title: [177Lu-DOTA 0-Tyr 3]-octreotate treatment in patients with disseminated gastroenteropancreatic neuroendocrine tumors: the value of measuring absorbed dose to the kidney.
abstract: BACKGROUND
  Peptide receptor radiation therapy (PRRT) using [(177)Lu-DOTA(0)-Tyr(3)]-octreotate is a new, promising option for treatment of disseminated gastroenteropancreatic neuroendocrine tumors (GEPNETs).
  
  
  METHODS
  During 2006-2008, 26 patients with disseminated GEPNETs were treated with (177)Lu-octreotate. Radiologic response (RECIST), biochemical response [plasma chromogranin-A (P-CgA)], hematologic toxicity [Common Toxicity Criteria (CTC)], absorbed dose to the kidneys (conjugate view method), and glomerular filtration rate (GFR) were analyzed.
  
  
  RESULTS
  (177)Lu-octreotate (8 GBq) was given one to five times (median = 3) with a 6-week interval between each. Sixteen of the 26 patients were evaluated radiologically; 6 (38%) had partial response (PR), 8 (50%) had stable disease (SD), and 2 (13%) had progressive disease (PD). Seventeen of the 26 patients were evaluated biochemically; 6 (35%) showed a >or=30% decrease, 8 (47%) showed a >or=20% increase, and 3 (18%) showed neither a >or=30% decrease nor a >or=20% increase. The mean absorbed dose to the kidneys was 24 Gy. With a dose limit of 27 Gy to the kidneys, 10 patients did not receive the planned four treatments, while four patients had the potential to receive additional treatment. A significant reduction (p = 0.0013) of GFR was observed at follow-up. Three patients experienced CTC grade 3 hematologic toxicity.
  
  
  CONCLUSIONS
  By using the absorbed dose to the kidneys as a limiting factor, treatment with (177)Lu-octreotate can be individualized, e.g., overtreatment can be avoided and patients with the potential to receive additional treatment can be identified. Further studies are needed to define tolerance doses to the kidneys so that treatment can be optimized.
authors.affiliation: Department of Surgery, University of Gothenburg, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden. christina.svard@vgregion.se
authors.forename: Christina
authors.initials: C
authors.lastname: Swärd
authors.forename: Peter
authors.initials: P
authors.lastname: Bernhardt
authors.forename: Håkan
authors.initials: H
authors.lastname: Ahlman
authors.forename: Bo
authors.initials: B
authors.lastname: Wängberg
authors.forename: Eva
authors.initials: E
authors.lastname: Forssell-Aronsson
authors.forename: Maria
authors.initials: M
authors.lastname: Larsson
authors.forename: Johanna
authors.initials: J
authors.lastname: Svensson
authors.forename: Rauni
authors.initials: R
authors.lastname: Rossi-Norrlund
authors.forename: Lars
authors.initials: L
authors.lastname: Kölby
mesh_terms: D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D018358:Neuroendocrine Tumors / Q000532:radiotherapy* / Q000628:therapy; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D009942:Organometallic Compounds; C447941:lutetium Lu 177 dotatate; D015282:Octreotide