Can 177Lu-DOTATATE Kidney Absorbed Doses be Predicted from Pretherapy SSTR PET? Findings from Multicenter Data
(2025) In Journal of nuclear medicine : official publication, Society of Nuclear Medicine 66(7). p.1082-1090- Abstract
Before performing 177Lu-DOTATATE therapy for neuroendocrine tumors, somatostatin receptor (SSTR) PET imaging is currently used to confirm sufficient tumor SSTR expression, but it also has potential to be used to personalize treatment by predicting absorbed doses to critical organs. This study aims to validate the predictive capability of SSTR PET in anticipating renal absorbed dose in the first cycle of 177Lu-DOTATATE using a multicenter dataset to analyze and derive insights from a broader patient population. Methods: Retrospective data from 5 centers were included in this study: 1 in Canada (n = 25), 1 in Norway (n = 75), 1 in Sweden (n = 18), and 2 in the United States (n = 36 and n = 26). At each center, pretherapy SSTR PET/CT... (More)
Before performing 177Lu-DOTATATE therapy for neuroendocrine tumors, somatostatin receptor (SSTR) PET imaging is currently used to confirm sufficient tumor SSTR expression, but it also has potential to be used to personalize treatment by predicting absorbed doses to critical organs. This study aims to validate the predictive capability of SSTR PET in anticipating renal absorbed dose in the first cycle of 177Lu-DOTATATE using a multicenter dataset to analyze and derive insights from a broader patient population. Methods: Retrospective data from 5 centers were included in this study: 1 in Canada (n = 25), 1 in Norway (n = 75), 1 in Sweden (n = 18), and 2 in the United States (n = 36 and n = 26). At each center, pretherapy SSTR PET/CT imaging and postcycle 1 177Lu imaging-based dosimetry were performed according to site-specific protocols. The mixed-effects model treating centers as random effects was developed using baseline SSTR PET renal uptake values to predict renal absorbed dose from 177Lu-DOTATATE. Additionally, leave-one-center-out cross-validation and leave-one-sample-out cross-validation were implemented for external and internal validation, respectively, measuring mean absolute error and mean relative absolute error. Results: Across all participating centers, the median cycle 1 renal absorbed dose was 0.56 Gy/GBq (range, 0.14-1.27 Gy/GBq), whereas the median pretherapy SSTR PET renal uptake was 110.7 Bq/mL/MBq (range, 28.6-287.7 Bq/mL/MBq). The differences among center means were statistically significant for both absorbed dose and PET uptake (P < 0.0001 from 1-way ANOVA). A significant (P < 0.05) correlation was observed between kidney SSTR PET uptake and 177Lu-DOTATATE absorbed dose for each center (center-specific coefficient of determination ranged from 0.14 to 0.53). When data across all centers were aggregated, the mixed-effects model achieved a coefficient of determination of 0.25 (P < 0.01), resulting in an mean absolute error of 0.15 Gy/GBq (SD, 0.11 Gy/GBq) and an mean relative absolute error of 28% (SD, 24%) for external validation and 0.12 Gy/GBq (SD, 0.10 Gy/GBq) and 22% (SD, 20%) for internal validation. Conclusion: The correlations observed between SSTR PET renal uptake and 177Lu-DOTATATE absorbed dose to kidneys across a multicenter population are statistically significant yet modest. The prediction model achieved a mean relative absolute error 28% or less for both external and internal validation of PET-predicted absorbed doses. The intercenter differences suggest the need for standardized imaging protocols and dosimetry workflows.
(Less)
- author
- organization
- publishing date
- 2025-07-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- 177Lu-DOTATATE PRRT, absorbed dose prediction, dosimetry, SSTR PET/CT
- in
- Journal of nuclear medicine : official publication, Society of Nuclear Medicine
- volume
- 66
- issue
- 7
- pages
- 9 pages
- publisher
- Society of Nuclear Medicine Inc.
- external identifiers
-
- pmid:40404396
- scopus:105010351882
- ISSN
- 0161-5505
- DOI
- 10.2967/jnumed.124.269098
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025 by the Society of Nuclear Medicine and Molecular Imaging.
