Puranik Ameya D, Rangarajan Venkatesh, Shetty Nitin Sudhakar, Gala Kunal, Kulkarni Suyash, Mohite Ashish, Marotkar Mandar, Gawale Yogesh, Dev Indraja D, Shrikhande Shailesh V, Chaudhari Vikram, Bhandare Manish, Agrawal Archi, Shah Sneha, Purandare Nilendu C, Ghosh Suchismita, Choudhury Sayak
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Department of Radiodiagnosis, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Nucl Med. 2024 Mar-Apr;39(2):71-76. doi: 10.4103/ijnm.ijnm_7_23. Epub 2024 May 29.
We proposed to administer Lu-177-DOTATATE in intra-arterial (IA) mode for higher first-pass localization to somatostatin receptors, higher residence time in liver metastases, and more radiation to tumor. This study aimed at assessing early hematological, renal and hepatotoxicity; and objective response to IA peptide receptor radionuclide therapy (PRRT).
Fourteen patients (4 females and 10 males) were prospectively assessed. 5/14 patients underwent 2 cycles, whereas 3/14 underwent 3 cycles, and 6/14 received 1 cycle of IA PRRT. 200 mCi of Lu-177-DOTATATE was administered in 15-20 min by IA route under angiographic guidance. Patients were asked to follow-up at 4 and 8 weeks with hematological, liver, and renal functional parameters, and Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT) after 8 weeks. Response was assessed using RECIST 1.1 and EORTC PET criteria.
2/14 patients had high total and direct bilirubin, which reverted to normal after IA PRRT. Three patients had low albumin, which improved after 1 cycle. Nine patients showed no worsening of liver function. Two patients showed Grade 1 hematotoxicity which reverted to normal. Five patients showed high creatinine, but preserved glomerular filtration rate and EC clearance. On follow-up at 8 weeks, serum creatinine reverted to normal. In five patients who underwent 2 cycles of IA PRRT, 3 showed partial response (PR) on RECIST 1.1 and partial metabolic response (PMR) on EORTC criteria, whereas 2 showed stable disease (SD). In patients who underwent 3 cycles, 1 showed SD, whereas other patient showed PMR on DOTANOC PET/CT, with PR in size. Among the remaining seven patients, 5 showed PMR, whereas the other 2 showed SD. Thus 9/14 patients showed PR, whereas 5 showed SD on metabolic and size criteria.
IA PRRT is a safe and efficacious approach for the treatment of liver dominant metastatic neuroendocrine tumors.
我们建议采用动脉内（IA）给药方式给予Lu-177-奥曲肽，以实现更高的首次通过时对生长抑素受体的定位、在肝转移灶中更长的停留时间以及对肿瘤更多的辐射。本研究旨在评估早期血液学、肾脏和肝脏毒性，以及IA肽受体放射性核素治疗（PRRT）的客观反应。
前瞻性评估了14例患者（4例女性和10例男性）。14例患者中有5例接受了2个周期的治疗，3例接受了3个周期的治疗，6例接受了1个周期的IA PRRT。在血管造影引导下，通过IA途径在15 - 20分钟内给予200mCi的Lu-177-奥曲肽。要求患者在4周和8周时进行随访，检测血液学、肝脏和肾脏功能参数，并在8周后进行Ga-68奥曲肽正电子发射断层扫描/计算机断层扫描（PET/CT）。使用RECIST 1.1和欧洲癌症研究与治疗组织（EORTC）PET标准评估反应。
14例患者中有2例总胆红素和直接胆红素升高，在IA PRRT后恢复正常。3例患者白蛋白水平低，在1个周期后有所改善。9例患者肝功能未恶化。2例患者出现1级血液毒性，随后恢复正常。5例患者肌酐升高，但肾小球滤过率和有效清除率保持正常。在8周随访时，血清肌酐恢复正常。在接受2个周期IA PRRT的5例患者中，3例根据RECIST 1.1标准显示部分缓解（PR），根据EORTC标准显示部分代谢缓解（PMR），而2例显示疾病稳定（SD）。在接受3个周期治疗的患者中，1例显示SD，而另1例在DOTANOC PET/CT上显示PMR，大小上为PR。在其余7例患者中，5例显示PMR，另外2例显示SD。因此，根据代谢和大小标准，14例患者中有9例显示PR，5例显示SD。
IA PRRT是治疗以肝脏为主的转移性神经内分泌肿瘤的一种安全有效的方法。
