Nuclear Medicine Department, University and Polytechnic Hospital La Fe, Valencia, Spain.
Endocrinology and Nutrition Department, University and Polytechnic Hospital La Fe, Valencia, Spain.
Front Endocrinol (Lausanne). 2022 Feb 7;13:778322. doi: 10.3389/fendo.2022.778322. eCollection 2022.
The aim of the study is to assess phenotypic imaging patterns and the response to treatment with [Lu]Lu-DOTA-TATE and/or [I]MIBG in paragangliomas (PGLs) and pheochromocytomas (PHEOs), globally and according to the primary location.
This is a 17-patient retrospective observational study, with 9 cases treated with [Lu]Lu-DOTA-TATE and 8 with [I]MIBG (37 total treatments). Functional imaging scans and treatment responses were studied in order to choose the best therapeutic option and to define the progression-free survival (PFS) and disease control rate (DCR) according to treatment modality and primary location.
All patients were studied with phenotypic nuclear medicine images. Twelve of 17 patients were tested with both [I]MIBG and somatostatin receptor images, and 6/12 showed appropriate expression of both targets to treatment in the phenotypic images. The rest of the patients were tested with one of the image modalities or only showed suitable uptake of a single radiotracer and were treated with the corresponding therapeutic option. [Lu]Lu-DOTA-TATE PFS was 29 months with a DCR of 88.8%. [I]MIBG PFS was 18.5 months with a 62.5% DCR. According to the primary location, the best PFS was in PHEOs treated with [Lu]Lu-DOTA-TATE. Although the series are small due to the low disease prevalence and do not allow to yield statistically significant differences, this first study comparing [Lu]Lu-DOTA-TATE and [I]MIBG displays a trend to an overall longer PFS with [Lu]Lu-DOTA-TATE, especially in the adrenal primary location. When both radionuclide targets are expressed, the patients' comorbidity and treatment effectiveness should be valued together with the intensity uptake in the phenotypic image in order to choose the best therapeutic option. These preliminary retrospective results reinforce the need for a prospective, multicentric trial to be confirmed.
本研究旨在评估嗜铬细胞瘤（PHEO）和副神经节瘤（PGL）的表型成像模式以及对[Lu]Lu-DOTA-TATE 和/或[I]MIBG 治疗的反应，整体上并根据主要部位进行评估。
这是一项 17 例患者的回顾性观察研究，其中 9 例接受[Lu]Lu-DOTA-TATE 治疗，8 例接受[I]MIBG 治疗（共 37 例治疗）。为了选择最佳治疗方案，研究了功能成像扫描和治疗反应，并根据治疗方式和主要部位定义无进展生存期（PFS）和疾病控制率（DCR）。
所有患者均接受表型核医学图像检查。17 例患者中有 12 例同时接受[I]MIBG 和生长抑素受体图像检查，其中 6/12 例在表型图像中对两种治疗靶点均有适当表达。其余患者仅接受了一种图像检查方式，或仅表现出单一放射性示踪剂的适当摄取，并接受了相应的治疗方案。[Lu]Lu-DOTA-TATE 的 PFS 为 29 个月，DCR 为 88.8%。[I]MIBG 的 PFS 为 18.5 个月，DCR 为 62.5%。根据主要部位，PHEO 接受[Lu]Lu-DOTA-TATE 治疗的 PFS 最佳。尽管由于疾病发病率低，系列较小，无法产生统计学上的显著差异，但这项比较[Lu]Lu-DOTA-TATE 和[I]MIBG 的首次研究显示，[Lu]Lu-DOTA-TATE 的总体 PFS 更长，尤其是在肾上腺原发部位。当两种放射性核素靶点均表达时，应综合考虑患者的合并症和治疗效果以及表型图像中的摄取强度，以选择最佳的治疗方案。这些初步的回顾性结果证实了需要进行一项前瞻性、多中心试验来证实。
