Kashyap Raghava, Raja Senthil, Adusumilli Ajay, Gopireddy Murali Mohan Reddy, Loveday Benjamin P T, Alipour Ramin, Kong Grace
Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
J Neuroendocrinol. 2025 Mar;37(3):e13425. doi: 10.1111/jne.13425. Epub 2024 Jun 27.
Peptide receptor radionuclide therapy (PRRT) is an established therapy for metastatic neuroendocrine neoplasms (NEN). The role of PRRT as a neoadjuvant treatment prior to surgery or other local therapies is uncertain. This scoping review aimed to define the landscape of evidence available detailing the utility of PRRT in the neo-adjuvant setting, including the clinical contexts, efficacy, and levels of evidence. A comprehensive literature search of PUBMED, SCOPUS, and EMBASE through to December 2022 was performed to identify reports of PRRT use as neoadjuvant therapy prior to local therapies. Observational studies and clinical trials were included. A total of 369 records were identified by the initial search, and 17 were included in the final analysis, comprising 179 patients treated with neoadjuvant PRRT. Publications included case reports, retrospective cohort series and a phase 2 trial. Definitions of unresectable disease were variable. Radioisotopes used included Lu (n = 142) and Y (n = 36), used separately (n = 178) or in combination (n = 1). A combination of PRRT with chemotherapy was also explored (n = 2). Toxicity data was reported in 11/17 studies. Survival analysis was reported in 3/17 studies. Surgical resection following PRRT was reported for both the primary tumor (n = 71) and metastases (n = 12). Resection rates could not be calculated as not all publications reported whether resection was completed. Published literature exploring the use of PRRT in the neoadjuvant setting is mostly limited to case reports and retrospective cohort studies. From these limited data there is reported to be a role of PRRT in neoadjuvant setting in the literature. However, the low quality of evidence precludes any definite conclusion on the grade of disease, site of primary, isotope used or use of concomitant chemotherapy that can benefit from this application. Further prospective studies will require collaboration between multiple centers to gain sufficient high-quality evidence.
肽受体放射性核素治疗（PRRT）是转移性神经内分泌肿瘤（NEN）的一种既定治疗方法。PRRT作为手术或其他局部治疗前的新辅助治疗的作用尚不确定。本综述旨在明确现有证据的情况，详细阐述PRRT在新辅助治疗中的效用，包括临床背景、疗效和证据水平。通过对截至2022年12月的PUBMED、SCOPUS和EMBASE进行全面文献检索，以确定PRRT作为局部治疗前新辅助治疗的使用报告。纳入观察性研究和临床试验。初步检索共识别出369条记录，最终分析纳入17条，包括179例接受新辅助PRRT治疗的患者。出版物包括病例报告、回顾性队列系列和一项2期试验。不可切除疾病的定义各不相同。使用的放射性同位素包括镥（n = 142）和钇（n = 36），单独使用（n = 178）或联合使用（n = 1）。还探讨了PRRT与化疗的联合应用（n = 2）。11/17项研究报告了毒性数据。3/17项研究报告了生存分析。PRRT后对原发性肿瘤（n = 71）和转移灶（n = 12）均进行了手术切除报告。由于并非所有出版物都报告了切除是否完成，因此无法计算切除率。探索PRRT在新辅助治疗中应用的已发表文献大多限于病例报告和回顾性队列研究。从这些有限的数据来看，文献报道PRRT在新辅助治疗中具有一定作用。然而，证据质量较低，无法就可从该应用中获益的疾病分级、原发部位、使用的同位素或联合化疗的使用得出任何明确结论。进一步的前瞻性研究需要多个中心之间的合作，以获得足够的高质量证据。
