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Radiation Safety and Technical Considerations for Implementing 177Lu-Dotatate in a Radiation Oncology-Based Program

N Maughan1*, H Kim1 , Y Hao1 , S Unangst2 , M Roach1 , J Garcia-Ramirez1 , M Altman1 , M Amurao1 , J Zoberi1 , (1) Washington University School of Medicine, Saint Louis, MO, (2) University of Missouri, Columbia, MO


(Tuesday, 7/16/2019) 1:15 PM - 1:45 PM

Room: Exhibit Hall | Forum 1

Purpose: Radiopeptide therapy of advanced midgut neuroendocrine tumors with Lutetium-177 (¹��Lu)-Dotatate (Lutathera) is an effective therapy. The treatment schema involves 200mCi x 4, every 8 weeks, administered intravenously with amino acids (AA). Here, we describe our steps for safely implementing an outpatient program in a radiation oncology center.

Methods: The following were identified: a team, treatment area, infusion technique, releasability criteria, and contamination control procedures. The team consisted of radiation oncologists (ROs), medical physicists (MPs), radiation therapists (RTTs), nurses, and radiation safety (RS) staff. The treatment area consisted of exam rooms that could be restricted for the treatment day, or longer if contaminated, with traffic control and dedicated restroom. RS prepared the treatment room for contamination control using absorbent materials. An IV-pump-based infusion technique was developed to deliver Lutathera and AA. Nurses prepared IV lines, and RO/RTTs delivered Lutathera using a checklist. MPs determined administered activity using surveys of the vial pre-/post-administration. Patients remained after Lutathera administration for AA infusion for another 3–4 hours with close monitoring by nursing. RTTs measured patient exposure rates (R) at 1m post Lutathera administration and at time of discharge (releasable per 10CFR35.75 if R<8.6mR/hr). RS surveyed and decontaminated the area.

Results: Eleven patients were enrolled on an expanded access protocol, yielding 36 administrations. Mean radiopharmaceutical infusion time was 37 mins (range 26–65 mins). Mean administered activity was 97% of prescription (range 90–99%). Mean R were 1.9mR/hr (range 1.0–4.1mR/hr) post-¹��Lu infusion and 0.9mR/hr (range 0.4–1.8mR/hr) at discharge, rendering patients releasable (with instructions) after infusion. Administration rooms/hallway were decontaminated and released same day. The restroom typically required more extensive decontamination but was releasable by the same evening for all treatments.

Conclusion: ¹��Lu-Dotatate was successfully implemented as a safe and efficient outpatient therapy in our radiation oncology center, where throughput has increased from 1 to 4 patients/day.




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