Radiation exposure and protection advice after [177Lu]Lu-DOTA-TATE therapy in China

Abstract

Background: We conducted a study on radiation exposure in patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) treated with [¹⁷⁷Lu]Lu-DOTA-TATE in China for the first time, aiming to provide guidance and reference for radiation protection in this regard. A total of 30 GEP-NENs patients who received [¹⁷⁷Lu]Lu-DOTA-TATE therapy were recruited in the study. We measured the external dose rate (EDR) values of each patient during the injection and 0-6 h post-administration period, as well as the radiation dose (RD) values to healthcare nurses and the surrounding environment. We performed a double exponential curve fitting and estimated the RD to the public from patients discharged at different times after [¹⁷⁷Lu]Lu-DOTA-TATE therapy.

Results: Among the 30 patients, 27 patients completed 4 cycles of [¹⁷⁷Lu]Lu-DOTA-TATE treatments, the estimated RD to the public indicated that for adult family members, children above 10 years old, children aged 3-10 and coworkers of the patients, patients could begin daily contact at least 24 h, 48 h, 144 h and 192 h after injection to ensure that the total RD values after four treatments not exceed the limit. During the hospitalization of patients receiving [¹⁷⁷Lu]Lu-DOTA-TATE, the cumulative dose received by the administering nurses and to the ward environment were both well below the national RD limits.

Conclusions: This study conducted a fitting analysis of the decay pattern of EDR values in GEP-NENs patients undergoing [¹⁷⁷Lu]Lu-DOTA-TATE therapy, in order to establish guidelines for patient discharge timing and provide recommendations for radiation protection for the general public after patient discharge. Trial registration A Study Comparing Treatment With Lutetium[177Lu] Oxodotreotide Injection to Octreotide LAR in Patients With GEP-NETs, NCT05459844. https://clinicaltrials.gov/study/NCT05459844?cond=NCT05459844&rank=1 . Registered 5 July 2022.

Keywords: Dosimetry; GEP-NENs; Patient discharge; Radiation exposure; [177Lu]Lu-DOTA-TATE.

Fig. 1

The SPECT images of the patient at A 4 h, B 24 h, C 96 h and D 144 h after the first treatment

Fig. 2

The SPECT images at 4 h after four treatment cycles of the patient. A First treatment cycle, B second treatment cycle, C third treatment cycle and D fourth treatment cycle

Fig. 3

The double exponential curve fitting results of EDR-1 m after [¹⁷⁷Lu]Lu-DOTA-TATE treatments for the patients. A–D The double exponential curve fitting results of overall EDR-1 m at various time points from the first to fourth treatment cycle for patients. E The double exponential curve fitting results of overall EDR-1 m values of four cycles. F The double exponential curve fitting results of the mean EDR-1 m value at the same time points for each patient

Fig. 4

The Two-way ANOVA analysis of EDR-1 m at different time points among patients receiving different cycles of treatments

Fig. 5

The double exponential curve fitting results for EDR during drug administration for patients. A–D The overall EDR double exponential curve fitting results at various time points from the first to fourth treatment cycle for patients. E The overall EDR double exponential curve fitting results at various time points of four cycles. F The double exponential curve fitting results for the mean EDR value at the same time points during drug administration for each patient