Department of Nuclear Medicine.
Department of Radiology.
Nucl Med Commun. 2020 Dec;41(12):1242-1249. doi: 10.1097/MNM.0000000000001284.
Peptide receptor radionuclide therapy and selective internal radiation therapy are effective radionuclide therapy modalities for unresectable metastatic neuroendocrine tumor patients that cannot be controlled with somatostatin analogs. The present study is intended to evaluate the therapeutic efficacy and toxicity of the combined therapy of selective internal radiation therapy and peptide receptor radionuclide therapy and stand-alone selective internal radiation therapy in patients with neuroendocrine tumor, a liver-dominant disease.
This cohort consists of 27 patients with metastatic neuroendocrine tumor and liver-dominant disease. They were grouped as the patients who were treated with selective internal radiation therapy for unresectable liver metastasis (n = 15) and the patients who received a combination of selective internal radiation therapy and peptide receptor radionuclide therapy (n = 12) for hepatic and extrahepatic metastasis. Treatment efficacy and treatment-associated toxicity were retrospectively assessed in both groups.
The objective treatment response and stable disease were found in 13 patients (86.6%) in the selective internal radiation therapy group and eight patients (66.6%) in the selective internal radiation therapy + peptide receptor radionuclide therapy group. The median overall survival rate was found to be 34.9 months, in the selective internal radiation therapy group and 67.5 months in the selective internal radiation therapy + peptide receptor radionuclide therapy group (P = 0.217). The median progression-free survival data was not reached, and the mean values of progression-free survival were 53.1 ± 9.9 months in the selective internal radiation therapy group, and 27.2 ± 5.9 months in the selective internal radiation therapy + peptide receptor radionuclide therapy group (P = 0.561). Temporary lymphopenia was the most common side effect. Grade 1-2 hepatotoxicity was observed to be 6.6% in the selective internal radiation therapy group, while it was not observed in selective internal radiation therapy + peptide receptor radionuclide therapy group.
In the neuroendocrine tumors with liver-dominant metastatic disease, personalized selective internal radiation therapy and peptide receptor radionuclide therapy and their combinations result in increased survival rates. Selective internal radiation therapy alone could be an effective treatment in patients with liver-limited and -dominant disease.
肽受体放射性核素治疗和选择性内放射治疗是无法用生长抑素类似物控制的不可切除转移性神经内分泌肿瘤患者的有效放射性核素治疗方法。本研究旨在评估联合治疗和单独选择性内放射治疗在以肝脏为主的神经内分泌肿瘤患者中的疗效和毒性。
本队列包括 27 例转移性神经内分泌肿瘤和肝脏为主的疾病患者。他们被分为接受不可切除肝转移选择性内放射治疗的患者（n = 15）和接受肝内和肝外转移联合选择性内放射治疗和肽受体放射性核素治疗的患者（n = 12）。对两组患者的治疗效果和治疗相关毒性进行回顾性评估。
选择性内放射治疗组中 13 例（86.6%）患者和选择性内放射治疗+肽受体放射性核素治疗组中 8 例（66.6%）患者出现客观治疗反应和稳定疾病。选择性内放射治疗组的中位总生存率为 34.9 个月，选择性内放射治疗+肽受体放射性核素治疗组为 67.5 个月（P = 0.217）。中位无进展生存期数据未达到，选择性内放射治疗组的无进展生存期平均值为 53.1 ± 9.9 个月，选择性内放射治疗+肽受体放射性核素治疗组为 27.2 ± 5.9 个月（P = 0.561）。暂时性淋巴细胞减少是最常见的副作用。选择性内放射治疗组观察到 6.6%的 1-2 级肝毒性，而选择性内放射治疗+肽受体放射性核素治疗组未观察到。
在以肝脏为主的转移性神经内分泌肿瘤中，个性化的选择性内放射治疗和肽受体放射性核素治疗及其联合治疗可提高生存率。对于肝局限性和主导性疾病的患者，单独选择性内放射治疗可能是一种有效的治疗方法。
