University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK,
Pituitary. 2014 Dec;17(6):530-8. doi: 10.1007/s11102-013-0540-y.
There are limited treatment options for progressive atypical pituitary adenomas and carcinomas. Peptide receptor radionuclide therapy that targets somatostatin receptors has recently been proposed as a potential treatment option. The theoretical rationale for efficacy is elegant but evaluation of outcomes in the first patients treated for this indication is required to assess whether further study is warranted.
We performed a case review of the three pituitary patients we have treated with (177)Lutetium DOTATATE in our institution (two atypical adenomas, one carcinoma) and dosimetric analysis of the radiation uptake in one patient.
Treatment was well tolerated. One patient with slowly progressive pituitary carcinoma has stable disease 40 months after completing the planned 4 cycles of treatment. Two patients with rapidly progressive atypical adenomas terminated treatment early due to continued disease progression. Dosimetric evaluation revealed inhomogenous uptake across the tumour (1.3-11.9 Gy with one cycle).
We have found mixed results in our first 3 patients with stable disease achieved only in the patient with the more slowly progressive tumour. As only a limited number of centres offer Peptide receptor radionuclide therapy, a formal study with prospective data collection may be feasible and if carried out should include dosimetric evaluation of absorbed dose.
对于进展性非典型垂体腺瘤和腺癌，治疗选择有限。最近提出肽受体放射性核素治疗作为一种潜在的治疗选择，该治疗针对生长抑素受体。疗效的理论依据很有说服力，但需要评估第一批为此适应证治疗的患者的结果，以评估是否需要进一步研究。
我们对在我们机构中用（177）Lu-DOTATATE 治疗的 3 例垂体患者（2 例非典型腺瘤，1 例腺癌）进行了病例回顾，并对 1 例患者的放射性摄取进行了剂量分析。
治疗耐受性良好。1 例进展缓慢的垂体癌患者在完成计划的 4 个周期治疗后 40 个月疾病稳定。2 例进展迅速的非典型腺瘤患者因疾病持续进展而提前终止治疗。剂量学评估显示肿瘤内摄取不均匀（1.3-11.9Gy，为 1 个周期）。
在我们的前 3 例患者中，仅在进展较慢的肿瘤患者中取得了稳定的疾病，结果喜忧参半。由于只有少数中心提供肽受体放射性核素治疗，因此进行一项包括前瞻性数据收集的正式研究可能是可行的，如果进行该研究，应包括吸收剂量的剂量学评估。
