The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume

Abstract Purpose Effective management of patients undergoing treatment with lutetium-177 labeled DOTA-ibandronic acid (177Lu-DOTA-IBA) necessitates the identification of radiological response biomarkers that can mitigate disease progression and facilitate patient stratification for subsequent treatm...

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Main Authors: Juan Yang, Lihan Zhang, Yue Chen
Format: Article
Language:English
Published: Springer 2025-07-01
Series:Journal of Cancer Research and Clinical Oncology
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Online Access:https://doi.org/10.1007/s00432-025-06258-y
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author Juan Yang
Lihan Zhang
Yue Chen
author_facet Juan Yang
Lihan Zhang
Yue Chen
author_sort Juan Yang
collection DOAJ
description Abstract Purpose Effective management of patients undergoing treatment with lutetium-177 labeled DOTA-ibandronic acid (177Lu-DOTA-IBA) necessitates the identification of radiological response biomarkers that can mitigate disease progression and facilitate patient stratification for subsequent treatment decisions. This study aims to evaluate the metabolic tumor volume (MTV) as a quantitative measure of radiological response in bone metastases using gallium-68 labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) PET/CT. Methods In a single-center retrospective study, 68Ga-DOTA-IBA PET/CT scans of patients with bone metastases who received 177Lu-DOTA-IBA injections. Eligible patients had available PET/CT scans both prior to 177Lu-DOTA-IBA therapy and at treatment cessation. The Hermes system was employed to delineate regions of interest at baseline and at treatment cessation to measure the MTV of bone metastases. Spearman’s rank correlation coefficient was utilized to assess the correlation between MTV and the baseline covariate, alkaline phosphatase (ALP). The Cox proportional hazards model and Kaplan-Meier curves were used to evaluate the association between baseline covariates, their changes at treatment termination, and overall survival (OS). The C-index measured the predictive discrimination of covariates for OS. Results Baseline 68Ga-DOTA-IBA PET/CT images were available for 54 patients. Additionally, 30 patients underwent both baseline and post-treatment 68Ga-DOTA-IBA PET/CT scans. Baseline MTV demonstrated a moderate correlation with ALP. Among baseline covariates, MTV and ALP were significantly associated with OS. Following treatment discontinuation, MTV decreased in 57% of patients, while ALP decreased in 83%. As a continuous variable, the relative change in MTV after treatment compared to baseline was significantly associated with OS, with a C-index of 0.69. Patients exhibiting a decrease in both MTV and ALP had a significantly longer median OS compared to those with a decrease in ALP alone. Conclusions Both baseline MTV and its changes at treatment cessation were significant parameters associated with OS. The study warrants prospective validation of MTV as a quantitative imaging response biomarker for predicting OS in patients with BM treated with 177Lu-DOTA-IBA.
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spelling doaj-art-6af2cd8ffdc14b068cb0c8dcd192959e2025-08-20T03:04:16ZengSpringerJournal of Cancer Research and Clinical Oncology1432-13352025-07-0115171810.1007/s00432-025-06258-yThe radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volumeJuan Yang0Lihan Zhang1Yue Chen2Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical UniversityDepartment of Neurosurgery, The Affiliated Hospital, Southwest Medical UniversityDepartment of Nuclear Medicine, The Affiliated Hospital of Southwest Medical UniversityAbstract Purpose Effective management of patients undergoing treatment with lutetium-177 labeled DOTA-ibandronic acid (177Lu-DOTA-IBA) necessitates the identification of radiological response biomarkers that can mitigate disease progression and facilitate patient stratification for subsequent treatment decisions. This study aims to evaluate the metabolic tumor volume (MTV) as a quantitative measure of radiological response in bone metastases using gallium-68 labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) PET/CT. Methods In a single-center retrospective study, 68Ga-DOTA-IBA PET/CT scans of patients with bone metastases who received 177Lu-DOTA-IBA injections. Eligible patients had available PET/CT scans both prior to 177Lu-DOTA-IBA therapy and at treatment cessation. The Hermes system was employed to delineate regions of interest at baseline and at treatment cessation to measure the MTV of bone metastases. Spearman’s rank correlation coefficient was utilized to assess the correlation between MTV and the baseline covariate, alkaline phosphatase (ALP). The Cox proportional hazards model and Kaplan-Meier curves were used to evaluate the association between baseline covariates, their changes at treatment termination, and overall survival (OS). The C-index measured the predictive discrimination of covariates for OS. Results Baseline 68Ga-DOTA-IBA PET/CT images were available for 54 patients. Additionally, 30 patients underwent both baseline and post-treatment 68Ga-DOTA-IBA PET/CT scans. Baseline MTV demonstrated a moderate correlation with ALP. Among baseline covariates, MTV and ALP were significantly associated with OS. Following treatment discontinuation, MTV decreased in 57% of patients, while ALP decreased in 83%. As a continuous variable, the relative change in MTV after treatment compared to baseline was significantly associated with OS, with a C-index of 0.69. Patients exhibiting a decrease in both MTV and ALP had a significantly longer median OS compared to those with a decrease in ALP alone. Conclusions Both baseline MTV and its changes at treatment cessation were significant parameters associated with OS. The study warrants prospective validation of MTV as a quantitative imaging response biomarker for predicting OS in patients with BM treated with 177Lu-DOTA-IBA.https://doi.org/10.1007/s00432-025-06258-yMetabolic tumor volumeImaging biomarkerBone metastases177Lu-DOTA-ibandronic acid
spellingShingle Juan Yang
Lihan Zhang
Yue Chen
The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume
Journal of Cancer Research and Clinical Oncology
Metabolic tumor volume
Imaging biomarker
Bone metastases
177Lu-DOTA-ibandronic acid
title The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume
title_full The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume
title_fullStr The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume
title_full_unstemmed The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume
title_short The radiological response of patients with advanced bone metastases to lutetium-177-labeled DOTA-ibandronic acid assessed by metabolic tumor volume
title_sort radiological response of patients with advanced bone metastases to lutetium 177 labeled dota ibandronic acid assessed by metabolic tumor volume
topic Metabolic tumor volume
Imaging biomarker
Bone metastases
177Lu-DOTA-ibandronic acid
url https://doi.org/10.1007/s00432-025-06258-y
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