Article Figures & Data
Figures
- FIGURE 1.
62-y-old man who initially presented with abdominal pain and had CT-documented mesenteric mass that, after excision, was found to be well-differentiated NET. Patient also had history of renal cell carcinoma of left kidney and had undergone left nephrectomy. (A and C) After disease-free period of 4 y, patient presented with disease recurrence, with 68Ga-DOTATATE PET/CT showing somatostatin receptor–expressing lesions in segments IV and VIII and a few peripancreatic nodules. (E) 18F-FDG PET/CT showed normal findings. Patient then underwent 5 cycles of 177Lu-based PRRT. (B and D) After the fifth cycle, 68Ga-DOTATATE PET/CT showed almost complete resolution of lesions in segment VIII and around the pancreas, with only the segment IV lesion seen. Overall assessment was good partial response to treatment. After 5 cycles, there was grade I chronic renal toxicity but no acute renal toxicity. Patient had same grade I chronic renal toxicity before undergoing PRRT. Baseline filtration fraction of 0.15 (rounded off) increased to 0.21 after 5 cycles of therapy because of reduction in ERFP compared with GFR (which was stable in this example). A color version of this figure is available as a supplemental file at http://tech.snmjournals.org.
Tables
Characteristic Value Age range 33–63 y Sex Men 3 Women 3 Histology Well differentiated 2 Intermediate 2 Poorly differentiated 2 Site of primary Pancreas 2 Kidney 1 Ureter 1 Unknown primary 1 Ileum 1 Number of metastases 5 5 5 1 Functioning kidney Right 5 Left 1 All data are number, except for age.
- TABLE 2
Cause of Single Functioning Kidney and Associated Level of Biochemical Tumor Marker
Patient Cause of single functioning kidney Serum chromogranin A* (ng/mL) 1 Pancreatic body and tail lesion extend into left adrenal and left kidney, rendering kidney nonfunctional 334→102 2 Nonfunctioning left kidney detecting incidentally during workup for PRRT 2,600→2,420 3 Horseshoe-kidney NET; partial nephrectomy for removal of primary 962→97.97 4 Previous history of left renal cell carcinoma; nephrectomy done for same 866.7→808.76 5 Left ureter NET; left kidney nonfunctional because of ureteric lesion from time of diagnosis 68.10→37.9 6 Polycystic dysplastic right kidney recognized at time of workup for PRRT 435.75→131.3 ↵* Change from baseline to final analysis.
Patient PRRT indication Grade 1 Severe abdominal pain and backache not relieved by pain killers and long-acting octreotide injections IV 2 Severe abdominal pain and backache not relieved by pain killers and long-acting octreotide injections IV 3 Severe abdominal pain and vomiting not relieved by pain killers and long-acting octreotide injections IV 4 Severe diarrhea and episodes of flushing not relieved by long-acting octreotide injections IV 5 Severe abdominal pain and loss of appetite; postoperative recurrence of unresectable pelvic mass III 6 Severe abdominal pain, vomiting, diarrhea, and backache not relieved by pain killers and long-acting octreotide injections IV Chemotherapy Patient Hypertension Diabetes Cisplatin Capecitabine 1 − − − − 2 − + + − 3 − − + − 4 − − − − 5 + − − − 6 − − − + For hypertension and diabetes, + indicates presence of condition for more than 10 y; for chemotherapy, + indicates receipt of 2 cycles.
Patient PRRT cycles (n) Cumulative activity (GBq) Follow-up (mo) Acute renal toxicity Chronic renal toxicity 1 3 16.6 12 − − 2 3 16.6 12 − − 3 5 36.2 56 − ++ 4 5 36.2 25 − + 5 3 16.6 15 − − 6 4 24.1 24 − + Patient PRRT cycle Follow-up (mo) Acute renal toxicity Chronic renal toxicity 1 Baseline 3 − − First 8 − − Second 12 − − Third 2 Baseline 3 − − First 8 − + Second 12 − − Third 3 Baseline 56 − ++ First − +++ Second − ++ Third − ++ Fourth − ++ Fifth − ++ 4 Baseline 3 − ++ First 8 − ++ Second 14 − + Third 20 − − Fourth 25 − + Fifth − + 5 Baseline 3 − − First 8 − + Second 15 − − Third − − 6 Baseline 3 − ++ First 10 − ++ Second 17 − ++ Third 24 − + Fourth - TABLE 7
Reduction in GFR and ERPF after PRRT and Corresponding Change in Filtration Fraction
Patient PRRT cycles (n) Follow-up (mo) GFR decrease from baseline (%) ERPF decrease from baseline (%) Filtration fraction change from baseline 1 3 12 13.8 20.7 0.23→0.24 2 3 12 5.3 31.4 0.17→0.24 3 5 56 — 2.8 0.49→0.55 4 5 25 — 30.2 0.15→0.21 5 3 15 — — — 6 4 24 — — —
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