- id
- 01693aef-d66f-4afd-8a25-66e9ba11a606
- date added to LUP
- 2025-12-12 13:30:00
- date last changed
- 2025-12-13 03:00:10
@article{01693aef-d66f-4afd-8a25-66e9ba11a606,
abstract = {{<p>Before performing 177Lu-DOTATATE therapy for neuroendocrine tumors, somatostatin receptor (SSTR) PET imaging is currently used to confirm sufficient tumor SSTR expression, but it also has potential to be used to personalize treatment by predicting absorbed doses to critical organs. This study aims to validate the predictive capability of SSTR PET in anticipating renal absorbed dose in the first cycle of 177Lu-DOTATATE using a multicenter dataset to analyze and derive insights from a broader patient population. Methods: Retrospective data from 5 centers were included in this study: 1 in Canada (n = 25), 1 in Norway (n = 75), 1 in Sweden (n = 18), and 2 in the United States (n = 36 and n = 26). At each center, pretherapy SSTR PET/CT imaging and postcycle 1 177Lu imaging-based dosimetry were performed according to site-specific protocols. The mixed-effects model treating centers as random effects was developed using baseline SSTR PET renal uptake values to predict renal absorbed dose from 177Lu-DOTATATE. Additionally, leave-one-center-out cross-validation and leave-one-sample-out cross-validation were implemented for external and internal validation, respectively, measuring mean absolute error and mean relative absolute error. Results: Across all participating centers, the median cycle 1 renal absorbed dose was 0.56 Gy/GBq (range, 0.14-1.27 Gy/GBq), whereas the median pretherapy SSTR PET renal uptake was 110.7 Bq/mL/MBq (range, 28.6-287.7 Bq/mL/MBq). The differences among center means were statistically significant for both absorbed dose and PET uptake (P < 0.0001 from 1-way ANOVA). A significant (P < 0.05) correlation was observed between kidney SSTR PET uptake and 177Lu-DOTATATE absorbed dose for each center (center-specific coefficient of determination ranged from 0.14 to 0.53). When data across all centers were aggregated, the mixed-effects model achieved a coefficient of determination of 0.25 (P < 0.01), resulting in an mean absolute error of 0.15 Gy/GBq (SD, 0.11 Gy/GBq) and an mean relative absolute error of 28% (SD, 24%) for external validation and 0.12 Gy/GBq (SD, 0.10 Gy/GBq) and 22% (SD, 20%) for internal validation. Conclusion: The correlations observed between SSTR PET renal uptake and 177Lu-DOTATATE absorbed dose to kidneys across a multicenter population are statistically significant yet modest. The prediction model achieved a mean relative absolute error 28% or less for both external and internal validation of PET-predicted absorbed doses. The intercenter differences suggest the need for standardized imaging protocols and dosimetry workflows.</p>}},
author = {{Akhavanallaf, Azadeh and Lu, Zhonglin and Peterson, Avery B. and Blakkisrud, Johan and Kurkowska, Sara and Yadav, Surekha and Wang, Chang and Uribe, Carlos and Stokke, Caroline and Rahmim, Arman and Wong, Ka Kit and Beauregard, Jean Mathieu and Hope, Thomas A. and Sjögreen Gleisner, Katarina and Dewaraja, Yuni K.}},
issn = {{0161-5505}},
keywords = {{177Lu-DOTATATE PRRT; absorbed dose prediction; dosimetry; SSTR PET/CT}},
language = {{eng}},
month = {{07}},
number = {{7}},
pages = {{1082--1090}},
publisher = {{Society of Nuclear Medicine Inc.}},
series = {{Journal of nuclear medicine : official publication, Society of Nuclear Medicine}},
title = {{Can <sup>177</sup>Lu-DOTATATE Kidney Absorbed Doses be Predicted from Pretherapy SSTR PET? Findings from Multicenter Data}},
url = {{http://dx.doi.org/10.2967/jnumed.124.269098}},
doi = {{10.2967/jnumed.124.269098}},
volume = {{66}},
year = {{2025}},
}