Purpose Peptide receptor radionuclide therapy (PRRT) has\nbecome an important treatment option in the management of\nadvanced neuroendocrine tumours. Long-lasting responses\nare reported for a majority of treated patients, with good tolerability\nand a favourable impact on quality of life. The treatment\nis usually limited by the cumulative absorbed dose to the\nkidneys, where the radiopharmaceutical is reabsorbed and\nretained, or by evident haematological toxicity. The aim of\nthis study was to evaluate how renal function affects (1)\nabsorbed dose to the kidneys, and (2) the development of\nhaematological toxicity during PRRT treatment.\nMethods The study included 51 patients with an advanced\nneuroendocrine tumour who received 177Lu-DOTATATE\ntreatment during 2006 ââ?¬â?? 2011 at Sahlgrenska University Hospital\nin Gothenburg. An average activity of 7.5 GBq\n(3.5 ââ?¬â?? 8.2 GBq) was given at intervals of 6 ââ?¬â?? 8 weeks on\none to five occasions. Patient baseline characteristics according\nto renal and bone marrow function, tumour burden and\nmedical history including prior treatment were recorded. Renal\nand bone marrow function were then monitored during\ntreatment. Renal dosimetry was performed according to the\nconjugate view method, and the residence time for the radiopharmaceutical\nin the whole body was calculated.\nResults A significant correlation between inferior renal function\nbefore treatment and higher received renal absorbed dose\nper administered activity was found (p<0.01). Patients with\ninferior renal function also experienced a higher grade of haematological\ntoxicity during treatment (p=0.01). The residence\ntime of 177Lu in the whole body (range 0.89 ââ?¬â?? 3.0 days) was\ncorrelated with grade of haematological toxicity (p=0.04) but\nnot with renal absorbed dose (p=0.53).\nConclusion Patients with inferior renal functionwere exposed\nto higher renal absorbed dose per administered activity and\ndeveloped a higher grade of haematological toxicity during\n177Lu-DOTATATE treatment. The study confirms the tolerability\nof PRRT in patients with an advanced neuroendocrine\ntumour but indicates that patients with inferior renal function\nare at risk of being exposed to higher absorbed doses to normal\ntissue on treatment.
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