Authors: Sofie Van Binnebeek Kristof Baete Christelle Terwinghe Bert Vanbilloen Karin Haustermans Luc Mortelmans Ivan Borbath Eric Van Cutsem Chris Verslype Felix M Mottaghy Alfons Verbruggen Christophe M Deroose
Publish Date: 2012/09/09
Volume: 27, Issue: 1, Pages: 74-77
Abstract
Peptide receptor radionuclide therapy PRRT with 90YDOTATOC and 177LuDOTATATE as most clinically used radiopeptides is widely used in the management of metastatic neuroendocrine tumors With respect to radiation dosimetry the kidneys are the critical organ for 90YDOTATOC Renal irradiation is significant because of reabsorption of the radiopeptide from the proximal tubuli and the resulting retention in the interstitium mainly in the inner cortical zone The high energy and consequently wide range in tissue of the yttrium90 beta particle result in high absorbed doses to the kidney cortex and medulla Accurate renal dosimetry can help minimizing radiation nephropathy We report a case of a 69yearold candidate for PRRT with an acceptable kidney function at the time of screening When performing 111Inoctreotide pretreatment dosimetry 3 weeks later we observed a drastic deterioration in kidney function caused by undisclosed nonsteroidal antiinflammatory drug intake The calculated kidney biological effective dose BED was 153 Gy after four projected cycles PRRT was canceled as our fullcourse BED limit is 37 Gy and the patient was switched to morphine analgesics Renal function normalized after 3 months and repeated dosimetry yielded an acceptable kidney BED of 28 Gy after four projected cycles 7 Gy/cycle This case emphasizes that acute kidney insufficiency can yield toxic kidney doses in a single therapy cycle with an inherent risk of persistent renal insufficiency All clinical factors which might influence kidney function should be verified at screening and before PRRT administration
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