肽受体放射性核素治疗非放射性碘亲和性分化型甲状腺癌

Peptide receptor radionuclide therapy for non-radioiodine-avid differentiated thyroid carcinoma.

作者信息

Teunissen Jaap J M, Kwekkeboom Dik J, Kooij Peter P M, Bakker Willem H, Krenning Eric P

机构信息

Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

J Nucl Med. 2005 Jan;46 Suppl 1:107S-14S.

PMID:15653659

Abstract

UNLABELLED

In patients with progressive metastatic (or recurrent) differentiated thyroid carcinoma (DTC) who do not respond to radioiodine therapy or do not show uptake on radioiodine scintigraphy, treatment options are few. Because these tumors may express somatostatin receptors, peptide receptor radionuclide therapy might be effective. We evaluated the therapeutic efficacy of the radiolabeled somatostatin analog (177)Lu-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid(0) (DOTA), Tyr(3)-octreotate ((177)Lu-DOTATATE) in patients with DTC. The uptake of radioactivity in tumors was also studied in relation to treatment outcome.

METHODS

Five patients with DTC (3 with Hurthle cell thyroid carcinoma [HCTC], 1 with papillary thyroid carcinoma [PTC], and 1 with follicular thyroid carcinoma [FTC]) were treated with 22.4-30.1 GBq of (177)Lu-DOTATATE. Response to therapy was evaluated with CT. Uptake on (177)Lu-DOTATATE scintigraphy (24 h after treatment), expressed as percentage of injected dose, was compared with uptake on pretherapy (111)In-octreotide scintigraphy (24 h after injection).

RESULTS

After the last treatment with (177)Lu-DOTATATE, 1 patient with HCTC had stable disease as a maximum response, 1 patient with HCTC had minor remission (tumor shrinkage between 25% and 50%), and 1 patient with HCTC had partial remission (shrinkage > or =50%). The responses in PTC and FTC were stable disease and progressive disease, respectively. A decrease in serum thyroglobulin level was found in patients with HCTC. Patients with minor and partial remissions had the highest (177)Lu-DOTATATE-to-(111)In-diethylenetriamine pentaacetic acid(0)-octreotide ((111)In-octreotide) uptake ratios (3.2 and 2.4, respectively) whereas the other patients had uptake ratios smaller than 1.5.

CONCLUSION

(177)Lu-DOTATATE therapy can be effective in patients with progressive DTC who have no therapeutic options and sufficient uptake of (111)In-octreotide in tumor lesions as shown on (111)In-octreotide scintigraphy. This finding is especially important in patients with HCTC, because they cannot benefit from radioiodine therapy because of non-iodine-avid lesions at diagnosis.

摘要

未标注

对于进展性转移性（或复发性）分化型甲状腺癌（DTC）患者，如果对放射性碘治疗无反应或在放射性碘闪烁扫描中未显示摄取，治疗选择很少。由于这些肿瘤可能表达生长抑素受体，肽受体放射性核素治疗可能有效。我们评估了放射性标记的生长抑素类似物1,4,7,10-四氮杂环十二烷-N,N',N'',N'''-四乙酸（0）（DOTA），酪氨酰（3）-奥曲肽（（177）Lu-DOTATATE）对DTC患者的治疗效果。还研究了肿瘤中放射性摄取与治疗结果的关系。

方法

5例DTC患者（3例为许特莱细胞甲状腺癌[HCTC]，1例为乳头状甲状腺癌[PTC]，1例为滤泡状甲状腺癌[FTC]）接受了22.4 - 30.1 GBq的（177）Lu-DOTATATE治疗。用CT评估治疗反应。将治疗后24小时的（177）Lu-DOTATATE闪烁扫描摄取量（以注射剂量的百分比表示）与治疗前（111）In-奥曲肽闪烁扫描（注射后24小时）的摄取量进行比较。

结果

在用（177）Lu-DOTATATE进行最后一次治疗后，1例HCTC患者的最大反应为疾病稳定，1例HCTC患者有轻度缓解（肿瘤缩小25%至50%），1例HCTC患者有部分缓解（缩小≥50%）。PTC和FTC患者的反应分别为疾病稳定和疾病进展。HCTC患者血清甲状腺球蛋白水平下降。轻度和部分缓解的患者（177）Lu-DOTATATE与（111）In-二乙烯三胺五乙酸（0）-奥曲肽（（111）In-奥曲肽）的摄取率最高（分别为3.2和2.4），而其他患者的摄取率小于1.5。