European Journal of Nuclear Medicine and Molecular Imaging ( IF 8.6 ) Pub Date : 2022-08-05 , DOI: 10.1007/s00259-022-05925-3 Florian Rosar 1 , Andrea Schaefer-Schuler 1 , Mark Bartholomä 1 , Stephan Maus 1 , Sven Petto 1 , Caroline Burgard 1 , Bastiaan M Privé 2 , Gerben M Franssen 2 , Yvonne H W Derks 2 , James Nagarajah 2 , Fadi Khreish 1 , Samer Ezziddin 1
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Purpose
Prostate-specific membrane antigen (PSMA)-targeted PET/CT has become increasingly important in the management of prostate cancer, especially in localization of biochemical recurrence (BCR). PSMA-targeted PET/CT imaging with long-lived radionuclides as 89Zr (T1/2 = 78.4 h) may improve diagnostics by allowing data acquisition on later time points. In this study, we present our first clinical experience including preliminary biodistribution and dosimetry data of [89Zr]Zr-PSMA-617 PET/CT in patients with BCR of prostate cancer.
Methods
Seven patients with BCR of prostate cancer who revealed no (n = 4) or undetermined (n = 3) findings on [68Ga]Ga-PSMA-11 PET/CT imaging were referred to [89Zr]Zr-PSMA-617 PET/CT. PET/CT imaging was performed 1 h, 24 h, 48 h, and 72 h post injection (p.i.) of 111 ± 11 MBq [89Zr]Zr-PSMA-617 (mean ± standard deviation). Normal organ distribution and dosimetry were determined. Lesions visually considered as suggestive of prostate cancer were quantitatively analyzed.
Results
Intense physiological uptake was observed in the salivary and lacrimal glands, liver, spleen, kidneys, intestine and urinary tract. The parotid gland received the highest absorbed dose (0.601 ± 0.185 mGy/MBq), followed by the kidneys (0.517 ± 0.125 mGy/MBq). The estimated overall effective dose for the administration of 111 MBq was 10.1 mSv (0.0913 ± 0.0118 mSv/MBq). In 6 patients, and in particular in 3 of 4 patients with negative [68Ga]Ga-PSMA-11 PET/CT, at least one prostate cancer lesion was detected in [89Zr]Zr-PSMA-617 PET/CT imaging at later time points. The majority of tumor lesions were first visible at 24 h p.i. with continuously increasing tumor-to-background ratio over time. All tumor lesions were detectable at 48 h and 72 h p.i.
Conclusion
[89Zr]Zr-PSMA-617 PET/CT imaging is a promising new diagnostic tool with acceptable radiation exposure for patients with prostate cancer especially when [68Ga]Ga-PSMA-11 PET/CT imaging fails detecting recurrent disease. The long half-life of 89Zr enables late time point imaging (up to 72 h in our study) with increased tracer uptake in tumor lesions and higher tumor-to-background ratios allowing identification of lesions non-visible on [68Ga]Ga-PSMA-11 PET/CT imaging.
中文翻译：
[89Zr]Zr-PSMA-617 PET/CT 在前列腺癌生化复发中的应用：初步研究的首次临床经验，包括生物分布和剂量估计
目的
前列腺特异性膜抗原 (PSMA) 靶向 PET/CT 在前列腺癌的治疗中变得越来越重要，尤其是在生化复发 (BCR) 的定位方面。使用长寿命放射性核素89 Zr (T 1/2 = 78.4 h) 的 PSMA 靶向 PET/CT 成像可以通过允许在稍后时间点采集数据来改进诊断。在这项研究中，我们展示了我们的第一个临床经验，包括 [ 89 Zr]Zr-PSMA-617 PET/CT 在前列腺癌 BCR 患者中的初步生物分布和剂量测定数据。
方法
7 名前列腺癌 BCR 患者在 [ 68 Ga]Ga-PSMA-11 PET/CT 成像中未发现 ( n = 4) 或未确定 ( n = 3) 结果，转诊至 [ 89 Zr]Zr-PSMA-617 PET /CT。PET/CT 成像在注射 111 ± 11 MBq [ 89 Zr]Zr-PSMA-617（平均值 ± 标准偏差）后 1 小时、24 小时、48 小时和 72 小时进行。确定了正常的器官分布和剂量测定。定量分析视觉上被认为提示前列腺癌的病变。
结果
在唾液腺和泪腺、肝、脾、肾、肠和泌尿道中观察到强烈的生理摄取。腮腺接受的吸收剂量最高 (0.601 ± 0.185 mGy/MBq)，其次是肾脏 (0.517 ± 0.125 mGy/MBq)。111 MBq 给药的估计总有效剂量为 10.1 mSv (0.0913 ± 0.0118 mSv/MBq)。在 6 名患者中，特别是 4 名 [ 68 Ga]Ga-PSMA-11 PET/CT 阴性患者中的 3 名患者，在 [ 89 Zr]Zr-PSMA-617 PET/CT 成像中至少检测到一个前列腺癌病变以后的时间点。大多数肿瘤病变在感染后 24 小时首次可见，肿瘤与背景的比率随时间不断增加。在感染后 48 小时和 72 小时可检测到所有肿瘤病变
结论
[ 89 Zr]Zr-PSMA-617 PET/CT 成像是一种很有前途的新诊断工具，对前列腺癌患者具有可接受的辐射暴露，尤其是当 [ 68 Ga]Ga-PSMA-11 PET/CT 成像未能检测到复发性疾病时。89 Zr的长半衰期使得后期时间点成像（在我们的研究中长达 72 小时）成为可能，同时增加了肿瘤病变中的示踪剂摄取和更高的肿瘤背景比，从而可以识别在 [ 68 Ga]Ga上不可见的病变-PSMA-11 PET/CT 成像。
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