Bodei Lisa, Handkiewicz-Junak Daria, Grana Chiara, Mazzetta Chiara, Rocca Paola, Bartolomei Mirco, Lopera Sierra Maribel, Cremonesi Marta, Chinol Marco, Mäcke Helmut R, Paganelli Giovanni
Nuclear Medicine Division, European Institute of Oncology, Milan, Italy.
Cancer Biother Radiopharm. 2004 Feb;19(1):65-71. doi: 10.1089/108497804773391694.
Metastatic medullary thyroid cancer (MTC) shows a progressive course. Surgery is the only curative treatment. In advanced disease, chemo- and radiotherapy show poor results. Newly developed somatostatin analogue [DOTA0,Tyr3]octreotide (DOTATOC) labeled to 90Y is administered in patients with endocrine tumors expressing somatostatin receptors, like MTC. Preliminary studies demonstrated that 90Y-DOTATOC could be safely administered, resulting in objective responses in 27% of patients.
To evaluate the efficacy of 90Y-DOTATOC therapy in metastatic MTC patients with positive OctreoScan, progressing after conventional treatments. Twenty-one patients were retrospectively evaluated after therapy, receiving 7.5-19.2 GBq in 2-8 cycles.
Two patients (10%) obtained a complete response (CR), as evaluated by CT, MRI and/or ultrasound, while a stabilization of disease (SD) was observed in 12 patients (57%); seven patients (33%) did not respond to therapy. The duration of the response ranged between 3-40 months. Using biochemical parameters (calcitonin and CEA), a complete response was observed in one patient (5%), while partial response in five patients (24%) and stabilization in three patients (14%). Twelve patients had progression (57%). Complete responses were observed in patients with lower tumor burden and calcitonin values at the time of the enrollment.
This retrospective analysis is consistent with the literature, regarding a low response rate in medullary thyroid cancers treated with 90Y-DOTATOC. Patients with smaller tumors and higher uptake of the radiopeptide tended to respond better. Studies with 90Y-DOTATOC administered in earlier phases of the disease will help to evaluate the ability of this treatment to enhance survival. New more specific peptides and new isotopes will also represent the key of a better treatment of MTC.
转移性甲状腺髓样癌（MTC）呈进行性病程。手术是唯一的治愈性治疗方法。在晚期疾病中，化疗和放疗效果不佳。新开发的标记有90Y的生长抑素类似物[DOTA0，Tyr3]奥曲肽（DOTATOC）被用于治疗表达生长抑素受体的内分泌肿瘤患者，如MTC。初步研究表明，90Y - DOTATOC可安全给药，27%的患者出现客观缓解。
评估90Y - DOTATOC治疗OctreoScan阳性、经传统治疗后病情进展的转移性MTC患者的疗效。对21例患者进行治疗后回顾性评估，在2 - 8个周期内接受7.5 - 19.2 GBq的治疗。
通过CT、MRI和/或超声评估，2例患者（10%）获得完全缓解（CR），12例患者（57%）病情稳定（SD）；7例患者（33%）对治疗无反应。缓解持续时间为3 - 40个月。使用生化参数（降钙素和癌胚抗原）评估，1例患者（5%）出现完全缓解，5例患者（24%）部分缓解，3例患者（14%）病情稳定。12例患者病情进展（57%）。入组时肿瘤负荷较低和降钙素值较低的患者出现完全缓解。
这项回顾性分析与文献一致，即90Y - DOTATOC治疗甲状腺髓样癌的缓解率较低。肿瘤较小且放射性肽摄取较高的患者往往反应较好。在疾病早期阶段使用90Y - DOTATOC的研究将有助于评估这种治疗提高生存率的能力。新的更特异性的肽和新的同位素也将是更好治疗MTC的关键。
