From the *Excel Diagnostics & Nuclear Oncology Center, and †RadioMedix Inc, Houston, TX.
Clin Nucl Med. 2017 Nov;42(11):822-828. doi: 10.1097/RLU.0000000000001818.
Peptide receptor radionuclide therapy (PRRT) with Lu-DOTATATE is shown to be an effective therapeutic option for somatostatin-expressing neuroendocrine neoplasms. Some concerns are raised over safety of this modality in patients with a history of regional chemoembolization and radionuclide hepatic embolization (CRHE) and is cause of reluctance among some physicians for suggesting Lu-DOTATATE in this patient population.
We retrospectively reviewed 143 patients with somatostatin-expressing neuroendocrine tumors who underwent Lu-DOTATATE PRRT. Statistical analysis was performed on effect of Lu-DOTATATE in patients with and without prior CRHE using resampling procedures and correlation coefficient (r).
Proportion of toxicity in patients with and without CRHE was comparable (P = 0.246). No statistically significant correlation (r) found between any toxicity and prior CRHE (r = -0.3 to -0.03) or time elapsed between embolization and the first cycle of PRRT (r = -0.59 to 0.17). Following PRRT, 76.5% of patients with CRHE experienced benefit (partial response + stable disease), whereas 23.4% experienced progressive disease. Patients with CRHE showed more stable disease (P = 0.048) and less progressive disease (P = 0.046) following PRRT compared with no CRHE. The CRHE and no-CRHE status shared same probability for developing partial response/complete response following PRRT (P = 0.50).
Treatment with Lu-DOTATATE did not show clinically or statistically significant toxicity in CRHE patients regardless of frequency of embolization or time interval between embolization and first PRRT. Results suggested a statistically significant higher response rate in patients with a history of CRHE. A prior history of CRHE is not a contraindication to subsequent PRRT.
用 Lu-DOTATATE 进行肽受体放射性核素治疗（PRRT）已被证明是表达生长抑素的神经内分泌肿瘤的有效治疗选择。对于有区域化疗栓塞和放射性核素肝栓塞（CRHE）病史的患者，人们对这种治疗方式的安全性提出了一些担忧，这也是一些医生不愿意在这类患者人群中推荐 Lu-DOTATATE 的原因。
我们回顾性分析了 143 例接受 Lu-DOTATATE PRRT 的表达生长抑素的神经内分泌肿瘤患者。采用重采样程序和相关系数（r）对有和无 CRHE 的患者 Lu-DOTATATE 的疗效进行了统计学分析。
有和无 CRHE 的患者的毒性比例相当（P = 0.246）。在任何毒性与之前的 CRHE 之间均未发现统计学显著相关性（r = -0.3 至 -0.03）或栓塞与 PRRT 第一周期之间的时间间隔（r = -0.59 至 0.17）之间的相关性。在 PRRT 后，有 CRHE 的患者中有 76.5%的患者受益（部分缓解+稳定疾病），而有 23.4%的患者出现进展性疾病。与无 CRHE 的患者相比，有 CRHE 的患者在 PRRT 后表现出更多的稳定疾病（P = 0.048）和更少的进展性疾病（P = 0.046）。CRHE 和无 CRHE 状态在 PRRT 后发生部分缓解/完全缓解的概率相同（P = 0.50）。
无论栓塞的频率或栓塞与 PRRT 第一周期之间的时间间隔如何，Lu-DOTATATE 治疗在 CRHE 患者中并未显示出临床或统计学上显著的毒性。结果表明，有 CRHE 病史的患者的反应率更高。既往有 CRHE 病史不是随后进行 PRRT 的禁忌症。
