Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Patient Survival and Its Relation to Tumor Absorbed Dose in [177Lu]Lu-DOTATATE Therapy of Neuroendocrine Tumors

Warfvinge, Carl Fredrik LU ; Kapidzic, Selma Curkic LU ; Gustafsson, Johan LU orcid ; Jessen, Lovisa LU ; Svensson, Johanna ; Sundlöv, Anna LU orcid and Sjögreen Gleisner, Katarina LU orcid (2026) In Journal of nuclear medicine : official publication, Society of Nuclear Medicine
Abstract

[177Lu]Lu-DOTATATE is an established treatment for metastasized neuroendocrine tumors (NETs). It is postulated that a higher tumor absorbed dose (AD) improves clinical efficacy. The aim of this study was to assess the average AD of the entire tumor burden and analyze its effect on survival outcomes. Methods: This post hoc analysis included 81 patients with metastasized grade 1 and grade 2 NETs treated with [177Lu]Lu-DOTATATE individualized based on renal dosimetry. Tumor ADs were quantified using quantitative SPECT imaging and mass-weighted averaging across all lesions. Patients were stratified into high- and low-AD groups based on median ADs for cycle 1 and cumulative AD over all cycles. Survival outcomes were assessed using... (More)

[177Lu]Lu-DOTATATE is an established treatment for metastasized neuroendocrine tumors (NETs). It is postulated that a higher tumor absorbed dose (AD) improves clinical efficacy. The aim of this study was to assess the average AD of the entire tumor burden and analyze its effect on survival outcomes. Methods: This post hoc analysis included 81 patients with metastasized grade 1 and grade 2 NETs treated with [177Lu]Lu-DOTATATE individualized based on renal dosimetry. Tumor ADs were quantified using quantitative SPECT imaging and mass-weighted averaging across all lesions. Patients were stratified into high- and low-AD groups based on median ADs for cycle 1 and cumulative AD over all cycles. Survival outcomes were assessed using Kaplan-Meier estimates and Cox proportional hazards models. Results: Higher tumor AD was significantly associated with improved progression-free survival and overall survival. In multivariable analysis, patients in the high-AD group had significantly lower hazard ratios (HRs) for progression-free survival (HR, 0.34 for cycle 1; HR, 0.37 for cumulative AD) and overall survival (HR, 0.41 for cycle 1; HR, 0.48 for cumulative AD). Patients with a cumulative AD of 118 Gy or more (top quartile) had significantly improved survival compared with the remaining cohort, without increased toxicity. Conclusion: Mean tumor AD to the entire tumor burden is an independent predictor of survival in patients with grade 1 and grade 2 NETs treated with [177Lu]Lu-DOTATATE. These findings support the use of tumor dosimetry in treatment planning and suggest that a target AD of around 118 Gy is clinically relevant.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
publisher
Society of Nuclear Medicine Inc.
external identifiers
  • pmid:42562609
ISSN
0161-5505
DOI
10.2967/jnumed.125.271439
language
English
LU publication?
yes
additional info
© 2026 by the Society of Nuclear Medicine and Molecular Imaging.
id
949f3a04-4b7c-42d4-bb74-360a1cf179d9
date added to LUP
2026-08-07 08:52:00
date last changed
2026-08-07 08:54:13
@article{949f3a04-4b7c-42d4-bb74-360a1cf179d9,
  abstract     = {{<p>[177Lu]Lu-DOTATATE is an established treatment for metastasized neuroendocrine tumors (NETs). It is postulated that a higher tumor absorbed dose (AD) improves clinical efficacy. The aim of this study was to assess the average AD of the entire tumor burden and analyze its effect on survival outcomes. Methods: This post hoc analysis included 81 patients with metastasized grade 1 and grade 2 NETs treated with [177Lu]Lu-DOTATATE individualized based on renal dosimetry. Tumor ADs were quantified using quantitative SPECT imaging and mass-weighted averaging across all lesions. Patients were stratified into high- and low-AD groups based on median ADs for cycle 1 and cumulative AD over all cycles. Survival outcomes were assessed using Kaplan-Meier estimates and Cox proportional hazards models. Results: Higher tumor AD was significantly associated with improved progression-free survival and overall survival. In multivariable analysis, patients in the high-AD group had significantly lower hazard ratios (HRs) for progression-free survival (HR, 0.34 for cycle 1; HR, 0.37 for cumulative AD) and overall survival (HR, 0.41 for cycle 1; HR, 0.48 for cumulative AD). Patients with a cumulative AD of 118 Gy or more (top quartile) had significantly improved survival compared with the remaining cohort, without increased toxicity. Conclusion: Mean tumor AD to the entire tumor burden is an independent predictor of survival in patients with grade 1 and grade 2 NETs treated with [177Lu]Lu-DOTATATE. These findings support the use of tumor dosimetry in treatment planning and suggest that a target AD of around 118 Gy is clinically relevant.</p>}},
  author       = {{Warfvinge, Carl Fredrik and Kapidzic, Selma Curkic and Gustafsson, Johan and Jessen, Lovisa and Svensson, Johanna and Sundlöv, Anna and Sjögreen Gleisner, Katarina}},
  issn         = {{0161-5505}},
  language     = {{eng}},
  month        = {{08}},
  publisher    = {{Society of Nuclear Medicine Inc.}},
  series       = {{Journal of nuclear medicine : official publication, Society of Nuclear Medicine}},
  title        = {{Patient Survival and Its Relation to Tumor Absorbed Dose in [177Lu]Lu-DOTATATE Therapy of Neuroendocrine Tumors}},
  url          = {{http://dx.doi.org/10.2967/jnumed.125.271439}},
  doi          = {{10.2967/jnumed.125.271439}},
  year         = {{2026}},
}