Thapa Pradeep, Parghane Rahul, Basu Sandip
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India.
World J Nucl Med. 2017 Jul-Sep;16(3):223-228. doi: 10.4103/1450-1147.207283.
The present study aimed at exploring the patient and imaging characteristics of primary neuroendocrine tumors (NETs) of rare sites who presented with metastatic and/or advanced inoperable stages and therefore was considered for peptide receptor radionuclide therapy (PRRT) with Lu-DOTATATE. A retrospective analysis was undertaken of these patients focusing on the aforementioned aspects. All patients underwent dual-tracer molecular functional imaging with somatostatin receptor (SSTR)-based imaging (with either Tc-HYNIC-TOC or Ga-DOTATATE) and fluorine fludeoxyglucose positron emission tomography-computed tomography as the pretherapy assessment. Based on the qualitative uptake of tracer in SSTR imaging, the lesions were divided into four categories Grade 0-III. The response was assessed post-PRRT by three parameters: (i) symptomatic response, (ii) biochemical response (serum tumor marker), and (iii) objective imaging response. The response profiles under each of these scales were assessed utilizing predefined criteria (detailed in methods). The overall response classification into partial response, stable disease, and progressive disease was done based on documentation of similar scale/category of at least two parameters among the triple parametric assessment. A total of nine patients (7 males, 2 females; age range: 33-59 years) with rare site primary NET were found: The primary sites included ureter ( = 1), sacrococcygeal ( = 1), esophagus ( = 1), thymus ( = 3), and mediastinum ( = 3). Treatment response assessment was undertaken in eight patients who received more than 2 cycles of PRRT with Lu-DOTATATE. In this response assessment group ( = 8), the patients received 2-5 cycles and follow-up duration ranged from 5 to 48 months. Symptomatic responses and better quality of life were observed in 4/8 (50%) patients, stable symptomatic disease in 3/8 (37.5%), and progression in 1/8 patients (12.5%). Biochemically, partial response was seen in 3/8 (37.5%), stable values was seen in 3/8 (37.5%), and progression of tumor marker was seen in 2/8 (25%) patients. Morphologically, partial response was seen in 2/8 (25%), stable disease in 5/8 (62.5%), and progressive disease in 1/8 (12.5%) patients. On overall assessment, 2/8 patients (25%) demonstrated partial response, 4/8 stable disease (50%), and 2/8 progressive disease (25%) at the time of assessment. As per the RECIST 1.1, seven patients had stable disease and one patient had progressive disease. No specific correlation could be obtained between dual-tracer molecular imaging features and the response likely due to small population of the study group. Overall, there was evidence of excellent disease stabilization, and symptom palliation with Lu-DOTATATE PRRT was documented in these advanced or metastatic NETs of various rare sites.
本研究旨在探索罕见部位原发性神经内分泌肿瘤（NETs）患者的特征及影像学特征，这些患者处于转移和/或晚期无法手术阶段，因此考虑接受镥[¹⁷⁷Lu]奥曲肽肽受体放射性核素治疗（PRRT）。对这些患者进行了回顾性分析，重点关注上述方面。所有患者在治疗前评估时均接受了基于生长抑素受体（SSTR）的双示踪剂分子功能成像（使用锝[⁹⁹mTc]泮替膦或镓[⁶⁸Ga]奥曲肽）以及氟代脱氧葡萄糖正电子发射断层扫描-计算机断层扫描。根据SSTR成像中示踪剂的定性摄取情况，将病变分为0-III级四类。PRRT治疗后通过三个参数评估疗效：（i）症状反应，（ii）生化反应（血清肿瘤标志物），以及（iii）客观影像学反应。利用预定义标准（方法部分详述）评估每个量表下的反应情况。基于三联参数评估中至少两个参数的相似量表/类别记录，将总体反应分类为部分缓解、疾病稳定和疾病进展。共发现9例罕见部位原发性NET患者（7例男性，2例女性；年龄范围：33-59岁）：原发部位包括输尿管（n = 1）、骶尾部（n = 1）、食管（n = 1）、胸腺（n = 3）和纵隔（n = 3）。对8例接受超过2个周期镥[¹⁷⁷Lu]奥曲肽PRRT治疗的患者进行了治疗反应评估。在这个反应评估组（n = 8）中，患者接受了2-5个周期的治疗，随访时间为5至48个月。4/8（50%）的患者出现症状缓解且生活质量改善，3/8（37.5%）症状稳定，1/8（12.5%）患者病情进展。生化方面，3/8（37.5%）出现部分缓解，3/8（37.5%）数值稳定，2/8（25%）患者肿瘤标志物进展。形态学方面，2/8（25%）出现部分缓解，5/8（62.5%）疾病稳定，1/8（12.5%）患者病情进展。总体评估时，2/8（25%）的患者出现部分缓解，4/8（50%）疾病稳定，2/8（25%）患者病情进展。根据实体瘤疗效评价标准（RECIST）1.1，7例患者疾病稳定，1例患者病情进展。由于研究组样本量小，双示踪剂分子成像特征与反应之间未获得特定相关性。总体而言，有证据表明这些不同罕见部位的晚期或转移性NETs患者经镥[¹⁷⁷Lu]奥曲肽PRRT治疗后疾病得到了良好的稳定，症状得到了缓解。
