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Can 177Lu-DOTATATE Kidney Absorbed Doses be Predicted from Pretherapy SSTR PET? Findings from Multicenter Data.

Azadeh Akhavanallaf1, Zhonglin Lu2, Avery B Peterson1

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Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|May 22, 2025
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Summary

Somatostatin receptor (SSTR) PET imaging can predict kidney absorbed doses from 177Lu-DOTATATE therapy for neuroendocrine tumors. While correlations are modest, the prediction model shows potential for personalized treatment planning with acceptable accuracy.

Keywords:
177Lu-DOTATATE PRRTSSTR PET/CTabsorbed dose predictiondosimetry

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Area of Science:

  • Nuclear Medicine
  • Radiopharmacology
  • Medical Imaging

Background:

  • 177Lu-DOTATATE therapy is used for neuroendocrine tumors, requiring confirmation of tumor somatostatin receptor (SSTR) expression via PET imaging.
  • SSTR PET imaging has potential for personalizing treatment by predicting absorbed doses to critical organs, particularly the kidneys.
  • Validating the predictive capability of SSTR PET for renal absorbed dose is crucial for optimizing 177Lu-DOTATATE therapy.

Purpose of the Study:

  • To validate the predictive capability of SSTR PET in anticipating renal absorbed dose in the first cycle of 177Lu-DOTATATE therapy.
  • To analyze a multicenter dataset to derive insights from a broader patient population regarding SSTR PET predictive accuracy.
  • To assess the correlation between pretherapy SSTR PET renal uptake and 177Lu-DOTATATE absorbed dose.

Main Methods:

  • Retrospective analysis of data from 5 international centers (Canada, Norway, Sweden, USA) involving 25, 75, 18, 36, and 26 patients, respectively.
  • Pretherapy SSTR PET/CT imaging and postcycle 1 177Lu imaging-based dosimetry were performed according to site-specific protocols.
  • A mixed-effects model using baseline SSTR PET renal uptake was developed to predict renal absorbed dose, with leave-one-center-out and leave-one-sample-out cross-validation for external and internal validation.

Main Results:

  • A statistically significant correlation (P < 0.05) was observed between kidney SSTR PET uptake and 177Lu-DOTATATE absorbed dose across centers (R2 range: 0.14-0.53).
  • The aggregated mixed-effects model achieved an R2 of 0.25 (P < 0.01), with mean absolute errors of 0.15 Gy/GBq (external) and 0.12 Gy/GBq (internal) validation.
  • Mean relative absolute errors were 28% (external) and 22% (internal) validation, indicating modest but significant predictive capability, with notable intercenter differences.

Conclusions:

  • SSTR PET renal uptake shows a statistically significant but modest correlation with 177Lu-DOTATATE absorbed dose to the kidneys in a multicenter setting.
  • The developed prediction model demonstrates a mean relative absolute error of 28% or less, supporting its potential for personalized dosimetry.
  • Significant intercenter differences highlight the need for standardized imaging protocols and dosimetry workflows to improve prediction accuracy and treatment consistency.