Current UK practice in [177Lu]-DOTATATE peptide receptor radionuclide therapy: a national survey of national health service centres

OBJECTIVES: With increasing use of [177Lu]-DOTATATE peptide receptor radionuclide therapy (PRRT) across the UK, variation in clinical and practical delivery aspects is likely to exist between centres. The aim of this study was to capture current practice in the UK by surveying administration methodologies, imaging and dosimetry protocols, discharge restrictions, workforce and task duration, and treatment-related incidents. METHODS: A web-based survey with 54 questions was used to investigate PRRT therapy practice. The survey included multiple-choice and free-text questions and was distributed to UK National Health Service centres via professional mailing lists and direct contact. Responses were reviewed and interpreted by a panel of nuclear medicine physicists. RESULTS: Twenty responses were received from National Health Service centres, representing 20/24 UK sites delivering [177Lu]-DOTATATE therapy. Inter-centre variation was observed in administration methods, imaging schedules, dosimetry practice, and discharge restrictions for radiation safety. Most centres (15/20) do not routinely perform dosimetry imaging, primarily due to imaging time and staffing constraints, and lack of interest due to limited perceived clinical benefit. Approximately 59 treatment-related incidents were reported over a 21-month period; contamination and human error were cited as the most common causes. CONCLUSION: This survey demonstrates variation in the practical aspects and implementation of [177Lu]-DOTATATE therapy in the UK. Variability in behavioural restrictions highlights the need for clear national guidance on performing risk assessments for PRRT, to ensure a consistent patient experience. Free-text responses, particularly those relating to administration methods and incident learning, demonstrate the range of experiences across centres and the potential value of shared learning.