Favourable outcomes of 177Lu-octreotate peptide receptor chemoradionuclide therapy in patients with FDG-avid neuroendocrine tumours
Favourable outcomes of 177Lu-octreotate peptide receptor chemoradionuclide therapy in patients with FDG-avid neuroendocrine tumours
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DOI：
10.1007/s00259-014-2906-4
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发表时间：
2015-02-01
影响因子：
9.1
通讯作者：
Hicks, Rodney J.
中科院分区：
文献类型：
--
作者：
Kashyap, Raghava;Hofman, Michael S.;Hicks, Rodney J.
目的FDG PET/CT显示糖酵解活性增加是一组预后不良的转移性胃肠胰腺神经内分泌肿瘤（NET）患者。对于更具侵袭性的NET，存在有限的全身治疗选择。然而，肽受体化学放射性核素治疗（PRCRT）在此类患者中的作用尚不清楚。本回顾性研究评估的结果与FDG-avid NET治疗与PRCRT。方法临床，生化和影像学反应进行了评估后，完成诱导治疗的PRCRT与5-氟尿嘧啶在52例选择治疗的基础上生长抑素受体成像无空间不一致FDG-avid疾病。队列中，67%的患者既往接受过化疗。结果PRCRT耐受性良好，3/4级毒性反应可忽略不计。中位随访期为36个月后，未达到中位OS，中位PFS为48个月。在完成PRCRT后3个月，2%的患者显示完全解剖学反应，28%部分反应，68%疾病稳定，仅2%进展。在FDG PET/CT上，27%的患者在随访期间实现了完全代谢反应。45%的患者出现生化反应（嗜铬粒蛋白A水平下降> 25%）。结论PRCRT是FDG-avid NET患者的有效治疗方法，即使是常规治疗失败的患者。鉴于明显高于替代治疗方案的反应率和低毒性，需要进一步研究以确定PRCRT是否应作为该患者人群的一线治疗方式。
Purpose Increased glycolytic activity on FDG PET/CT defines a subgroup of patients with metastatic gastroenteropancreatic neuroendocrine tumour (NET) with a poor prognosis. A limited range of systemic treatment options exist for more aggressive NET. The role of peptide receptor chemoradionuclide therapy (PRCRT) in such patients is, however, unclear. This retrospective study assessed the outcomes of patients with FDG-avid NET treated with PRCRT.Methods Clinical, biochemical and imaging response was assessed after completion of induction treatment of PRCRT with 5-fluorouracil in 52 patients selected for treatment on the basis of somatostatin-receptor imaging without spatially discordant FDG-avid disease. Of the cohort, 67 % had received prior chemotherapy. Overall survival (OS) and progression-free survival (PFS) were also analysed.Results PRCRT was well tolerated with negligible grade 3/4 toxicities. After a median follow-up period of 36 months, the median OS was not achieved with a median PFS of 48 months. At 3 months after completion of PRCRT 2 % of patients showed a complete anatomical response, 28 % a partial response, 68 % stable disease, and only 2 % progression. On FDG PET/CT, 27 % achieved a complete metabolic response during the follow-up period. A biochemical response (>25 % fall in chromogranin-A levels) was seen in 45 %.Conclusion PRCRT is an effective treatment in patients with FDG-avid NET, even in patients who have failed conventional therapies. Given apparently higher response rates than with alternative therapeutic options and low toxicity, further research is needed to establish whether PRCRT should be used as a first-line treatment modality in this patient population.