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Pituitary function after high-dose 177Lu-DOTATATE therapy and long-term follow-up

Sundlöv, Anna LU orcid ; Sjögreen-Gleisner, Katarina LU ; Tennvall, Jan LU ; Dahl, Ludvig LU ; Svensson, Johanna ; Åkesson, Anna ; Bernhardt, Peter and Lindgren, Ola LU (2021) In Neuroendocrinology p.344-353
Abstract

INTRODUCTION: The pituitary gland has a high expression of somatostatin receptors (SSTRs) and is therefore a potential organ at risk for radiation-induced toxicity after 177Lu-DOTATATE treatment.

OBJECTIVE: To study changes in pituitary function in patients with neuroendocrine tumors (NETs) treated with dosimetry-based 177Lu-DOTATATE to detect possible late toxicity.

METHODS: 68 patients from a phase II clinical trial of dosimetry-based, individualized 177Lu-DOTATATE-therapy were included in this analysis. Patients had received a median of 5 (range 3-9) treatment cycles of 7.4 GBq/cycle. Median follow-up was 30 months (range 11-89). The GH/IGF1-axis, gonadotropins, adrenal and thyroid axes were analyzed from baseline and on... (More)

INTRODUCTION: The pituitary gland has a high expression of somatostatin receptors (SSTRs) and is therefore a potential organ at risk for radiation-induced toxicity after 177Lu-DOTATATE treatment.

OBJECTIVE: To study changes in pituitary function in patients with neuroendocrine tumors (NETs) treated with dosimetry-based 177Lu-DOTATATE to detect possible late toxicity.

METHODS: 68 patients from a phase II clinical trial of dosimetry-based, individualized 177Lu-DOTATATE-therapy were included in this analysis. Patients had received a median of 5 (range 3-9) treatment cycles of 7.4 GBq/cycle. Median follow-up was 30 months (range 11-89). The GH/IGF1-axis, gonadotropins, adrenal and thyroid axes were analyzed from baseline and on a yearly basis thereafter. Percent changes in hormonal levels over time were analyzed statistically using a linear mixed model and described graphically using boxplots. The absorbed radiation dose to the pituitary was estimated based on post-therapeutic imaging, and the results analyzed vs % change in IGF1-levels over time.

RESULTS: A statistically significant decrease in the levels of IGF1 was found (p<0.005), which was correlated to the number of treatment cycles (p=0.008) and absorbed radiation dose (p=0.03). A similar decrease, although non-significant, was seen in the gonadotropins in post-menopausal women, while in men there was an increase during the first years post-therapy, after which the levels returned to baseline. No change was observed in the adrenal nor thyroid axes.

CONCLUSIONS: No signs of severe endocrine disorder were detected, although a significant decrease in the GH/IGF1-axis was found, where dosimetric analyses indicate radiation-induced damage to the pituitary gland as a probable cause.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Neuroendocrinology
pages
10 pages
publisher
Karger
external identifiers
  • scopus:85103148381
  • pmid:32259830
ISSN
0028-3835
DOI
10.1159/000507761
language
English
LU publication?
yes
id
ae9524e0-ace4-414d-a0e0-880006da7668
date added to LUP
2020-11-12 17:57:27
date last changed
2024-07-11 01:20:36
@article{ae9524e0-ace4-414d-a0e0-880006da7668,
  abstract     = {{<p>INTRODUCTION: The pituitary gland has a high expression of somatostatin receptors (SSTRs) and is therefore a potential organ at risk for radiation-induced toxicity after 177Lu-DOTATATE treatment.</p><p>OBJECTIVE: To study changes in pituitary function in patients with neuroendocrine tumors (NETs) treated with dosimetry-based 177Lu-DOTATATE to detect possible late toxicity.</p><p>METHODS: 68 patients from a phase II clinical trial of dosimetry-based, individualized 177Lu-DOTATATE-therapy were included in this analysis. Patients had received a median of 5 (range 3-9) treatment cycles of 7.4 GBq/cycle. Median follow-up was 30 months (range 11-89). The GH/IGF1-axis, gonadotropins, adrenal and thyroid axes were analyzed from baseline and on a yearly basis thereafter. Percent changes in hormonal levels over time were analyzed statistically using a linear mixed model and described graphically using boxplots. The absorbed radiation dose to the pituitary was estimated based on post-therapeutic imaging, and the results analyzed vs % change in IGF1-levels over time.</p><p>RESULTS: A statistically significant decrease in the levels of IGF1 was found (p&lt;0.005), which was correlated to the number of treatment cycles (p=0.008) and absorbed radiation dose (p=0.03). A similar decrease, although non-significant, was seen in the gonadotropins in post-menopausal women, while in men there was an increase during the first years post-therapy, after which the levels returned to baseline. No change was observed in the adrenal nor thyroid axes.</p><p>CONCLUSIONS: No signs of severe endocrine disorder were detected, although a significant decrease in the GH/IGF1-axis was found, where dosimetric analyses indicate radiation-induced damage to the pituitary gland as a probable cause.</p>}},
  author       = {{Sundlöv, Anna and Sjögreen-Gleisner, Katarina and Tennvall, Jan and Dahl, Ludvig and Svensson, Johanna and Åkesson, Anna and Bernhardt, Peter and Lindgren, Ola}},
  issn         = {{0028-3835}},
  language     = {{eng}},
  pages        = {{344--353}},
  publisher    = {{Karger}},
  series       = {{Neuroendocrinology}},
  title        = {{Pituitary function after high-dose 177Lu-DOTATATE therapy and long-term follow-up}},
  url          = {{http://dx.doi.org/10.1159/000507761}},
  doi          = {{10.1159/000507761}},
  year         = {{2021}},
}