| خلاصه مقاله | Aim/Introduction: Radiopharmaceutical therapies with Lutetium-177 prostate-specific membrane antigen (PSMA) ligands have shown promising results in metastatic castration-resistant prostate cancer (mCRPC). Patient-specific activity personalization is currently impossible due to the lack of absorbed dose-effect relationships. Dosimetry needs to be incorporated into the routine clinical workflow of radiopharmaceutical therapies using simplified methods such as single time point (STP) imaging protocols rather than multiple time point (MTP). This study aims to assess differences between image-based dosimetry for 177Lu-PSMA-617 therapy on lacrimal glands, salivary glands, and tumors using STP versus MTP.
Materials and Methods: There were 40 patients with mCRPC with 177Lu-SPECT imaging data (24h, and 72h post-drug administration) available on the first and second 177Lu-PSMA-617 treatment cycles. We employed two different dosimetry methods: the MTP method, which incorporated images from both imaging time points, and the STP method. A method based on the difference between Gaussian curves was used to delineate tumors, while salivary glands and lacrimal glands were drawn manually. Support vector machines were used to classify tumors based on their mean density and coefficient of variation.
Results: There were a few exceptions to the pattern of decreasing absorbed doses and the number of tumors with each therapy cycle. The 2-point method seemed to correlate well with the second imaging interval. Furthermore, the mean absorbed dose per time-integrated activity for lacrimal glands was 0.61 ± 0.11 (MTP method), 0.65 ± 0.13 (STP method 24h-image), and 0.52 ± 0.12(STP method 72h-image) Gy/GBq, to submandibular glands it was 0.41 ± 0.11(MTP method), 0.37 ± 0.15 (STP method 24h-image), 0.23 ± 0.12 (STP method 72 h-image) Gy/GBq, and for parotid glands 0.35 ± 0.10 (MTP method), 0.37 ± 0.11 (STP method 24h-image) and 0.24 ± 0.16 (MTP method 72h-image) Gy/GBq.
Conclusion: Based on the low mean difference in absorbed dose compared to MTP, STP dosimetry for 177Lu-PSMA-617 therapy at 24 h was found to be sufficiently accurate for 177Lu-PSMA-617 therapy. |