Królicki Leszek, Kunikowska Jolanta, Bruchertseifer Frank, Kuliński Radosław, Pawlak Dariusz, Koziara Henryk, Rola Rafał, Morgenstern Alfred, Merlo Adrian
From the Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland.
European Commission, Joint Research Centre, Karlsruhe, Germany.
Clin Nucl Med. 2023 May 1;48(5):387-392. doi: 10.1097/RLU.0000000000004608. Epub 2023 Mar 1.
Glioblastoma (GB) is the most malignant primary brain tumor. Therefore, introduction of new treatment options is critically important. The aim of this study was to assess local treatment with α emitters [ 213 Bi]Bi-DOTA-substance P (SP) and [ 225 Ac]Ac-DOTA-SP.
Treatment was performed as salvage therapy in patients with recurrent primary and secondary GB. [ 213 Bi]Bi-DOTA-SP with injected activity 1.85 GBq per cycle was used in 20 primary (48.2 ± 11.8 years old) and in 9 secondary (38.8 ± 10.8 years old) GB patients and [ 225 Ac]Ac-DOTA-SP in 15 primary (45.1 ± 9.9 years old) and in 6 secondary (37.8 ± 6.4 years old) GB patients with a dose escalation scheme (10, 20, and 30 MBq).
Local treatment with [ 213 Bi]Bi-DOTA-SP and [ 225 Ac]Ac-DOTA-SP was well tolerated with only few adverse effects. There was no statistically significant difference between [ 213 Bi]Bi-DOTA-SP and [ 225 Ac]Ac-DOTA-SP groups in survival parameters. For primary GB, survival parameters of patients treated with [ 213 Bi]Bi-DOTA-SP and [ 225 Ac]Ac-DOTA-SP were as follows(in months): progression-free survival time, 2.7 versus 2.4; OS-d (overall survival from time of diagnosis to death from any cause), 23.6 versus 21.0; OS-t (overall survival from the start of treatment to death from any cause), 7.5 versus 5.0; and OS-r (overall survival from recurrence in primary tumors to death from any cause), 10.9 versus 12.0. Survival parameters of secondary GB patients treated with [ 213 Bi]Bi-DOTA-SP and [ 225 Ac]Ac-DOTA-SP were as follows (in months): progression-free survival time, 5.8 versus 2.4; OS-d, 52.3 versus 65.0; OS-t, 16.4 versus 16.0; and OS-c (overall survival from conversion into secondary GB multiforme to death from any cause), 18.4 versus 36.0.
The similarity results of 213 Bi or 225 Ac may suggest that the local treatment of brain tumors can be greatly simplified. The experience to date shows that local radioisotope treatment of brain tumors requires further dosimetry studies, taking into account the complexity of biological processes.
胶质母细胞瘤（GB）是最恶性的原发性脑肿瘤。因此，引入新的治疗方案至关重要。本研究的目的是评估用α发射体[213Bi]Bi-DOTA-物质P（SP）和[225Ac]Ac-DOTA-SP进行局部治疗。
对复发性原发性和继发性GB患者进行挽救治疗。[213Bi]Bi-DOTA-SP每周期注射活度为1.85GBq，用于20例原发性GB患者（年龄48.2±11.8岁）和9例继发性GB患者（年龄38.8±10.8岁），[225Ac]Ac-DOTA-SP用于15例原发性GB患者（年龄45.1±9.9岁）和6例继发性GB患者（年龄37.8±6.4岁），采用剂量递增方案（10、20和30MBq）。
用[213Bi]Bi-DOTA-SP和[225Ac]Ac-DOTA-SP进行局部治疗耐受性良好，不良反应较少。[213Bi]Bi-DOTA-SP组和[225Ac]Ac-DOTA-SP组在生存参数方面无统计学显著差异。对于原发性GB，用[213Bi]Bi-DOTA-SP和[225Ac]Ac-DOTA-SP治疗的患者的生存参数如下（单位：月）：无进展生存期，2.7对2.4；OS-d（从诊断到任何原因死亡的总生存期），23.6对21.0；OS-t（从治疗开始到任何原因死亡的总生存期），7.5对5.0；以及OS-r（从原发性肿瘤复发到任何原因死亡的总生存期），10.9对12.0。用[213Bi]Bi-DOTA-SP和[225Ac]Ac-DOTA-SP治疗的继发性GB患者的生存参数如下（单位：月）：无进展生存期，5.8对2.4；OS-d，52.3对65.0；OS-t，16.4对16.0；以及OS-c（从转变为继发性多形性GB到任何原因死亡的总生存期），18.4对36.0。
213Bi或225Ac的相似结果可能表明脑肿瘤的局部治疗可以大大简化。迄今为止的经验表明，考虑到生物过程的复杂性，脑肿瘤的局部放射性同位素治疗需要进一步的剂量学研究。
