Nuclear Medicine Department, Medical University of Warsaw, ul. Banacha 1 a, 02-097, Warsaw, Poland.
Eur J Nucl Med Mol Imaging. 2011 Oct;38(10):1788-97. doi: 10.1007/s00259-011-1833-x. Epub 2011 May 7.
Peptide receptor radionuclide therapy (PRRT) using radiolabelled somatostatin analogues is a treatment option for patients with disseminated neuroendocrine tumours (NET). A combination treatment using the high-energy 90Y beta emitter for larger lesions and the lower energy 177Lu for smaller lesions has been postulated in the literature.The aim of the study was to evaluate combined 90Y/177Lu-DOTATATE therapy in comparison to 90Y-DOTATATE alone.
Fifty patients with disseminated NET were included in the study prospectively and divided into two groups: group A (n=25) was treated with 90Y-DOTATATE, whereas group B (n=25) received the 1:1 90Y/177Lu-DOTATATE. The administered activity was based on 3.7 GBq/m2 body surface area in three to five cycles, with amino acid infusion for nephroprotection.
The median overall survival time in group A was 26.2 months while in group B median survival was not reached. Overall survival was significantly higher in group B (p=0.027). Median event-free survival time in group A was 21.4 months and in group B 29.4 months (p>0.1). At the 12-month follow-up, comparison of group A vs group B showed stable disease (SD) in 13 vs 16 patients, disease regression (RD) in 5 vs 3 patients and disease progression (PD) in 3 vs 4 patients; 4 and 2 patients died, respectively. The 24-month follow-up results were SD in nine vs ten patients, RD in one patient vs none and PD in four patients in both groups; three and four patients died, respectively. Side effects were rare and mild.
The results indicate that therapy with tandem radioisotopes (90Y/177Lu-DOTATATE) provides longer overall survival than with a single radioisotope (90Y-DOTATATE) and the safety of both methods is comparable.
使用放射性标记的生长抑素类似物的肽受体放射性核素疗法（PRRT）是治疗弥散性神经内分泌肿瘤（NET）患者的一种选择。文献中提出了一种联合使用高能 90Yβ发射器治疗较大病变和低能 177Lu 治疗较小病变的联合治疗方法。本研究的目的是评估联合 90Y/177Lu-DOTATATE 治疗与单独使用 90Y-DOTATATE 的疗效。
50 例弥散性 NET 患者前瞻性纳入本研究，并分为两组：A 组（n=25）接受 90Y-DOTATATE 治疗，B 组（n=25）接受 1:1 的 90Y/177Lu-DOTATATE 治疗。根据 3.7GBq/m2 体表面积给予三次至五次循环的放射性药物，并用氨基酸输注进行肾保护。
A 组的中位总生存期为 26.2 个月，而 B 组的中位生存期未达到。B 组的总生存期明显高于 A 组（p=0.027）。A 组的中位无进展生存期为 21.4 个月，B 组为 29.4 个月（p>0.1）。在 12 个月的随访中，A 组与 B 组相比，稳定疾病（SD）在 13 例和 16 例患者中，疾病缓解（RD）在 5 例和 3 例患者中，疾病进展（PD）在 3 例和 4 例患者中；分别有 4 例和 2 例患者死亡。24 个月的随访结果为 SD 在 9 例和 10 例患者中，RD 在 1 例和无患者中，PD 在 4 例和 4 例患者中；分别有 3 例和 4 例患者死亡。不良反应罕见且轻微。
结果表明，与单一放射性同位素（90Y-DOTATATE）相比，使用串联放射性同位素（90Y/177Lu-DOTATATE）治疗可提供更长的总生存期，两种方法的安全性相当。
