Department of GI Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA.
J Neuroendocrinol. 2021 Feb;33(2):e12936. doi: 10.1111/jne.12936. Epub 2021 Jan 20.
Lu-Dotatate treatment is indicated for progressive, well-differentiated, small bowel neuroendocrine tumours) NETs. These tumours often metastasise to mesenteric lymph nodes and produce a desmoplastic reaction, consisting of tumour cells interspersed with fibrotic tissue. We hypothesised that, in patients treated with Lu-Dotatate, mesenteric tumours would remain stable even as liver tumour size changes were observed. We retrospectively reviewed the records of all patients treated with Lu-Dotatate between April 2018 and December 2019. Among patients with desmoplastic mesenteric tumours and liver metastases, we evaluated changes in tumour size of mesenteric and liver lesions based on pre- and post-treatment anatomic scans. As a result of the infrequency of objective radiographic response, any reported changes in tumour size were considered significant. Twenty-one patients met the inclusion criteria: nine had evidence of shrinkage of liver lesion(s), one had mild progression of liver lesions, seven had stable hepatic disease and four had a mixed hepatic response. Two of the patients with hepatic tumour shrinkage met the criteria for a partial response via RECIST 1.1 (https://recist.eortc.org). Desmoplastic mesenteric lesions remained unchanged in size, regardless of the changes detected in liver lesions. In conclusion, Lu-Dotatate does not impact desmoplastic mesenteric tumours which are typically associated with midgut NETs. Patients whose disease is predominantly confined to desmoplastic mesenteric lesions are unlikely to respond radiographically to peptide receptor radionuclide therapy. Moreover, the inclusion of desmoplastic mesenteric lesions as target lesions in RECIST measurements tends to increase rates of disease stability vs response or progression.
Lu-Dotatate 治疗适用于进行性、分化良好的小肠神经内分泌肿瘤（NETs）。这些肿瘤常转移至肠系膜淋巴结并产生纤维母细胞反应，由肿瘤细胞散布于纤维组织中。我们假设，在接受 Lu-Dotatate 治疗的患者中，即使观察到肝脏肿瘤大小的变化，肠系膜肿瘤仍保持稳定。我们回顾性分析了 2018 年 4 月至 2019 年 12 月期间所有接受 Lu-Dotatate 治疗的患者的记录。在患有纤维母细胞瘤性肠系膜肿瘤和肝转移的患者中，我们根据治疗前后的解剖扫描评估肠系膜和肝病变的肿瘤大小变化。由于客观放射反应的罕见性，任何报告的肿瘤大小变化均被认为具有显著意义。21 名患者符合纳入标准：9 名患者肝脏病变有缩小的证据，1 名患者肝脏病变有轻微进展，7 名患者肝脏疾病稳定，4 名患者混合性肝脏反应。2 名肝脏肿瘤缩小的患者符合 RECIST 1.1（https://recist.eortc.org）的部分缓解标准。无论肝脏病变检测到何种变化，纤维母细胞瘤性肠系膜病变的大小均保持不变。总之，Lu-Dotatate 不会影响与中肠 NET 相关的纤维母细胞瘤性肠系膜肿瘤。主要局限于纤维母细胞瘤性肠系膜病变的患者不太可能对肽受体放射性核素治疗产生影像学反应。此外，将纤维母细胞瘤性肠系膜病变纳入 RECIST 测量的靶病变会增加疾病稳定率，而不是反应率或进展率。
