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Long-term Efficacy, Survival, and Toxicity of Peptide Receptor Radionuclide Therapy in Patients With Refractory Meningioma.

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Long-term Nephrotoxicity after PRRT: Myth or Reality.

Richard P Baum1,2, Xin Fan3,4,5,6, Vivianne Jakobsson3,4

  • 1CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, Wiesbaden, Germany.

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|January 3, 2024
PubMed
Summary

Peptide receptor radionuclide therapy (PRRT) for neuroendocrine neoplasms (NENs) showed minimal risk of kidney damage in a large 18-year study. Proper renal protection during PRRT appears to prevent significant nephrotoxicity, making it a safe treatment option.

Keywords:
long-termlutetium-177 (177Lu)nephrotoxicitypeptide receptor radionuclide therapy (PRRT)somatostatin analogsyttrium-90 (90Y)

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Nephrology

Background:

  • Kidney toxicity is a primary concern for peptide receptor radionuclide therapy (PRRT).
  • Neuroendocrine neoplasms (NENs) are often treated with PRRT, necessitating careful evaluation of renal safety.
  • Long-term data on PRRT-induced nephrotoxicity in NEN patients is crucial for treatment planning.

Purpose of the Study:

  • To assess the long-term risk of nephrotoxicity in a large cohort of NEN patients treated with PRRT over 18 years.
  • To identify factors influencing renal function changes after PRRT.
  • To evaluate the effectiveness of renal protection strategies in mitigating PRRT-related kidney damage.

Main Methods:

  • Retrospective analysis with prospective documentation of 1361 NEN patients receiving 1-10 cycles of PRRT (177Lu or 90Y based).
  • Comprehensive kidney function monitoring (serum creatinine, BUN, cGFR, electrolytes) before and during follow-up.
  • Adverse events graded using CTCAE v.5.0, with restaging every 6 months.

Main Results:

  • Out of 1281 patients with follow-up, only a small increase in Grade 3/4 renal insufficiency was observed (0.2% to 0.7%).
  • Mean creatinine levels showed a minor increase post-treatment.
  • Age, number of cycles, radionuclide type (90Y higher risk), and follow-up duration were factors affecting renal toxicity.

Conclusions:

  • PRRT, when administered with renal protection, demonstrated a low risk of long-term nephrotoxicity in NEN patients.
  • The study suggests that significant PRRT-related nephrotoxicity is uncommon with appropriate protective measures.
  • Individualized treatment approaches and careful patient selection are key to safe PRRT administration.