A systematic literature review on the use of dosimetry for 177Lu-DOTA-TATE therapy for neuroendocrine tumours

Abstract

Background: The Rotterdam Peptide Receptor Radionuclide Therapy (PRRT) standard protocol, increasingly used in Europe, involves 4 cycles of 7.4 GBq of [177Lu] Lu-DOTA-TATE for the treatment of somatostatin receptor-positive neuroendocrine tumours. Despite its widespread implementation, the efficacy of this empirical approach is questioned. Recent studies suggest that dosimetry-guided PRRT, allowing for higher doses without exceeding organ dose limits, may yield better results. Objectives: This study aims to identify whether individualised, dosimetry-guided PRRT is the best approach for the treatment of NET using [177Lu] Lu-DOTA-TATE, by comparing individualised, dosimetry-guided PRRT with the empirical protocol. Research Methodology: A comparative systematic literature review and mixed-methods approach were used. Data were gathered from PubMed, MEDLINE, and Scopus with specific search terms, filtered by inclusion and exclusion criteria. Studies were categorized based on dosimetric or empirical approaches. Data extraction included dosimetric methods, progression free survival statistics, organ and tumor dosimetry, administered activities and imaging time points. Central tendency measures compared absorbed doses and progression free survival. Results: Most patients could receive more than 4 PRRT cycles without exceeding kidney and bone marrow dose limits (23 Gy and 2 Gy). Dosimetry-guided studies reported higher administered activities within safe dose limits compared to the empirical approach, indicating potential undertreatment with the latter. However, no correlation was found between higher administered activities and increased cumulative absorbed dose to neuroendocrine tumours due to limited data. Survival statistics did not show a clear advantage for either approach. Conclusions: Dosimetry-guided PRRT allows for higher administered activities without exceeding dose limits, suggesting potential for improved treatment efficacy over the empirical approach. This method may help avoid undertreatment and maximize therapeutic outcomes. Recommendations: Dosimetry-guided PRRT with [177Lu] Lu-DOTA-TATE is recommended for use in oncology centres for maximizing injected activity and treatment efficacy, provided sufficient resources are available. Simplified dosimetric procedures could reduce resource burdens, enhancing the feasibility of such methods.