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Long term follow-up of tubular renal function after peptide receptor radionuclide therapy with Y-90 DOTA-TATE/Lu-177 DOTA-TATE

¹ Dept. of Nuclear Medicine/PET Center, Zentralklinik Bad Berka, Bad Berka, Germany

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Objectives: Nephrotoxicity can occur after peptide receptor radionuclide therapy (PRRT). The present study was carried out to determine the long term effects of PRRT on renal function.

Methods: More than 475 patients with metastasized neuroendocrine tumor (NET) have been treated since 2002. Out of these, 68 pts. having received 4 cycle of PRRT were included in this study. For PRRT with Y-90-DOTA-TATE (Y-90) and/or Lu-177-DOTA-TATE (Lu-177), a fractionated, low dose protocol was used, applying 3 different treatment regimes: Y-90 alone (n=19), Lu-177 alone (n=8) and Y-90+Lu-177 (n=41) in combination. Mean dose administered per cycle every 3-5 months: Y-90 2-5 GBq, Lu-177 3-7 GBq. Renal tubular extraction rate (TER) was monitored every 3-4 months using Tc-99m-MAG3.

Results: Median follow-up time in Y-90/Lu-177/Y-90+Lu-177 combination therapy was 36/22/25 months. Percentage (mean/median) fall in TER was: Y-90 24/16, Lu-177 12/13 and in the Y-90+Lu-177 group 13/13. Mean/median TER fall/year was: Y-90 8.2/5.3, Lu-177 6.8/7.4 and Y-90+Lu-177 5.8/6. Overall, 19/68 patients showed a fall in TER> 10%/yr: Y-90 group 6/19, Lu-177 2/8 and Y-90+Lu-177 10/44. Only 2 patients with long-standing hypertension(HT) and diabetes mellitus(DM) reached preterminal end-stage renal disease (no need for dialysis). A significant association (univariate analysis of variance) existed only between the presence of HT, chemo/radio and combination of DM*HT, DM*chemo/radio as risk factors.

Conclusions: Although PRRT appears to be nephrotoxic, significant toxicity can be prevented if used in fractionated low dose. Risk factors for increased toxicity of PRRT have to be taken seriously into account before choosing the therapy dose.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Prasad, V. Articles by Baum, R. PubMed Articles by Prasad, V. Articles by Baum, R.