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The potential of 223Ra and 18F-fluoride imaging to predict bone lesion response to treatment with 223Ra-dichloride in castration-resistant prostate cancer

Murray, Iain; Chittenden, Sarah J.; Denis-Bacelar, Ana M.; Hindorf, Cecilia LU ; Parker, Christopher; Chua, Sue and Flux, Glenn D. (2017) In European Journal of Nuclear Medicine and Molecular Imaging p.1-13
Abstract

Purpose: The aims of this study were to calculate bone lesion absorbed doses resulting from a weight-based administration of 223Ra-dichloride, to assess the relationship between those doses and corresponding 18F-fluoride uptake and to assess the potential of quantitative 18F-fluoride imaging to predict response to treatment. Methods: Five patients received two intravenous injections of 223Ra-dichloride, 6 weeks apart, at 110 kBq/kg whole-body weight. The biodistribution of 223Ra in metastatic lesions as a function of time after administration as well as associated lesion dosimetry were determined from serial 223Ra scans. PET/CT imaging using 18F-fluoride was... (More)

Purpose: The aims of this study were to calculate bone lesion absorbed doses resulting from a weight-based administration of 223Ra-dichloride, to assess the relationship between those doses and corresponding 18F-fluoride uptake and to assess the potential of quantitative 18F-fluoride imaging to predict response to treatment. Methods: Five patients received two intravenous injections of 223Ra-dichloride, 6 weeks apart, at 110 kBq/kg whole-body weight. The biodistribution of 223Ra in metastatic lesions as a function of time after administration as well as associated lesion dosimetry were determined from serial 223Ra scans. PET/CT imaging using 18F-fluoride was performed prior to the first treatment (baseline), and at week 6 immediately before the second treatment and at week 12 after baseline. Results: Absorbed doses to metastatic bone lesions ranged from 0.6 Gy to 44.1 Gy. For individual patients, there was an average factor difference of 5.3 (range 2.5–11.0) between the maximum and minimum lesion dose. A relationship between lesion-absorbed doses and serial changes in 18F-fluoride uptake was demonstrated (r2 = 0.52). A log-linear relationship was demonstrated (r2 = 0.77) between baseline measurements of 18F-fluoride uptake prior to 223Ra-dichloride therapy and changes in uptake 12 weeks after the first cycle of therapy. Correlations were also observed between both 223Ra and 18F-fluoride uptake in lesions (r = 0.75) as well as between 223Ra absorbed dose and 18F-fluoride uptake (r = 0.96). Conclusions: There is both inter-patient and intra-patient heterogeneity of absorbed dose estimates to metastatic lesions. A relationship between 223Ra lesion absorbed dose and subsequent lesion response was observed. Analysis of this small group of patients suggests that baseline uptake of 18F-fluoride in bone metastases is significantly correlated with corresponding uptake of 223Ra, the associated 223Ra absorbed dose and subsequent lesion response to treatment.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
F, Ra, -Fluoride, Absorbed dose, Alpha emitter, Radium, Treatment planning
in
European Journal of Nuclear Medicine and Molecular Imaging
pages
13 pages
publisher
Springer
external identifiers
  • scopus:85020722676
  • wos:000408337300007
ISSN
1619-7070
DOI
10.1007/s00259-017-3744-y
language
English
LU publication?
yes
id
39e48ce4-3d3b-4472-97a9-d3f7e970bec2
date added to LUP
2017-08-11 15:42:04
date last changed
2017-09-18 11:41:34
@article{39e48ce4-3d3b-4472-97a9-d3f7e970bec2,
  abstract     = {<p>Purpose: The aims of this study were to calculate bone lesion absorbed doses resulting from a weight-based administration of <sup>223</sup>Ra-dichloride, to assess the relationship between those doses and corresponding <sup>18</sup>F-fluoride uptake and to assess the potential of quantitative <sup>18</sup>F-fluoride imaging to predict response to treatment. Methods: Five patients received two intravenous injections of <sup>223</sup>Ra-dichloride, 6 weeks apart, at 110 kBq/kg whole-body weight. The biodistribution of <sup>223</sup>Ra in metastatic lesions as a function of time after administration as well as associated lesion dosimetry were determined from serial <sup>223</sup>Ra scans. PET/CT imaging using <sup>18</sup>F-fluoride was performed prior to the first treatment (baseline), and at week 6 immediately before the second treatment and at week 12 after baseline. Results: Absorbed doses to metastatic bone lesions ranged from 0.6 Gy to 44.1 Gy. For individual patients, there was an average factor difference of 5.3 (range 2.5–11.0) between the maximum and minimum lesion dose. A relationship between lesion-absorbed doses and serial changes in <sup>18</sup>F-fluoride uptake was demonstrated (r<sup>2</sup> = 0.52). A log-linear relationship was demonstrated (r<sup>2</sup> = 0.77) between baseline measurements of <sup>18</sup>F-fluoride uptake prior to <sup>223</sup>Ra-dichloride therapy and changes in uptake 12 weeks after the first cycle of therapy. Correlations were also observed between both <sup>223</sup>Ra and <sup>18</sup>F-fluoride uptake in lesions (r = 0.75) as well as between <sup>223</sup>Ra absorbed dose and <sup>18</sup>F-fluoride uptake (r = 0.96). Conclusions: There is both inter-patient and intra-patient heterogeneity of absorbed dose estimates to metastatic lesions. A relationship between <sup>223</sup>Ra lesion absorbed dose and subsequent lesion response was observed. Analysis of this small group of patients suggests that baseline uptake of <sup>18</sup>F-fluoride in bone metastases is significantly correlated with corresponding uptake of <sup>223</sup>Ra, the associated <sup>223</sup>Ra absorbed dose and subsequent lesion response to treatment.</p>},
  author       = {Murray, Iain and Chittenden, Sarah J. and Denis-Bacelar, Ana M. and Hindorf, Cecilia and Parker, Christopher and Chua, Sue and Flux, Glenn D.},
  issn         = {1619-7070},
  keyword      = {F,Ra,-Fluoride,Absorbed dose,Alpha emitter,Radium,Treatment planning},
  language     = {eng},
  month        = {06},
  pages        = {1--13},
  publisher    = {Springer},
  series       = {European Journal of Nuclear Medicine and Molecular Imaging},
  title        = {The potential of <sup>223</sup>Ra and <sup>18</sup>F-fluoride imaging to predict bone lesion response to treatment with <sup>223</sup>Ra-dichloride in castration-resistant prostate cancer},
  url          = {http://dx.doi.org/10.1007/s00259-017-3744-y},
  year         = {2017},
}