| 1. |
- Meerkhan, Suaad, et al.
(författare)
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Testis dosimetry in individual patients by combining a small-scale dosimetry model and pharmacokinetic modeling-application of (111)In-Ibritumomab Tiuxetan (Zevalin(®)).
- 2014
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Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 1361-6560 .- 0031-9155. ; 59:24, s. 7889-7904
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Tidskriftsartikel (refereegranskat)abstract
- A heterogeneous distribution of radionuclides emitting low-energy electrons in the testicles may result in a significant difference between an absorbed dose to the radiosensitive spermatogonia and the mean absorbed dose to the whole testis. This study focused on absorbed dose distribution in patients at a finer scale than normally available in clinical dosimetry, which was accomplished by combining a small-scale dosimetry model with patient pharmacokinetic data. The activity in the testes was measured and blood sampling was performed for patients that underwent pre-therapy imaging with (111)In-Zevalin(®). Using compartment modeling, testicular activity was separated into two components: vascular and extravascular. The uncertainty of absorbed dose due to geometry variations between testicles was explored by an assumed activity micro-distribution and by varying the radius of the interstitial tubule. Results showed that the absorbed dose to germ cells might be strongly dependent on the location of the radioactive source, and may exceed the absorbed dose to the whole testis by as much as a factor of two. Small-scale dosimetry combined with compartmental analysis of clinical data proved useful for gauging tissue dosimetry and interpreting how intrinsic geometric variation influences the absorbed dose.
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| 2. |
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| 3. |
- Garkavij, Michael, et al.
(författare)
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Lu-177-[DOTA0,Tyr3] Octreotate Therapy in Patients With Disseminated Neuroendocrine Tumors: Analysis of Dosimetry With Impact on Future Therapeutic Strategy
- 2010
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Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 116:4, s. 1084-1092
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Lu-177-(DOTAO,Tyr3) octreotate is a new treatment modality for disseminated neuroendocrine tumors. According to a consensus protocol, the calculated maximally tolerated absorbed dose to the kidney should not exceed 27 Gy. In commonly used dosimetry methods, planar imaging is used for determination of the residence time, whereas the kidney mass is determined from a computed tomography (CT) scan. METHODS: Three different quantification methods were used to evaluate the absorbed dose to the kidneys. The first method involved common planar activity imaging, and the absorbed dose was calculated using the medical internal radiation dose (MIRD) formalism, using CT scan-based kidney masses. For this method, 2 region of interest locations for the background correction were investigated. The second method also included single-photon emission computed tomography (SPECT) data, which were used to scale the amplitude of the time-activity curve obtained from planar images. The absorbed dose was calculated as in the planar method. The third method used quantitative SPECT images converted to absorbed dose rate images, where the median absorbed dose rate in the kidneys was calculated in a volume of interest defined over the renal cortex. RESULTS: For some patients, the results showed a large difference in calculated kidney-absorbed doses, depending on the dosimetry method. The 2 SPECT-based methods generally gave consistent values, although the calculations were based on different assumptions. Dosimetry using the baseline planar method gave higher absorbed doses in all patients. The values obtained from planar imaging with a background region of interest placed adjacent to the kidneys were more consistent with dosimetry also including SPECT. For the accumulated tumor absorbed dose, the first 2 of the 4 planned therapy cycles made the major contribution. CONCLUSIONS: The results suggested that patients evaluated according to the conventional planar-based dosimetry method may have been undertreated compared with the other methods. Hematology and creatinine did not indicate any restriction for a more aggressive approach, which would be especially useful in patients with more aggressive tumors where there is not time for more protracted therapy. Cancer 2010;116(4 suppl):1084-92. (C) 2010 American Cancer Society.
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| 4. |
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| 5. |
- Lindén, Ola, et al.
