四周期肽受体放射性核素治疗（PRRT）后 1 年的肾毒性和血液毒性及其对未来治疗计划的影响 - 一项回顾性分析。
Nephrotoxicity and hematotoxicity one year after four cycles of peptide receptor radionuclide therapy (PRRT) and its impact on future treatment planning - A retrospective analysis.
机构信息
Medical University Innsbruck, Department of Nuclear Medicine, Austria.
Medical University Innsbruck, Department of Nuclear Medicine, Austria.
出版信息
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2022 May-Jun;41(3):138-145. doi: 10.1016/j.remnie.2021.04.007. Epub 2021 Apr 15.
PURPOSE
Nephro- and hematotoxicity after peptide receptor radionuclide therapy (PRRT) have been described in multiple studies with heterogeneous cumulative activities, number of cycles or radiolabelled peptides. Though highly differentiated metastasized neuroendocrine tumours (NET) have long progression free survival, they may progress. We analysed long-term side effects in a homogenous treatment schedule in PRRT-patients and their impact on future oncologic treatment in case of progression.
METHODS
From our database 89/384 patients receiving the same PRRT (Lu-177-DOTATATE or Y-90-DOTATOC) 4 times every 10-12 weeks and a follow-up at 12 months were analysed. One patient had three and 11 patients had two times four PRRT-cycles resulting in 102 cases. eGFR, Hb, WBC and platelets before the first and one year after the fourth therapy cycle were compared. eGFR-Grading was done according to chronic kidney disease classification (CKD) and grading of hematotoxicity according to CTCAE. Impact of age, gender, cumulative activity, type of PRRT on long-term-toxicity was also assessed.
RESULTS
eGFR grade 1-2 dropped from 87/102 at the baseline to 71 cases at follow-up (p < 0.001). Before treatment grade 3a was found in 13, grade 3b in 2 cases, and at follow-up grade 3a in 25, grade 3b in 5, and grade 4 in 1 case. Anaemia prior to PRRT and at follow-up was grade 0 in 63 versus 48 (p < 0.001), grade 1 in 36 versus 48, and grade 2 in three versus six cases. In white blood cell count and platelets, there were no significant changes in grading occurring. Subgroup analysis revealed that only in the age group 65 and older was there a higher incidence for anaemia (p = 0.006).
CONCLUSION
In roughly 20% of cases an increase in grading of nephro- or hematotoxicity is observed. In those patients, except in one, toxicity findings were mild or moderate one year after completion of four cycles of PRRT with either Y-90- or Lu-177-SST-analogues. In terms of safety, PRRT has no critical impact on further oncologic treatment options in the case of disease progression.
目的
肽受体放射性核素疗法（PRRT）后的肾毒性和血液毒性已在多项研究中报道，这些研究的累积活度、周期数或放射性标记肽的数量存在差异。尽管高度分化的转移性神经内分泌肿瘤（NET）有很长的无进展生存期，但它们也可能进展。我们分析了在同质 PRRT 治疗方案中患者的长期副作用及其对进展后未来肿瘤治疗的影响。
方法
从我们的数据库中，分析了 89/384 名接受相同 PRRT（Lu-177-DOTATATE 或 Y-90-DOTATOC）治疗的患者，每 10-12 周进行 4 次治疗，随后在 12 个月时进行随访。有 1 名患者进行了 3 次，11 名患者进行了 2 次 4 个周期的 PRRT，共 102 例。比较了首次治疗前和第四次治疗周期后 1 年的 eGFR、Hb、WBC 和血小板。根据慢性肾脏病（CKD）分类和 CTCAE 对 eGFR 进行分级，根据 CTCAE 对血液毒性进行分级。还评估了年龄、性别、累积活度、PRRT 类型对长期毒性的影响。
结果
eGFR 1-2 级从基线时的 87/102 例下降到随访时的 71 例（p<0.001）。治疗前，3a 级有 13 例，3b 级有 2 例，随访时，3a 级有 25 例，3b 级有 5 例，4 级有 1 例。PRRT 前和随访时，贫血为 0 级的有 63 例，48 例（p<0.001），1 级的有 36 例，48 例，2 级的有 3 例，6 例。白细胞计数和血小板计数的分级无显著变化。亚组分析显示，只有 65 岁及以上年龄组贫血发生率较高（p=0.006）。
结论
大约 20%的患者观察到肾毒性或血液毒性分级增加。在这些患者中，除 1 例外，在完成 Y-90-或 Lu-177-SST 类似物的 4 个周期 PRRT 治疗后 1 年，毒性发现为轻度或中度。在安全性方面，在疾病进展的情况下，PRRT 对进一步的肿瘤治疗选择没有关键影响。
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