Lutetium-177 dotatate, marketed under the name Lutathera®, is proving to be a valuable tool for physicians treating patients with neuroendocrine somatostatin-receptive tumors. Treatment consists of four cycles of 7.4 GBq of 177Lu dotatate infused intravenously over 30 to 40 minutes. This paper focuses on the radiation safety implications of patients undergoing 177Lu dotatate treatments at two large medical centers in the United States under the manufacturer’s Expanded Access Protocol. Radiation safety precautions are described for the treatment of patients to control for radiation exposure and potential contamination. Ideally, the room used for administration should have a toilet, or one that is in close proximity, and covering should be provided to minimize contamination and clean up. The patient will meet the requirements in 10 CFR Part 35.75 for immediate release based on administered activity or measured exposure rate, but will need to be provided with written instruction on how to keep doses to other individuals ALARA. Disposal of the radioactive waste from 177Lu dotatate therapy can present some hazard control issues due to the long-lived 177mLu contaminant.
Based on our experience, 177Lu dotatate therapy is an effective outpatient procedure that can safely occur in any hospital procedural room without the need for additional local shielding. Administration can be accomplished safely with attention paid to the administration set-up and proper administration procedures. Exposure to staff or to adjacent areas is minimal.
1Mayo Clinic Arizona, 5777 East Mayo Blvd., Phoenix, AZ 85054
2Univerisity of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260.
The authors declare no conflicts of interest.
Kevin Nelson, CHP, Ph.D., is a medical health physicist and RSO at Mayo Clinic Arizona. In his nearly 40 years in health physics, he has worked at the University of Minnesota, 3M, and Mayo Clinic Jacksonville, the latter serving as RSO. Dr. Nelson is a Fellow in the Health Physics Society and has served as its President as well as on numerous HPS committee activities.
Online date: September 10, 2019