Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
Radiat Oncol. 2012 Jun 21;7:99. doi: 10.1186/1748-717X-7-99.
External beam radiotherapy (EBRT) is the treatment of choice for irresectable meningioma. Due to the strong expression of somatostatin receptors, peptide receptor radionuclide therapy (PRRT) has been used in advanced cases. We assessed the feasibility and tolerability of a combination of both treatment modalities in advanced symptomatic meningioma.
10 patients with irresectable meningioma were treated with PRRT (177Lu-DOTA0,Tyr3 octreotate or - DOTA0,Tyr3 octreotide) followed by external beam radiotherapy (EBRT). EBRT performed after PRRT was continued over 5-6 weeks in IMRT technique (median dose: 53.0 Gy). All patients were assessed morphologically and by positron emission tomography (PET) before therapy and were restaged after 3-6 months. Side effects were evaluated according to CTCAE 4.0.
Median tumor dose achieved by PRRT was 7.2 Gy. During PRRT and EBRT, no side effects > CTCAE grade 2 were noted. All patients reported stabilization or improvement of tumor-associated symptoms, no morphologic tumor progression was observed in MR-imaging (median follow-up: 13.4 months). The median pre-therapeutic SUV(max) in the meningiomas was 14.2 (range: 4.3-68.7). All patients with a second PET after combined PRRT + EBRT showed an increase in SUV(max) (median: 37%; range: 15%-46%) to a median value of 23.7 (range: 8.0-119.0; 7 patients) while PET-estimated volume generally decreased to 81 ± 21% of the initial volume.
The combination of PRRT and EBRT is feasible and well tolerated. This approach represents an attractive strategy for the treatment of recurring or progressive symptomatic meningioma, which should be further evaluated.
对于无法切除的脑膜瘤，外照射放疗（EBRT）是首选治疗方法。由于生长抑素受体表达较强，放射性核素肽受体治疗（PRRT）已被用于晚期病例。我们评估了这两种治疗方式联合用于晚期有症状脑膜瘤的可行性和耐受性。
对 10 例无法切除的脑膜瘤患者进行 PRRT（177Lu-DOTA0，Tyr3 奥曲肽或-DOTA0，Tyr3 奥曲肽）治疗，然后进行外照射放疗（EBRT）。PRRT 后进行 EBRT，采用调强放疗技术（IMRT），连续进行 5-6 周（中位剂量：53.0Gy）。所有患者在治疗前均进行形态学和正电子发射断层扫描（PET）评估，并在 3-6 个月后进行重新分期。根据 CTCAE 4.0 评估不良反应。
PRRT 实现的肿瘤中位剂量为 7.2Gy。在 PRRT 和 EBRT 期间，未观察到 CTCAE 分级>2 的不良反应。所有患者报告肿瘤相关症状稳定或改善，磁共振成像（MR）未见形态学肿瘤进展（中位随访时间：13.4 个月）。脑膜瘤治疗前 SUV(max)的中位数为 14.2（范围：4.3-68.7）。所有接受联合 PRRT+EBRT 治疗后进行第二次 PET 检查的患者，SUV(max)均有升高（中位数：37%；范围：15%-46%），至中位数 23.7（范围：8.0-119.0；7 例），而 PET 估计的肿瘤体积通常降至初始体积的 81±21%。
PRRT 和 EBRT 的联合应用是可行且耐受良好的。这种方法代表了一种有吸引力的治疗复发性或进行性有症状脑膜瘤的策略，值得进一步评估。
