68Ga-DOTATATE PET/CT parameters predict response to peptide receptor radionuclide therapy in neuroendocrine tumours
68Ga-DOTATATE PET/CT parameters predict response to peptide receptor radionuclide therapy in neuroendocrine tumours
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DOI：
10.1016/j.radonc.2019.09.003
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发表时间：
2019-12-01
影响因子：
5.7
通讯作者：
Barwick, Tara D.
中科院分区：
文献类型：
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作者：
Sharma, Rohini;Wang, Wai Meng;Barwick, Tara D.
目的：[Lu-177]DOTATATE延长转移性神经内分泌肿瘤（NETs）的无进展生存期（PFS）。但客观反应率较低。这一点，加上治疗时间长，费用高，表明需要更好的选择。我们的目的是评估基线[Ga-68]DOTATATE-PET/CT参数，以及PET反应评估是否能准确预测[Lu-177]DOTATATE的临床结果。实验设计：对接受[Lu-177]DOTATATE治疗的患者进行回顾性研究。随访3个月，直至病情进展。在基线和随访时确定了四个[Ga-68]DOTATATE-PET参数（单个病变SUVmax，肿瘤与脾脏和肝脏的SUV比率，以及多器官部位多达五个目标病变的SUVmax-av）。确定这些PET参数在基线时或治疗后的任何变化与PET反应标准（PERCIST和修改的PERCIST）之间的关系，以预测PFS。随访3个月，直至病情进展。使用RECIST 1.1确定响应。评估SSTR2的基线表达并与PET参数进行比较。结果：55例转移性NETs患者主要来自小肠（N = 18）和胰腺（N = 8）。低年级16例，中级15例，高年级3例。PRRT应答（N = 47）：部分缓解（PR） 28%，病情稳定（SD） 60%，病情进展（PD） 13%。PRRT反应预测PFS: PR 71.8个月（95%CI：未实现），SD 29.1个月（95%CI: 15.2-43.1）， PD 9.7个月（95%CI: 0-21.02）。基线，单个病变SUVmax预测反应和PFS， SUV截止值为13.0，具有高灵敏度和特异性。肿瘤SUVmax与SSTR2表达相关，Spearman’s rho - 0.69, p < 0.01。结论：基线单灶SUVmax和SUVmax-av预测对[Lu-177]DOTATATE的反应。PRRT后的客观反应定义了PFS显著改善的患者子集基线SUVmax 13.0定义了一个阈值，低于该阈值的患者对PRRT反应差，PFS更差。SUV阈值分析应纳入前瞻性研究。爱思唯尔B.V.版权所有
Purpose: [Lu-177]DOTATATE prolongs progression free survival (PFS) in metastatic neuroendocrine tumours (NETs). However, objective response rate is low. This, coupled with long duration of therapy and expense suggest need for better selection. We aim to assess whether baseline [Ga-68]DOTATATE-PET/CT parameters, and whether response assessment by PET accurately predicts clinical outcome to [Lu-177]DOTATATE.Experimental design: Retrospective study of patients receiving [Lu-177]DOTATATE was conducted. Patients were followed 3-monthly until disease progression. Four [Ga-68]DOTATATE-PET parameters (single lesion SUVmax, tumour to spleen and liver SUV ratios, and SUVmax-av using up to five target lesions in multiple organ sites) were determined at baseline and follow-up. The association between these PET parameters either at baseline, or any changes following treatment, and PET response criteria (PERCIST and modified PERCIST) to predict PFS were determined. Patients were followed 3-monthly until disease progression. Response was determined using RECIST 1.1. Baseline SSTR2 expression was assessed and compared with PET parameters.Results: 55 patients with metastatic NETs were identified predominantly small bowel (N = 18) and pancreatic (N = 8) in origin. 16 were low grade, 15 intermediate and 3 high grade. Response to PRRT (N = 47): partial response (PR) 28%, stable disease (SD) 60% progressive disease (PD) 13%. Response to PRRT predicted PFS: PR 71.8 months (95%CI: not achieved), SD 29.1 months (95%CI: 15.2-43.1), and PD 9.7 months (95%CI: 0-21.02). Baseline, single lesion SUVmax predicted both response and PFS with SUV cut-off of 13.0 giving high sensitivity and specificity. Tumoural SUVmax correlated with SSTR2 expression, Spearman's rho - 0.69, p < 0.01.Conclusions: Baseline single lesion SUVmax and SUVmax-av predicts response to [Lu-177]DOTATATE. Objective response following PRRT defines a subset of patients with markedly improved PFSBaseline SUVmax 13.0 defines a threshold below which patients have poor response to PRRT and worse PFS. SUV threshold analysis should be taken forward into prospective studies. Crown Copyright (C) 2019 Published by Elsevier B.V. All rights reserved.