Department of Nuclear Medicine, University Hospital, Bonn, Germany.
J Nucl Med. 2011 Aug;52(8):1197-203. doi: 10.2967/jnumed.111.090373. Epub 2011 Jul 15.
Peptide receptor radionuclide therapy (PRRT) is an efficient treatment for gastroenteropancreatic neuroendocrine tumors (GEP NETs), with outstanding overall response rates and survival. However, little is known about the particular efficacy regarding bone metastasis (BM).
We retrospectively analyzed a consecutive subgroup of 42 patients with BM of GEP NETs treated with PRRT ((177)Lu-octreotate, 4 intended cycles at 3 monthly intervals [10-14 wk]; mean activity per cycle, 8.1 GBq). Availability of restaging and outcome data was required for patient inclusion. Baseline characteristics, including age, tumor origin, performance score, Ki-67 index, tumor load, tumor uptake, plasma chromogranin A, and neuron-specific enolase, were analyzed regarding impact on tumor regression (modified M.D. Anderson criteria) and time to progression. Survival analyses were performed using Kaplan-Meier curves, log-rank test at a significance level of P less than 0.05, and Cox proportional hazards model for uni- and multivariate analyses.
Median follow-up was 32 mo. The observed response of BMs consisted of complete remission in 2 (4.8%), partial remission in 14 (33.3%), minor response in 5 (11.9%), stable disease in 16 (38.1%), and progressive disease in 5 (11.9%) patients. Median progression-free survival and overall survival (OS) were 35 mo (26-44, 95% confidence interval) and 51 mo (37-65, 95% confidence interval), respectively. Patients with responding BMs (complete remission, partial remission, or minor response) exhibited a trend toward better OS (median OS not reached after 53 mo) when compared to nonresponding patients (39 mo, P = 0.076). Only Ki-67 index (>10%) and chromogranin A level (>600 ng/mL) contributed to regression analysis.
BM of GEP NETs is effectively controlled by PRRT, with long progression-free survival and OS. Poor patient condition and multifocality of BMs do not clearly affect treatment efficacy, possibly encouraging the use of PRRT in advanced bone metastatic disease. Larger studies are needed to assess predictors of treatment outcome in these patients.
探讨肽受体放射性核素治疗（PRRT）在治疗胃肠胰神经内分泌肿瘤（GEP NETs）骨转移（BM）中的疗效。
回顾性分析 42 例接受 PRRT（177Lu-奥曲肽，4 个周期，每 3 个月 1 次[10-14 周]；每个周期的平均活度为 8.1GBq）治疗的 GEP NETs 伴 BM 患者的连续亚组资料。需要有患者随访和结局资料才能入组。分析患者的基线特征，包括年龄、肿瘤起源、表现评分、Ki-67 指数、肿瘤负荷、肿瘤摄取、血浆嗜铬粒蛋白 A 和神经元特异性烯醇化酶，以评估其对肿瘤缓解（改良的 M.D.安德森标准）和疾病进展时间的影响。采用 Kaplan-Meier 曲线、log-rank 检验（显著性水平 P<0.05）和 Cox 比例风险模型进行单因素和多因素分析。
中位随访时间为 32 个月。BM 的观察缓解包括完全缓解 2 例（4.8%）、部分缓解 14 例（33.3%）、轻度缓解 5 例（11.9%）、稳定疾病 16 例（38.1%）和进展疾病 5 例（11.9%）。中位无进展生存期和总生存期（OS）分别为 35 个月（26-44 个月，95%置信区间）和 51 个月（37-65 个月，95%置信区间）。与无反应患者（39 个月，P=0.076）相比，有反应的 BM（完全缓解、部分缓解或轻度缓解）患者的 OS 有改善趋势（53 个月后未达到中位 OS）。仅 Ki-67 指数（>10%）和嗜铬粒蛋白 A 水平（>600ng/ml）对缓解分析有影响。
PRRT 能有效控制 GEP NETs 的 BM，无进展生存期和 OS 较长。患者一般状况较差和 BM 多发性并不能明显影响治疗效果，可能鼓励在晚期骨转移疾病中使用 PRRT。需要更大的研究来评估这些患者的治疗结果预测因素。
