The impact of 177Lu-octreotide therapy on 99mTc-MAG3 clearance is not predictive for late nephropathy
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Rudolf A. Werner1,2, Seval Beykan1, Takahiro Higuchi1,2, Katharina Lückerath1, Alexander Weich3, Michael Scheurlen3, Christina Bluemel1, Ken Herrmann1,4, Andreas K. Buck1,2, Michael Lassmann1, Constantin Lapa1,* and Heribert Hänscheid1,*
1 Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
2 Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
3 Department of Internal Medicine II, Gastroenterology, University Hospital Würzburg, Würzburg, Germany
4 Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
* These authors have contributed equally to this work
Heribert Hänscheid, email:
Keywords: renal scintigraphy, MAG3, PRRT, neuroendocrine tumor, 177Lu
Received: April 04, 2016 Accepted: May 23, 2016 Published: June 01, 2016
Peptide Receptor Radionuclide Therapy (PRRT) for the treatment of neuroendocrine tumors may lead to kidney deterioration. This study aimed to evaluate the suitability of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) clearance for the early detection of PRRT-induced changes on tubular extraction (TE). TE rate (TER) was measured prior to 128 PRRT cycles (7.6±0.4 GBq 177Lu-octreotate/octreotide each) in 32 patients. TER reduction during PRRT was corrected for age-related decrease and analyzed for the potential to predict loss of glomerular filtration (GF). The GF rate (GFR) as measure for renal function was derived from serum creatinine. The mean TER was 234 ± 53 ml/min/1.73 m² before PRRT (baseline) and 221 ± 45 ml/min/1.73 m² after a median follow-up of 370 days. The age-corrected decrease (mean: -3%, range: -27% to +19%) did not reach significance (p=0.09) but significantly correlated with the baseline TER (Spearman p=-0.62, p<0.001). Patients with low baseline TER showed an improved TER after PRRT, high decreases were only observed in individuals with high baseline TER. Pre-therapeutic TER data were inferior to plasma creatinine-derived GFR estimates in predicting late nephropathy. TER assessed by 99mTc-MAG3clearance prior to and during PRRT is not suitable as early predictor of renal injury and an increased risk for late nephropathy.
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