58 Dose estimation for an extravasation in a patient treated with <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" altimg="si1.gif" overflow="scroll"><mml:mrow><mml:msup><mml:mrow/><mml:mrow><mml:mn>177</mml:mn></mml:mrow></mml:msup></mml:mrow></mml:math>Lu-DOTATATE

Tylski, P.; Vuillod, Aurélie; Goutain-Majorel, C.; Jalade, P.

doi:10.1016/j.ejmp.2018.09.071

Cited by 7 publications

(13 citation statements)

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“…The lack of complications after extravasation of [ 177 Lu]Lu-PSMA and the serious complications observed after extravasation of [ 131 I]I-MIBG and 223 RaCl 2 are inconsistent with the hypothesis that extravasation of small molecules should result in little radiation damage of the skin due to a lower retention in subcutaneous tissue. Instead, we note that in the above-mentioned cases [3,4,8], as well as the present case, where no complications were observed, there was an immediate treatment by local heating, massage, or exercise, as recommended both in the EANM procedure guidelines for treatment with [ 90 Y]Y-Ibritumomab tiuxetan (Zevalin®) [17] and 223 RaCl 2 (Xofigo®) [18] and in the product characteristics of Lutathera® ([ 177 Lu]Lu-DOTATATE) [19]. In most of the reported cases with serious radiation damage [5,14,15,16], no immediate treatment was initiated, while in one recent case with [ 90 Y]Y-Ibritumomab tiuxetan [6], a patient was in need for surgery with removal of necrotic skin and soft tissue even though extravasation was quickly realized and early treatment was attempted by aspiration of the puncture site and massage of the arm.…”

Section: Discussionmentioning

confidence: 76%

“…As already mentioned, only one of the cases of extravasation reported in the literature is concerned with a 177 Lu-labelled peptide. Tylski and colleagues [3] described a case with [ 177 Lu]Lu-DOTATATE, where they found a quick elimination of the drug from the arm with an effective half-life of 3 h and that the elimination could be increased by local warming and repeated massage of the injection site. This patient was also without any clinical signs of radiation damage.…”

Section: Discussionmentioning

confidence: 99%

“…It is also noteworthy that in the cases without tissue damage [3,4,8], relatively large volumes of saline was co-infused with the therapeutic drug leading to a somewhat lower radioactivity concentration than in cases with tissue damage. In particular, the infusion of 1.2 GBq of 90 Y in 10 ml in Zevalin treatments results in a relatively high concentration of the high-energy beta-emitter 90 Y and hence a relatively high absorbed dose near the injection site in the arm.…”

Section: Discussionmentioning

confidence: 99%

“…In a publication from 2017 by van der Pol and colleagues [2], the consequences of radiopharmaceutical extravasation and possible therapeutic interventions were reviewed with mention of 10 cases of extravasation of therapeutic radiopharmaceuticals-in most cases with the isotope 90 Y. More recently cases with 177 Lu [3,4], 223 Ra [5], and an additional case with 90 Y [6] have been reported. In some cases, little or no medical consequences of extravasation are reported, while in other cases severe skin damage can be observed.…”

Section: Introductionmentioning

confidence: 99%

“…In some cases, little or no medical consequences of extravasation are reported, while in other cases severe skin damage can be observed. To the best of our knowledge, only one other case with extravasation of 177 Lu-labelled peptides has been published [3], in spite of the fact that hundreds of daily treatment cycles with [ 177 Lu]Lu-DOTATATE and [ 177 Lu]Lu-DOTATOC take place in the PRRT setting in NET-centers all over the world today.…”

Section: Introductionmentioning

confidence: 99%

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Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

et al. 2020

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Background: In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation. Case presentation: A case of extravasation of [ 177 Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [ 177 Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects. Conclusions: The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

et al. 2020

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EANM dosimetry committee recommendations for dosimetry of 177Lu-labelled somatostatin-receptor- and PSMA-targeting ligands

Gleisner

Chouin

Gabiña

et al. 2022

Eur J Nucl Med Mol Imaging

104

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The purpose of the EANM Dosimetry Committee is to provide recommendations and guidance to scientists and clinicians on patient-specific dosimetry. Radiopharmaceuticals labelled with lutetium-177 (177Lu) are increasingly used for therapeutic applications, in particular for the treatment of metastatic neuroendocrine tumours using ligands for somatostatin receptors and prostate adenocarcinoma with small-molecule PSMA-targeting ligands. This paper provides an overview of reported dosimetry data for these therapies and summarises current knowledge about radiation-induced side effects on normal tissues and dose-effect relationships for tumours. Dosimetry methods and data are summarised for kidneys, bone marrow, salivary glands, lacrimal glands, pituitary glands, tumours, and the skin in case of radiopharmaceutical extravasation. Where applicable, taking into account the present status of the field and recent evidence in the literature, guidance is provided. The purpose of these recommendations is to encourage the practice of patient-specific dosimetry in therapy with 177Lu-labelled compounds. The proposed methods should be within the scope of centres offering therapy with 177Lu-labelled ligands for somatostatin receptors or small-molecule PSMA.

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Patient-specific Extravasation Dosimetry Using Uptake Probe Measurements

et al. 2021

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Extravasation is a common problem in radiopharmaceutical administration and can result in significant radiation dose to underlying tissue and skin. The resulting radiation effects are rarely studied and should be more fully evaluated to guide patient care and meet regulatory obligations. The purpose of this work was to show that a dedicated radiopharmaceutical injection monitoring system can help clinicians characterize extravasations for calculating tissue and skin doses. We employed a commercially available radiopharmaceutical injection monitoring system to identify suspected extravasation of 18 F-fluorodeoxyglucose and 99m Tc-methylene diphosphonate in 26 patients and to characterize their rates of biological clearance. We calculated the self-dose to infiltrated tissue using Monte Carlo simulation and standard MIRD dosimetry methods, and we used VARSKIN software to calculate the shallow dose equivalent to the epithelial basal-cell layer of overlying skin. For 26 patients, injection-site count rate data were used to characterize extravasation clearance. For each, the absorbed dose was calculated using representative tissue geometries. Resulting tissue-absorbed doses ranged from 0.6 to 11.2 Gy, and the shallow dose equivalent to a 10 cm 2 area of adjacent skin in these patients ranged from about 0.1 to 5.4 Sv. Extravasated injections of radiopharmaceuticals can result in unintentional doses that exceed well-established radiation protection and regulatory limits; they should be identified and characterized. An external injection monitoring system may help to promptly identify and characterize extravasations and improve dosimetry calculations. Patient-specific characterization can help clinicians determine extravasation severity and whether the patient should be followed for adverse tissue reactions that may present later in time.

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58 Dose estimation for an extravasation in a patient treated with 177Lu-DOTATATE

Cited by 7 publications

References 1 publication

Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

EANM dosimetry committee recommendations for dosimetry of 177Lu-labelled somatostatin-receptor- and PSMA-targeting ligands

Patient-specific Extravasation Dosimetry Using Uptake Probe Measurements

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