Extravasation of [177Lu]Lu-DOTATOC: case report and discussion

Anne Kirstine Arveschoug; Anne Charlotte Bekker; Peter Iversen; Henrik Bluhme; Gerda Elisabeth Villadsen; Peter Frøhlich Staanum

doi:10.1186/s13550-020-00658-6

Extravasation of [¹⁷⁷Lu]Lu-DOTATOC: case report and discussion

Anne Kirstine Arveschoug, Anne Charlotte Bekker, Peter Iversen, Henrik Bluhme, Gerda Elisabeth Villadsen, Peter Frøhlich Staanum^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

12 Citations (Scopus)

Abstract

Background: In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation. Case presentation: A case of extravasation of [¹⁷⁷Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [¹⁷⁷Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects. Conclusions: The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.

Original language	English
Article number	68
Journal	EJNMMI research
Volume	10
ISSN	2191-219X
DOIs	https://doi.org/10.1186/s13550-020-00658-6
Publication status	Published - Jan 2020

Keywords

Extravasation
Kidney dosimetry
Peptide-receptor radionuclide therapy (PRRT)
[Lu]Lu-DOTATOC

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10.1186/s13550-020-00658-6

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@article{fc6f0327cfe2472c92a7066e8fa1e635,

title = "Extravasation of [177Lu]Lu-DOTATOC: case report and discussion",

abstract = "Background: In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation. Case presentation: A case of extravasation of [177Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [177Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects. Conclusions: The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.",

keywords = "Extravasation, Kidney dosimetry, Peptide-receptor radionuclide therapy (PRRT), [Lu]Lu-DOTATOC",

author = "Arveschoug, {Anne Kirstine} and Bekker, {Anne Charlotte} and Peter Iversen and Henrik Bluhme and Villadsen, {Gerda Elisabeth} and Staanum, {Peter Fr{\o}hlich}",

year = "2020",

month = jan,

doi = "10.1186/s13550-020-00658-6",

language = "English",

volume = "10",

journal = "EJNMMI research",

issn = "2191-219X",

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TY - JOUR

T1 - Extravasation of [177Lu]Lu-DOTATOC

T2 - case report and discussion

AU - Arveschoug, Anne Kirstine

AU - Bekker, Anne Charlotte

AU - Iversen, Peter

AU - Bluhme, Henrik

AU - Villadsen, Gerda Elisabeth

AU - Staanum, Peter Frøhlich

PY - 2020/1

Y1 - 2020/1

N2 - Background: In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation. Case presentation: A case of extravasation of [177Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [177Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects. Conclusions: The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.

AB - Background: In the case of extravasation of radioactive drugs used in peptide-receptor radionuclide therapy of neuroendocrine tumors, or in radionuclide therapy in general, rapid action is important to reduce or avoid complications. The literature on extravasation of drugs for radionuclide therapy is sparse. Based on the present case, we discuss handling and consequences of extravasation. Further, we demonstrate that dosimetry can aid in judging if the treatment of neuroendocrine tumors is satisfactory even after extravasation. Case presentation: A case of extravasation of [177Lu]Lu-DOTATOC with a treatment strategy involving exercise and elevation of the affected arm and application of a compression bandage and heating is reported. Redistribution of the drug is verified and quantified by whole-body imaging and quantitative SPECT/CT and measurements of the dose rate at contact with the injection site. [177Lu]Lu-DOTATOC was redistributed to tumors and organs within 1 day. The patient did not report any discomfort during or after hospitalization, and no side effects related to extravasation were observed. Quantitative SPECT/CT scans at the subsequent treatment cycle of the same patient were analyzed for a comparison between the treatments. Dosimetry showed the treatments were similar with respect to the kidney and tumor absorbed doses. The radiation dose to the epidermal basal layer near the injection site was estimated and found to be consistent with the lack of side effects. Conclusions: The treatment of extravasation was successful, and the redistribution of the drug can be easily verified through measurement of the dose rate at contact with the skin. From the results of dosimetry, it was assessed that no change of the treatment course was necessary to compensate for a possibly incomplete treatment as a result of the extravasation.

KW - Extravasation

KW - Kidney dosimetry

KW - Peptide-receptor radionuclide therapy (PRRT)

KW - [Lu]Lu-DOTATOC

UR - http://www.scopus.com/inward/record.url?scp=85086778823&partnerID=8YFLogxK

U2 - 10.1186/s13550-020-00658-6

DO - 10.1186/s13550-020-00658-6

M3 - Journal article

C2 - 32577838

AN - SCOPUS:85086778823

SN - 2191-219X

VL - 10

JO - EJNMMI research

JF - EJNMMI research

M1 - 68

ER -

Extravasation of [¹⁷⁷Lu]Lu-DOTATOC: case report and discussion

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