Extravasation frequency of [(177)Lu]Lu-DOTATATE: Insights and implications derived from 1,314 cycles of treated patients - A single-site analysis Journal Article
| Authors: | Kayal, G.; Augensen, F.; Bodei, L.; Chu, B.; Marquis, H.; Carter, L. M.; Humm, J.; Kesner, A. L. |
| Article Title: | Extravasation frequency of [(177)Lu]Lu-DOTATATE: Insights and implications derived from 1,314 cycles of treated patients - A single-site analysis |
| Abstract: | Extravasation of radiopharmaceuticals raises potential concerns, including adverse tissue reactions and reduction in both quantitative accuracy and therapeutic efficacy. This study presents a single-center experience reviewing extravasation events during [177Lu]Lu-DOTATATE administration in peptide receptor radionuclide therapy, assessing their frequency, impact on patient care, and dosimetric effects. Methods: [177Lu]Lu-DOTATATE was administered intravenously to outpatients following standard peptide receptor radionuclide ther apy protocols. Whole-body planar imaging was performed 3–4h after injection to confirm administration and assess extravasation, indicated by focal increased uptake at the infusion site. Qualitative image reviews by nuclear medicine physicians or technologists f lagged potential extravasations. For these cases, regions of inter est were delineated over the infused and contralateral arm and on the thighs. Extravasated activity was quantified relative to injected and whole-body activity. Absorbed dose calculations were per formed using the MIRD formalism, assuming a monoexponential clearance model and accounting for varying extravasate volumes, with infiltration depths ranging from 2 to 7 mm. Statistical analyses compared retained activity and dosimetric parameters between extravasation and control groups. Results: Among 1,314 adminis trations in 365 outpatients, 14 cases (1.1%) had increased uptake at the infusion site, suggesting extravasation. The maximum radio pharmaceutical retention at the infused site was less than 1% of total injected activity and less than 2.1% whole-body activity (accounting for bladder voiding). The corresponding extravasated activity related to administered activity was 0.07% and 0.01% in the extravasation and control groups, respectively (P < 0.001). The extravasation group had higher absorbed dose estimates at the infusion site than did the control group (median, 0.53 Gy [range, 0.12–1.23 Gy] vs. 0.32 Gy [range, 0.17–0.71 Gy]; P = 0.3), with a significantly higher median extravasated dose (0.14 Gy [range, 0.03–0.67 Gy] vs. 0.02 Gy [range, 0.0–0.19 Gy]; P < 0.001). We did not observe any radiogenic tissue reactions. Conclusion: Extravasa tion during [177Lu]Lu-DOTATATE therapy was rare and resulted in minimal dosimetric consequences, with absorbed doses at the infu sion site well below the thresholds for deterministic effects and soft tissue necrosis. These findings indicate that extravasation had a negligible impact on treatment efficacy and patient safety in this patient cohort, reinforcing the safety of [177Lu]Lu-DOTATATE admin istration protocols and emphasizing the low clinical risk associated with radiopharmaceutical extravasation during therapy. © 2025 Elsevier B.V., All rights reserved. |
| Keywords: | adult; aged; aged, 80 and over; middle aged; radiopharmaceuticals; diagnostic imaging; radiopharmaceutical agent; octreotide; radiometry; epidemiology; organometallic compound; organometallic compounds; infiltration; extravasation; contrast medium extravasation; extravasation of diagnostic and therapeutic materials; very elderly; humans; human; male; female; radiopharmaceutical therapy; lutetium lu 177 dotatate; lutetium dotatate lu 177; [177lu]lu-dotatate |
| Journal Title: | Journal of Nuclear Medicine |
| Volume: | 66 |
| Issue: | 8 |
| ISSN: | 0161-5505 |
| Publisher: | Society of Nuclear Medicine |
| Date Published: | 2025-08-01 |
| Start Page: | 1258 |
| End Page: | 1264 |
| Language: | English |
| DOI: | 10.2967/jnumed.124.269411 |
| PUBMED: | 40571351 |
| PROVIDER: | scopus |
| PMCID: | PMC12320563 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Gunjan Kayal -- Source: Scopus |
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