cycles. Similar results were obtained with fewer therapy cycles. Conclusion: Estimated radiation ADs and patient management decisions were similar with the STP and MTP models. The STP model can simplify the dosimetry process while also reducing scanner and staff time and improving patient comfort.

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177Lu PRRT吸收剂量的单时间点估计对患者管理的影响:159名患者和477个治疗周期中训练的多元线性回归模型的验证。
177Lu DOTATATE肽受体放射性核素治疗(PRRT)后的剂量测定能够估计正常器官和靶病变吸收的辐射剂量。这个过程很耗时,需要在接下来的几天里进行多次治疗后研究。在之前的一项研究中,我们描述了一种新开发的多元线性回归模型,用于预测单时间点(STP)治疗后研究的吸收剂量(AD) 第一次输注后h和24 h,具有与标准多时间点(MTP)协议类似的结果。本研究旨在在大型患者队列中验证该模型,并评估与我们的MTP方案相比,STP剂量测定是否影响患者管理决策。方法:回顾性分析159例连续患者(172个治疗,477个治疗周期)PRRT后177Lu DOTATE SPECT/CT的定量数据。将从STP模型获得的AD与使用MTP模型获得的那些进行比较。我们评估了STP模型对是否因预期肾脏AD超过安全阈值而停止PRRT的决定的影响。我们假设,在至少90%的病例中,基于STP模型的患者管理与基于MTP模型的患者处理没有差异。结果:在172种治疗中,有170种(98.8%)的MTP和STP模型在管理决策上没有差异。Fisherχ2检验的综合概率产生0.0003的复合P值。对于接受4个治疗周期的患者,STP和MTP模型之间的平均累积AD相对差异分别为0.8%±8.0%、-7.7%±4.8%、0.0%±11.4%、-2.8%±6.3%和-2.1%±18.4%(Pearson r=0.99)。使用较少的治疗周期也获得了类似的结果。结论:估计的辐射AD和患者管理决策与STP和MTP模型相似。STP模型可以简化剂量测定过程,同时减少扫描仪和工作人员的时间,提高患者的舒适度。
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来源期刊
Journal of Nuclear Medicine
Journal of Nuclear Medicine 医学-核医学
CiteScore
13.00
自引率
8.60%
发文量
340
审稿时长
1 months
期刊介绍: The Journal of Nuclear Medicine (JNM), self-published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), provides readers worldwide with clinical and basic science investigations, continuing education articles, reviews, employment opportunities, and updates on practice and research. In the 2022 Journal Citation Reports (released in June 2023), JNM ranked sixth in impact among 203 medical journals worldwide in the radiology, nuclear medicine, and medical imaging category.
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