Possible Risk Factors to Consider Before PRLT

One of the first factors for risk to be considered is a patient’s bone marrow condition in the event there is severe bone marrow depression due to the following:

• Disseminated metastases
• Previous irradiation of spine or pelvis
• Concurrent chemotherapy – allow 6 wk before PRLT
• Getting Ra-223 therapy – allow 2-3 months before PRLT

Other risk factors to consider:

If patient has severe anemia – correct with transfusion of packed red blood cells before PRLT

If patient has severe renal insufficiency

If patient has a fixed post-renal obstruction, corrected by ureteral stenting or percutaneous nephrostomy before PRLT.

What are the Side Effects?

Each patient is different in terms of how they react to PRLT, but there are some side-effects that are more commonly and less commonly observed among patients. The duration of these side effects can vary greatly from a few hours to many days. Patients getting PRLT should probably consider having some medications on hand for nausea and pain to be taken on the return trip to their home. Typically if a patient expriences nausea, vomiting or pain during the actual administration of the PRLT, then medication is immediately provided to the patient.

The More Common Side-effects are:

• Nausea

• Vomiting

• Abdominal discomfort or pain

The Less Common Side-effects are:

• Subacute hematological toxicity

• Temporary hair loss

In some cases there is delayed toxicity to the kidneys and renal insufficiency can be experienced. Unlike the use of Lu-177 for NETs cancer, application for PRLT does not appear to affect the kidneys. 

Serious hematologic toxicity is rare.