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Influence of increased injected activities up 9.0 GBq [177Lu]Lu-PSMA-I&T on absorbed doses to lesions and kidneys

Zachary Ells, Linus Hempel, Julia Ells, Muyu Wu and 11 more

EJNMMI Physics | Sep 11, 2026

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No evidence of a clinically relevant tumor sink effect in patients with 2 L) lacks.

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Abstract Introduction Administration activities of 177 Lu-PSMA were chosen cautiously in the treatment of advanced prostate cancer. The primary aim was to investigate the association between increased injected activities, and the calculated absorbed doses (AD). Methods In this single center, retrospective analysis, patients with PSMA-avid metastatic castration-resistant prostate cancer treated with [ 177 Lu]Lu-PSMA-I&T were included. Patients underwent multiple timepoint SPECT/CT imaging at 24, 48, and 72 h post-injection. Patients included were injected with 7.4, or 9.1 GBq. Segmentations were completed manually for the kidneys (CT-based), while a 3.0 SUV threshold-based approach was used for lesions. Dosimetry calculations were then performed using a multiple-timepoint protocol. Manual verification of the individual segmentations coregistered between timepoints was completed. All time activity data was fit using a mono-exponential function. Time-integrated activity was then convolved with voxel-s-value using a predefined 177 Lu kernel resulting the AD in Gy. No further partial volume corrections were made. Results 76 patients treated were included: 22 and 54 were injected with 9.1 ± 0.3 and 7.4 ± 0.3 GBq respectively. The AD/GBq to the kidney was comparable, 0.29 ± 0.08 vs. 0.33 ± 0.13 Gy/GBq [ p =0.193] (9.1 vs. 7.4 GBq). The tumor AD/GBq was comparable between 9.1 and 7.4 GBq cohorts: total tumor burden (0.95 ± 0.42 vs. 0.92 ± 0.52 Gy/GBq) [ p =0.302]; bone lesions 0.78 ± 0.42 vs. 0.74 ± 0.46 Gy/GBq [ p = 2 L) lacks.

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Zachary Ells

first | LMU Klinikum | ORCID 0000-0002-5985-6052

Linus Hempel

middle | LMU Klinikum

Julia Ells

middle | LMU Klinikum

Muyu Wu

middle | LMU Klinikum | ORCID 0000-0003-0780-1946

Maximilian Scheifele

middle | LMU Klinikum

Magdalena Schoell

middle | LMU Klinikum

Sophie C. Siegmund

middle | LMU Klinikum

Mathias Zacherl

middle | LMU Klinikum

Rudolf A. Werner

middle | LMU Klinikum

Jeremie Calais

middle | Molecular Theranostics (United States)

Magnus Dahlbom

middle | Molecular Theranostics (United States)

Guido Böning

middle | LMU Klinikum

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@article{Ells2026Influence,
  title = {Influence of increased injected activities up 9.0 GBq [177Lu]Lu-PSMA-I&T on absorbed doses to lesions and kidneys},
  author = {Zachary Ells and Linus Hempel and Julia Ells and Muyu Wu and Maximilian Scheifele and Magdalena Schoell and Sophie C. Siegmund and Mathias Zacherl and Rudolf A. Werner and Jeremie Calais and Magnus Dahlbom and Guido Böning and Adrien Holzgreve and Astrid Delker and Lena M. Unterrainer},
  journal = {EJNMMI Physics},
  year = {2026},
  doi = {10.1186/s40658-026-00932-x},
  url = {https://doi.org/10.1186/s40658-026-00932-x}
}

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