多肽受体放射性核素治疗（PRRT）与串联同位素 - [90Y] Y/[177Lu] Lu-DOTATATE 在波兰多中心经验中，根据 [18F] FDG PET/CT 资格对弥散性神经内分泌肿瘤患者的影响 - 我们是否需要 [18F] FDG PET/CT 进行 PRRT 资格认证？
Effect of peptide receptor radionuclide therapy (PRRT) with tandem isotopes - [90Y]Y/[177Lu]Lu-DOTATATE in patients with disseminated neuroendocrine tumours depending on [18F]FDG PET/CT qualification in Polish multicentre experience - do we need [18F]FDG PET/CT for qualification to PRRT?
机构信息
Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland.
出版信息
Endokrynol Pol. 2020;71(3):240-248. doi: 10.5603/EP.a2020.0014. Epub 2020 Apr 15.
INTRODUCTION
Peptide receptor radionuclide therapy (PRRT) using radiolabelled somatostatin analogues is a treatment option for patients with disseminated neuroendocrine tumours (NET). The aim of the study was the evaluation of the role of [¹⁸F]FDG PET/CT in predicting response, progression-free survival (PFS) and overall survival (OS) after tandem therapy [⁹⁰Y]Y/[¹⁷⁷Lu]Lu-DOTATATE.
MATERIAL AND METHODS
Seventy-five patients with histopathologically proven NET G1 and G2 were included in the study. Before treatment [⁶⁸Ga]Ga-DOTATATE PET/CT and [¹⁸F]FDG PET/CT was performed. Patients were treated with [⁹⁰Y]Y/[¹⁷⁷Lu]Lu-DOTATATE (1:1) with mixed amino-acid infusion for kidney protection.
RESULTS
Progression-free survival was 22.2 months for [¹⁸F]FDG-positive patients and 59.3 months for [¹⁸F]FDG-negative patients (p = 0.003). The OS from diagnosis (OS-D) and from the start of PRRT (OS-T) was not reached in [¹⁸F]FDG-negative patients, and in [¹⁸F]FDG-positive patients it was 71.8 months and 55.8 months, respectively. The observed overall one-year survival in [¹⁸F]FDG-positive vs. [¹⁸F]FDG-negative patients was 96.8% vs. 99.1%, two-year survival was 88.9% vs. 96%, and five-year survival was 58.8% vs. 88%, respectively. The one-year and two-year risk of progression was 15%vs. 58.9% in [¹⁸F]FDG-positive patients and 11% vs. 32% in [18F]FDG-negative patients. The objective response rate (ORR) [¹⁸F]FDG-positive vs. [¹⁸F]FDG-negative patients was 41.7% vs. 17%.
CONCLUSIONS
[¹⁸F]FDG-positive patients have statistically significant shorter survival parameters than [¹⁸F]FDG-negative patients. The risk of progression in [¹⁸F]FDG-positive vs. [¹⁸F]FDG-negative patients in one-year follow-up is comparable, whereas in two-year follow-up it is nearly two times higher for [¹⁸F]FDG PET/CT-positive patients.
介绍
使用放射性标记的生长抑素类似物的肽受体放射性核素治疗（PRRT）是治疗弥散性神经内分泌肿瘤（NET）患者的一种选择。本研究的目的是评估[¹⁸F]FDG PET/CT 在预测串联治疗[⁹⁰Y]Y/[¹⁷⁷Lu]Lu-DOTATATE 后反应、无进展生存期（PFS）和总生存期（OS）中的作用。
材料和方法
75 例经组织病理学证实的 NET G1 和 G2 患者纳入本研究。在治疗前进行了[⁶⁸Ga]Ga-DOTATATE PET/CT 和[¹⁸F]FDG PET/CT 检查。患者接受[⁹⁰Y]Y/[¹⁷⁷Lu]Lu-DOTATATE（1:1）治疗，并混合氨基酸输注进行肾脏保护。
结果
[¹⁸F]FDG 阳性患者的无进展生存期为 22.2 个月，[¹⁸F]FDG 阴性患者为 59.3 个月（p=0.003）。[¹⁸F]FDG 阴性患者的 OS 从诊断开始（OS-D）和 PRRT 开始（OS-T）未达到，而[¹⁸F]FDG 阳性患者的 OS-D 和 OS-T 分别为 71.8 个月和 55.8 个月。[¹⁸F]FDG 阳性患者的观察到的总一年生存率为 96.8%，[¹⁸F]FDG 阴性患者为 99.1%，两年生存率分别为 88.9%和 96%，五年生存率分别为 58.8%和 88%。[¹⁸F]FDG 阳性患者的一年和两年进展风险分别为 15%和 58.9%，[¹⁸F]FDG 阴性患者的一年和两年进展风险分别为 11%和 32%。[¹⁸F]FDG 阳性患者的客观缓解率（ORR）为 41.7%，[¹⁸F]FDG 阴性患者为 17%。
结论
与[¹⁸F]FDG 阴性患者相比，[¹⁸F]FDG 阳性患者的生存参数具有统计学显著差异。在一年随访中，[¹⁸F]FDG 阳性与[¹⁸F]FDG 阴性患者的进展风险相当，而在两年随访中，[¹⁸F]FDG PET/CT 阳性患者的进展风险几乎高出两倍。
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