Prediction of [ <sup>177</sup>Lu]Lu-DOTA-TATE therapy response using the absorbed dose estimated from [ <sup>177</sup>Lu]Lu-DOTA-TATE SPECT/CT in patients with metastatic neuroendocrine tumour

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Abstract

Background

Peptide receptor radionuclide therapy (PRRT) with [ ¹⁷⁷Lu]Lu-DOTA-TATE has shown efficacy in patients with metastatic neuroendocrine tumours (NETs). Personalised dosimetry is crucial to optimise treatment outcomes and minimise adverse events. In this study, we investigated the correlation between the tumour-absorbed dose (TAD) estimated from [ ¹⁷⁷Lu]Lu-DOTA-TATE SPECT/CT and the therapeutic response.

Method

A retrospective analysis was conducted on patients with advanced well-differentiated NETs grades 1–3 who underwent PRRT and exhibited greater uptake than liver on pre-therapeutic [ ⁶⁸Ga]Ga-DOTA-TOC PET/CT. Target lesions were selected based on the RECIST 1.1 and PERCIST 1.0 criteria using [ ¹⁷⁷Lu]Lu-DOTA-TATE SPECT/CT and pre-therapeutic contrast-enhanced CT scans. For anatomical image analysis, the sum of the longest diameter (SLD) of the target lesions was measured using the RECIST 1.1 criteria for patient-based analysis and the longest diameter (LD) of the target lesion using the RECIST-L criteria for lesion-based analysis. Standardised uptake values (SUVs) were measured on SPECT/CT images, and TADs were calculated based on the SUVs. Dosimetry was performed using a single SPECT/CT imaging time point at day 4–5 post-therapy. Statistical analyses were conducted to investigate correlations and determine the target lesion responses.

Results

Twenty patients with primary tumour sites and hepatic metastases were included. Fifty-five target lesions, predominantly located in the pancreas and liver, were analysed. The cumulative TAD (lesion-based analysis: r = 0.299–0.301, p = 0.025–0.027), but not the cycle 1 SUV (lesion-based analysis: r = 0.198–0.206, p = 0.131–0.147) or cycle 1 TAD (lesion-based analysis: r = 0.209–0.217, p = 0.112–0.126), exhibited a significant correlation with the change in LD of the target lesion. Binary logistic regression analysis identified the significance of the cumulative TAD in predicting disease control according to the RECIST-L criteria (odds ratio = 1.031–1.051, p = 0.024–0.026).

Conclusions

The cumulative TAD estimated from [ ¹⁷⁷Lu]Lu-DOTA-TATE SPECT/CT revealed a significant correlation with change in LD, which was significantly higher for the cumulative TAD than for the cycle 1 SUV or TAD. A higher cumulative TAD was associated with disease control in the target lesion. However, considering the limitations inherent to a confined sample size, careful interpretation of these findings is required. Estimation of the cumulative TAD of [ ¹⁷⁷Lu]Lu-DOTA-TATE therapy could guide the platform towards personalised therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40658-024-00620-8.

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Author and article information

Contributors

Yong-il Kim:

ORCID: http://orcid.org/0000-0002-4113-8351

kyi821209@naver.com

Journal

Journal ID (nlm-ta): EJNMMI Phys

Journal ID (iso-abbrev): EJNMMI Phys

Title: EJNMMI Physics

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2197-7364

Publication date (Electronic): 5 February 2024

Publication date PMC-release: 5 February 2024

Publication date Collection: December 2024

Volume: 11

Electronic Location Identifier: 14

Affiliations

[1 ]GRID grid.267370.7, ISNI 0000 0004 0533 4667, Department of Nuclear Medicine, Asan Medical Center, , University of Ulsan College of Medicine, ; Seoul, Republic of Korea

[2 ]Theranostics Center, Asan Cancer Institute, Asan Medical Center, ( https://ror.org/03s5q0090) Seoul, Republic of Korea

[3 ]GRID grid.267370.7, ISNI 0000 0004 0533 4667, Department of Oncology, Asan Medical Center, , University of Ulsan College of Medicine, ; Seoul, Republic of Korea

Author information

Yong-il Kim http://orcid.org/0000-0002-4113-8351

Article

Publisher ID: 620

DOI: 10.1186/s40658-024-00620-8

PMC ID: 10844176

PubMed ID: 38315270

SO-VID: b65e0e9e-cb68-4814-ad42-b407634b8bda

License:

Open Access This 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/.

History

Date received : 25 July 2023

Date accepted : 29 January 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003625, Ministry of Health and Welfare;

Award ID: HR18C0016

Award Recipient : Yong-il Kim Jin-Sook Ryu

Funded by: FundRef http://dx.doi.org/10.13039/501100005006, Asan Institute for Life Sciences, Asan Medical Center;

Award ID: 2021IF0022

Award Recipient : Changhoon Yoo Baek-Yeol Ryoo

Custom metadata

Keywords: neuroendocrine tumour,[177lu]lu-dota-tate,spect/ct,dosimetry,absorbed dose

Data availability:

Keywords: neuroendocrine tumour, [177lu]lu-dota-tate, spect/ct, dosimetry, absorbed dose