(författare)
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Radioimmunotherapy using 131I-labeled anti-CD22 monoclonal antibody (LL2) in patients with previously treated B-cell lymphomas
- 1999
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Ingår i: Clinical Cancer Research. - 1078-0432. ; 5:10 Suppl, s. 3287-3291
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Tidskriftsartikel (refereegranskat)abstract
- Experience in using rapidly internalizing antibodies, such as the anti-CD22 antibody, for radioimmunotherapy of B-cell lymphomas is still limited. The present study was conducted to assess the efficacy and toxicity of a 131I-labeled anti-CD22 monoclonal antibody (mAb), LL2, in patients with B-cell lymphomas failing first- or second-line chemotherapy. Eligible patients were required to have measurable disease, less than 25% B cells in unseparated bone marrow, and an uptake of 99mTc-labeled LL2Fab' in at least one lymphoma lesion on immunoscintigram. Eight of nine patients examined with immunoscintigraphy were unequivocally found to have an uptake, and therapy with 131I-labeled anti-CD22 [1330 MBq/m2 (36 mCi/m2)] preceded by 20 mg of naked anti-CD22 mAb was administered. Three patients achieved partial remission (duration, 12, 3, and 2 months), and one patient with progressive lymphoma showed stable disease for 17 months. Four patients exhibited progressive disease. The toxicity was hematological. Patients with subnormal counts of neutrophils or platelets before therapy seemed to be more at risk for hematological side effects. Radioimmunotherapy in patients with B-cell lymphomas using 131I-labeled mouse anti-CD22 can induce objective remission in patients with aggressive as well as indolent lymphomas who have failed prior chemotherapy.
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| 6. |
- Ljungberg, Michael, et al.
(författare)
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3D absorbed dose calculations based on SPECT: Evaluation for 111-In/90-Y therapy using Monte Carlo simulations.
- 2003
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Ingår i: Cancer Biotherapy & Radiopharmaceuticals. - : Mary Ann Liebert Inc. - 1557-8852 .- 1084-9785. ; 18:1, s. 99-107
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Tidskriftsartikel (refereegranskat)abstract
- A general method is presented for patient-specific three-dimensional (3D) absorbed dose calculations based on quantitative SPECT activity measurements. The computational scheme includes a method for registration of the CT study to the SPECT image, and compensation for attenuation, scatter, and collimator-detector response including septal penetration, performed as part of an iterative reconstruction method. From SPECT images, the absorbed dose rate is calculated using an EGS4 Monte Carlo code, which converts the activity distribution to an absorbed dose rate distribution. Evaluation of the accuracy in the activity quantification and the absorbed dose calculation is based on realistic Monte Carlo simulated SPECT data of a voxel-computer phantom and In-111 and Y-90. Septal penetration was not included in this study. The SPECT-based activity concentrations and absorbed dose distributions are compared to the actual values; the results imply that the corrections for attenuation and scatter yield results of high accuracy. The presented method includes compensation for most parameters deteriorating the quantitative image information. Inaccuracies are, however, introduced by the limited spatial resolution of the SPECT system, which are not fully compensated by the collimator-response correction. The proposed evaluation methodology may be used as a basis for future inter-comparison of different dosimetry calculation schemes.
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| 7. |
- Ljungberg, Michael, et al.
(författare)
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A 3-dimensional absorbed dose calculation method based on quantitative SPECT for radionuclide therapy: evaluation for (131)I using monte carlo simulation.
