Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio.
Ohio State University College of Medicine, Columbus, Ohio.
Int J Radiat Oncol Biol Phys. 2024 Mar 15;118(4):979-985. doi: 10.1016/j.ijrobp.2023.10.014. Epub 2023 Oct 21.
The current standard for meningioma treatment planning involves magnetic resonance imaging-based guidance. Somatostatin receptor ligands such as Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptors 1 and 2 in meningioma tissue. We hypothesized that Ga-DOTATATE positron emission tomography (PET)-guided treatment management for patients with meningiomas is safe and effective and can identify which patients benefit most from adjuvant radiation therapy.
A single-institution prospective registry study was created for inclusion of patients with intracranial meningiomas who received a Ga-DOTATATE PET/CT to assist with radiation oncologist decision making. Patients who received a PET scan from January 1, 2018, to February 25, 2022, were eligible for inclusion.
Of the 60 patients included, 40%, 47%, and 5% had World Health Organization grades 1, 2, and 3 meningiomas, respectively, and 8% (5 patients) had no grade assigned. According to Radiation Therapy Oncology Group 0539 criteria, 22%, 72%, and 7% were categorized as high, intermediate, and low risk, respectively. After completing their PET scans, 48 patients, 11 patients, and 1 patient proceeded with radiation therapy, observation, and redo craniotomy, respectively. The median follow-up for the entire cohort was 19.5 months. Of the 3 patients (5%) who experienced local failure between 9.2 and 28.5 months after diagnosis, 2 had PET-avid disease in their postoperative cavity and elected for observation before recurrence, and 1 high-risk patient with multifocal disease experienced local failure 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. Only 1 grade 3 toxicity was attributed to PET-guided radiation.
This study examined one of the largest known populations of patients with intracranial meningiomas followed by physicians who used Ga-DOTATATE PET-guided therapy. Incorporating Ga-DOTATATE PET into future trials may assist with clinician decision making and improve patient outcomes.
目前，脑膜瘤治疗计划的标准涉及基于磁共振成像的指导。生长抑素受体配体，如 Ga-DOTATATE，由于脑膜瘤组织中生长抑素受体 1 和 2 的近乎普遍表达，正在被探索用于脑膜瘤治疗计划。我们假设 Ga-DOTATATE 正电子发射断层扫描（PET）引导的治疗管理对脑膜瘤患者是安全有效的，并可以确定哪些患者最受益于辅助放疗。
创建了一个单机构前瞻性登记研究，纳入了接受 Ga-DOTATATE PET/CT 以协助放射肿瘤学家决策的颅内脑膜瘤患者。2018 年 1 月 1 日至 2022 年 2 月 25 日期间接受 PET 扫描的患者符合纳入条件。
在纳入的 60 名患者中，分别有 40%、47%和 5%的患者为世界卫生组织（WHO）分级 1、2 和 3 级脑膜瘤，8%（5 名患者）无分级。根据放射治疗肿瘤学组（RTOG）0539 标准，分别有 22%、72%和 7%的患者被归类为高、中、低风险。在完成 PET 扫描后，48 名患者、11 名患者和 1 名患者分别接受了放疗、观察和再次开颅手术。整个队列的中位随访时间为 19.5 个月。在诊断后 9.2 至 28.5 个月期间，有 3 名患者（5%）发生局部复发，其中 2 名患者在术后肿瘤腔内有 PET 摄取，在复发前选择了观察，1 名高危、多发病灶患者在第二次放疗后 2 年和多次复发后发生局部复发。值得注意的是，有 5 名患者在 PET 上无任何局部摄取，因此进行了观察，这些患者均未复发。只有 1 例 3 级毒性归因于 PET 引导的放疗。
本研究检查了颅内脑膜瘤患者中已知最大的人群之一，这些患者由使用 Ga-DOTATATE PET 引导治疗的医生进行治疗。将 Ga-DOTATATE PET 纳入未来的试验中可能有助于临床医生做出决策，并改善患者的结局。
