Search

Objective: 177Lu-DOTATATE peptide receptor therapy (PRRT) is an established treatment for patients suffering from neuroendocrine tumors. In the last few years, intra-arterial PRRT is being considered for patients having liver metastatic disease predominantly. The aim of our study is to measure the radiation doses received by the treating intervention radiologists involved in intra-arterial PRRT treatment using 177Lu-DOTATATE. Materials and Methods: Radiation safety-related data of 31 patients who underwent 177Lu-DOTATATE intra-arterial PRRT treatment were used for this study. The exposure rate was measured at the hand and eye and chest level of treating intervention radiologists continuously from the beginning to the end of the administration. Exposure from the patient at the body surface (at the level of liver, thigh, and extremities) and 1 m from the body surface was measured just after the administration. The mean radiation exposure from the patient at the body surface and 1 m from the body was also calculated. Results: The mean administered activity was found to be 194 (±17) mCi. The mean radiation exposure at the surface at the level of the liver, thigh, and feet and at 1 m from the surface was found to be 100 (±25.11), 9 (±1.27), 5.6 (±0.52), and 5.3± (0.50) μSv/hr, respectively. The mean administration time was found to be 23 ± 5.6 min. The mean radiation dose to the hands, and eyes, of the treating intervention radiologist per procedure, was found to be 6.425 ± 2.75 μSv, 5.43 ± 1.76 μSv and 1-m exposure from the patient was found to be 5.3 ± 0.246 μSv, respectively. Conclusion: Our result shows that the radiation exposure from the patient postadministration is below the permissible limit of discharge. The radiation exposure to the intervention radiologist is also suggestive of a safe procedure to be performed by maintaining the radiation dose well within the permissible limit for radiation professionals. [ABSTRACT FROM AUTHOR]

Extracranial metastasis from high-grade glial tumors is an extremely rare condition with its reported incidence being <1%. The most common sites reported in the literature are leptomeninges and spinal cord, followed by the liver, lung, and skeletal system. Its low incidence is thought to be related to the intrinsic aggressive biology of the tumor, thus reducing median overall survival in patients. As there is lack of knowledge about the mechanism of extracranial spread of glioma cells, its diagnosis and management remain a major challenge. We report two cases of extracranial metastases from glial tumors to cervical nodes and postoperative site involving preauricular region detected on F18 Fluoro ethyl tyrosine (FET) positron emission tomography-computed tomography and later on confirmed with histopathology Fluoro ethyl tyrosine. [ABSTRACT FROM AUTHOR]

Purpose: We proposed to administer Lu‑177‑DOTATATE in intra‑arterial (IA) mode for higher first‑pass localization to somatostatin receptors, higher residence time in liver metastases, and more radiation to tumor. This study aimed at assessing early hematological, renal and hepatotoxicity; and objective response to IA peptide receptor radionuclide therapy (PRRT). Materials and Methods: Fourteen patients (4 females and 10 males) were prospectively assessed. 5/14 patients underwent 2 cycles, whereas 3/14 underwent 3 cycles, and 6/14 received 1 cycle of IA PRRT. 200 mCi of Lu‑177‑DOTATATE was administered in 15–20 min by IA route under angiographic guidance. Patients were asked to follow‑up at 4 and 8 weeks with hematological, liver, and renal functional parameters, and Ga‑68 DOTATATE positron emission tomography/computed tomography (PET/CT) after 8 weeks. Response was assessed using RECIST 1.1 and EORTC PET criteria. Results: Safety: 2/14 patients had high total and direct bilirubin, which reverted to normal after IA PRRT. Three patients had low albumin, which improved after 1 cycle. Nine patients showed no worsening of liver function. Two patients showed Grade 1 hematotoxicity which reverted to normal. Five patients showed high creatinine, but preserved glomerular filtration rate and EC clearance. On follow‑up at 8 weeks, serum creatinine reverted to normal. Efficacy: In five patients who underwent 2 cycles of IA PRRT, 3 showed partial response (PR) on RECIST 1.1 and partial metabolic response (PMR) on EORTC criteria, whereas 2 showed stable disease (SD). In patients who underwent 3 cycles, 1 showed SD, whereas other patient showed PMR on DOTANOC PET/ CT, with PR in size. Among the remaining seven patients, 5 showed PMR, whereas the other 2 showed SD. Thus 9/14 patients showed PR, whereas 5 showed SD on metabolic and size criteria. Conclusions: IA PRRT is a safe and efficacious approach for the treatment of liver dominant metastatic neuroendocrine tumors. [ABSTRACT FROM AUTHOR]