- 2002
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Ingår i: Journal of Nuclear Medicine. - 0161-5505. ; 43:8, s. 1101-1109
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Tidskriftsartikel (refereegranskat)abstract
- A general method is presented for patient-specific 3-dimensional absorbed dose calculations based on quantitative SPECT activity measurements. METHODS: The computational scheme includes a method for registration of the CT image to the SPECT image and position-dependent compensation for attenuation, scatter, and collimator detector response performed as part of an iterative reconstruction method. A method for conversion of the measured activity distribution to a 3-dimensional absorbed dose distribution, based on the EGS4 (electron-gamma shower, version 4) Monte Carlo code, is also included. The accuracy of the activity quantification and the absorbed dose calculation is evaluated on the basis of realistic Monte Carlo-simulated SPECT data, using the SIMIND (simulation of imaging nuclear detectors) program and a voxel-based computer phantom. CT images are obtained from the computer phantom, and realistic patient movements are added relative to the SPECT image. The SPECT-based activity concentration and absorbed dose distributions are compared with the true ones. RESULTS: Correction could be made for object scatter, photon attenuation, and scatter penetration in the collimator. However, inaccuracies were imposed by the limited spatial resolution of the SPECT system, for which the collimator response correction did not fully compensate. CONCLUSION: The presented method includes compensation for most parameters degrading the quantitative image information. The compensation methods are based on physical models and therefore are generally applicable to other radionuclides. The proposed evaluation methodology may be used as a basis for future intercomparison of different methods.
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| 8. |
- Minarik, David, et al.
(författare)
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90Y Bremsstrahlung Imaging for Absorbed-Dose Assessment in High-Dose Radioimmunotherapy.
- 2010
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Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 51:12, s. 1974-1978
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Tidskriftsartikel (refereegranskat)abstract
- This feasibility study demonstrates (90)Y quantitative bremsstrahlung imaging of patients undergoing high-dose myeloablative (90)Y-ibritumomab treatment. METHODS: The study includes pretherapy (111)In SPECT/CT and planar whole-body (WB) imaging at 7 d and therapy (90)Y SPECT/CT at 6 d and (90)Y WB imaging at 1 d. Time-activity curves and organ-absorbed doses derived from (90)Y SPECT images were compared with pretherapy (111)In estimates. Organ activities derived from (90)Y WB images at the first day were compared with corresponding pretherapy estimates. RESULTS: Pretherapy (111)In images from 3 patients were similar to the (90)Y images. Differences between absorbed-dose estimates from pretherapy (111)In and (90)Y therapy were within 25%, except for the lungs. Corresponding activity differences derived from WB images were within 25%. Differences were ascribed to incomplete compensation methods and real differences in pharmacokinetics between pretherapy and therapy. CONCLUSION: Quantitative bremsstrahlung imaging to estimate organ activities and absorbed doses is feasible.
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| 9. |
- Nickel, Mattias, et al.
(författare)
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Development and evaluation of a pharmacokinetic model for prediction of radioimmunotherapy based on pretherapy data.
- 2009
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Ingår i: Cancer Biotherapy & Radiopharmaceuticals. - : Mary Ann Liebert Inc. - 1557-8852 .- 1084-9785. ; 24:1, s. 111-121
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this work was to develop a pharmacokinetic model for the analysis of the pharmacokinetics of (111)Inlabeled monoclonal antibodies (mAbs) in B-cell lymphoma patients and to evaluate the model's ability to predict a subsequent radioimmunotherapy by (90)Y-labeled mAbs. Data from quantified scintillation camera images and blood samples were used to fit a compartment model. The modeling included two steps: 1) a two-compartment model describing the total-body kinetics for the estimation of a set of global parameters and 2) a multicompartment model for estimating the model parameters for organs. In both steps, a correction for radiochemical impurity in the form of (111)In-DTPA (diethylene triamine pentaacetic acid) was included. The model was found to describe all patient data with good accuracy. From the model, the time-activity data of all organs could be separated into extravascular and vascular components, where the estimates of the regional vascular volumes were found to be in close agreement with literature data. A significant improvement of the model fit to total-body activity data was obtained by correcting for radiochemical impurity. The therapy kinetics area under the curves (AUCs) predicted from pretherapy data were in good agreement with the measured therapy AUCs. The good correlation between the model estimates and measured data, the accurate prediction of the therapy kinetics, and the good estimates of regional vascular volumes demonstrates the reliability of the model. These findings also indicate that the model can be useful for individual optimization of the amount of activity to be administered with respect to patient dosimetry.
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