A systematic literature review on the use of dosimetry for Lu-177 PSMA therapy for prostate cancer

Abstract

Background: Radionuclide therapy with Lutetium-177-labelled prostate specific membrane antigen ligands has emerged as a promising treatment for prostate cancer patients. Optimising dosimetric practices is essential to maximise therapeutic benefits and minimise adverse effects. This study investigates the significance and application of precise dosimetry in this therapeutic context. Objectives: The primary objective of this study is to evaluate the effectiveness and safety of Lutetium-177-prostate specific membrane antigen therapy by analysing dosimetric patterns and patient outcomes. Additionally, the study aims to compare the benefits of personalised dosimetry against the standard empirical dose of 7.4 GBq per cycle and assess the role of pre-therapeutic imaging in predicting therapy outcomes. Research Methodology: A comprehensive review and comparison of multiple studies were conducted, focusing on dosimetric data and patient outcomes. Studies included provided a robust dataset for analysis. The empirical dose of 7.4 GBq was critically evaluated in relation to personalized dosimetry practices. The impact of pre-therapeutic imaging on predicting therapeutic efficacy and safety was also examined. Results: The findings indicate three primary trends in absorbed doses over therapy cycles: an initial increase followed by a gradual decrease in organs such as kidneys and salivary glands, a consistent decrease in the spleen and liver, and stable doses in the bone marrow and whole body. High tumour-to-kidney uptake ratios were observed, affirming the targeted efficacy of the therapy. Patients tolerated the therapy well, with minimal severe adverse effects, and cumulative activities up to 60 GBq were deemed safe. Pre-therapeutic imaging significantly predicted therapy outcomes, highlighting the importance of tailored treatment plans. Conclusions: This study underscores the importance of personalised dosimetry in optimising Lutetium-177-prostate specific membrane antigen therapy for prostate cancer. Tailoring treatments to individual patients enhances therapeutic efficacy and minimises adverse effects. Pre-therapeutic imaging is vital for accurate dosimetric predictions and treatment planning.