Nephrotoxicity after PRRT with 177Lu-DOTA-octreotate

Autor: Eric P. Krenning, Dik J. Kwekkeboom, Wouter A. van der Zwan, Hendrik Bergsma, P. P. M. Kooij, Boen L. R. Kam, Mark Konijnenberg, Jaap J.M. Teunissen, Katya Mauff
Rok vydání: 2016
Předmět:
Male
medicine.medical_treatment
177Lu-Octreotate
Comorbidity
Octreotide
030218 nuclear medicine & medical imaging
chemistry.chemical_compound
0302 clinical medicine
Coordination Complexes
Risk Factors
Neoplasms
Molecular Targeted Therapy
Nephrotoxicity
Netherlands
Aged
80 and over
Incidence
Radiotherapy Dosage
General Medicine
Survival Rate
Somatostatin
Radiology Nuclear Medicine and imaging
030220 oncology & carcinogenesis
Toxicity
Original Article
Female
Kidney Diseases
PRRT
medicine.medical_specialty
Urology
Renal function
03 medical and health sciences
Dosimetry
Internal medicine
medicine
Humans
Radiology
Nuclear Medicine and imaging
External beam radiotherapy
Radiation Injuries
Aged
Creatinine
Radiotherapy
business.industry
Kidneys
Radiation therapy
Endocrinology
chemistry
Radionuclide therapy
Radiopharmaceuticals
business
Zdroj: European Journal of Nuclear Medicine and Molecular Imaging
ISSN: 1619-7089
1619-7070
DOI: 10.1007/s00259-016-3382-9
Popis: Purpose After peptide receptor radionuclide therapy (PRRT), renal toxicity may occur, particular in PRRT with 90Y-labelled somatostatin analogues. Risk factors have been identified for increased probability of developing renal toxicity after PRRT, including hypertension, diabetes and age. We investigated the renal function over time, the incidence of nephrotoxicity and associated risk factors in patients treated with PRRT with [177Lu-DOTA0,Tyr3]-Octreotate (177Lu-Octreotate). Also, radiation dose to the kidneys was evaluated and compared with the accepted dose limits in external beam radiotherapy and PRRT with 90Y-radiolabelled somatostatin analogues. Methods The annual decrease in creatinine clearance (CLR) was determined in 209 Dutch patients and the incidence of grade 3 or 4 renal toxicity (according to CTCAE v4.03) was evaluated in 323 patients. Risk factors were analysed using a nonlinear mixed effects regression model. Also, radiation doses to the kidneys were calculated and their association with high annual decrease in renal function were analysed. Results Of the 323 patients, 3 (1 %) developed (subacute) renal toxicity grade 2 (increase in serum creatinine >1.5 – 3.0 times baseline or upper limit of normal). No subacute grade 3 or 4 nephrotoxicity was observed. The estimated average baseline CLR (± SD) was 108 ± 5 ml/min and the estimated average annual decrease in CLR (± SD) was 3.4 ± 0.4 %. None of the risk factors (hypertension, diabetes, high cumulative injected activity, radiation dose to the kidneys and CTCAE grade) at baseline had a significant effect on renal function over time. The mean absorbed kidney dose in 228 patients was 20.1 ± 4.9 Gy. Conclusion Nephrotoxicity in patients treated with 177Lu-octreotate was low. No (sub)acute grade 3 or 4 renal toxicity occurred and none of the patients had an annual decrease in renal function of >20 %. No risk factors for renal toxicity could be identified. Our data support the idea that the radiation dose threshold, adopted from external beam radiotherapy and PRRT with 90Y-labelled somatostatin analogues, does not seem valid for PRRT with 177Lu-octreotate. Electronic supplementary material The online version of this article (doi:10.1007/s00259-016-3382-9) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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