Purpose: Refractory and/or recurrent meningiomas have poor outcomes, and the treatment options are limited. Peptide receptor radionuclide therapy (PRRT) has been used in this setting with promising results. We have documented our experience of using intravenous (IV) and intra-arterial (IA) approaches of Lu-177 DOTATATE PRRT. Methods: Eight patients with relapsed/refractory high-grade meningioma received PRRT with Lu-177 DOTATATE by IV and an IA route. At least 2 cycles were administered. Time to progression was calculated from the first PRRT session to progression. The response was assessed on MRI using RANO criteria, and visual analysis of uptake was done on Ga-68 DOTANOC PET/CT. Post-therapy dosimetry calculations for estimating the absorbed dose were performed. Results: Median time to progression was 8.9 months. One patient showed disease progression, whereas seven patients showed stable disease at 4 weeks following 2 cycles of PRRT. Dosimetric analysis showed higher dose and retention time by IA approach. No significant peri-procedural or PRRT associated toxicity was seen. Conclusion: PRRT is a safe and effective therapeutic option for relapsed/refractory meningioma. The IA approach yields better dose delivery and should be routinely practised. [ABSTRACT FROM AUTHOR]

Objective: The objective is to evaluate incidental detection of COVID-19 lung involvement in asymptomatic individuals who undergo fluorodeoxyglucose (FDG) positron emission tomography-computerized tomography (PET/CT) scans for oncologic indications. Patients and Methods: The study was conducted in a tertiary care oncology hospital and included patients who were asymptomatic for COVID-19 infection and underwent FDG PET/CT scans for standard oncologic indications between April 15, 2020, and September 30, 2020. Patients who showed CO-RADS category 4/5 changes (high level of suspicion) on the CT chest component of the PET/CT study were considered for analysis. CT severity score, presence of FDG uptake, and maximum standardized uptake value of FDG avid lung involvement were noted and correlated with reverse transcriptase-polymerase chain reaction (RT-PCR) test. Results: 1982 PET/CT scans were performed, 78 (3.9%) patients showed lung changes with high degree of suspicion of COVID-19 pneumonia (CO-RADS 4/5). Hematolymphoid and head-neck cancer were the most common tumor types (23%), and restaging/response evaluation was the most common PET/CT indication. Of the patients who underwent RT-PCR testing, 70% showed a positive result. The mean CT severity score was 6 (standard deviation 5.9) with no significant difference seen between the RT-PCR positive and negative groups. FDG avidity in lung lesions was noted in 41 out 57 (72%) patients. A significant correlation was seen between the RT-PCR positivity and FDG uptake in lung lesions. Conclusion: A small but significant proportion of patients undergoing routine oncologic PET/CT scans showed incidental COVID-19 lung involvement. Lung involvement in these asymptomatic patients showed a low CT severity score in all patients and FDG avidity in majority. Timely detection of such incidental cases can initiate further confirmatory RT-PCR testing and isolation measures that not only influence patient's cancer treatment protocols but also have a larger community impact of limiting the spread of infection. [ABSTRACT FROM AUTHOR]

Giant cell tumors (GCTs) are benign bone lesions which are treated with curettage and bone grafting. Infrequently, GCTs show local site recurrences which are then treated with either surgical excision or radiation therapy. Radiation-induced sarcoma is rarely seen as a late complication of radiation therapy which needs to be differentiated from recurrent GCT. We report one such rare case of radiation-induced sarcoma detected on Flourine-18 fluorodeoxyglucose (18F FDG) positron emission tomography/computed tomography in a 40-year-old male who was treated with radiation therapy for recurrent GCT 9 years ago. [ABSTRACT FROM AUTHOR]

There is a sudden upsurge in the literature over the last fortnight on strategies to be followed by imaging services during this SARS-CoV-2 global pandemic. This compilation of strategies, experiences, and precautions is intended to support nuclear medicine departments, as they make decisions regarding patient care. These guidelines are a good resource to tackle the current crisis, however, situations such as these may occur again, and long-term readiness measures need to be discussed and implemented. [ABSTRACT FROM AUTHOR]