Risk of Radiation Exposure to Clinical Staff from Paracenteses of Large-Volume Chylous Ascites After Lu-177-DOTATATE Infusion

Lu-177-DOTATATE has gained wide clinical acceptance for the treatment of advanced gastroenteropancreatic neuroendocrine tumors; however, little is known regarding its accumulation in ascites. As such, clinical staff performing paracenteses shortly after a treatment dose may be concerned about their potential radiation exposure or the risk of contamination. Methods: In this report, therapeutic paracenteses were performed on a patient with metastatic intestinal carcinoid complicated by recurrent chylous ascites at various time intervals after a standard 7.4 GBq dose of Lu-177-DOTATATE. Samples of the fluid were analyzed in a scintillation counter to estimate the concentration of radioactivity. Results: The concentration of activity in the ascitic fluid obtained 3 d after an infusion was exceptionally low (175.3 +/- 25.9 Bq/mL). Conclusion: Our findings suggest that paracenteses conducted as soon as 3 d after a standard dose of Lu-177-DOTATATE pose little to no risk in terms of radiation safety to staff performing the procedure.