Long-term results of PRRT in advanced bronchopulmonary carcinoid
Long-term results of PRRT in advanced bronchopulmonary carcinoid
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DOI：
10.1007/s00259-015-3190-7
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发表时间：
2016-03-01
影响因子：
9.1
通讯作者：
Grana, Chiara Maria
中科院分区：
文献类型：
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作者：
Mariniello, Annapaola;Bodei, Lisa;Grana, Chiara Maria
肽受体放射性核素疗法（PRRT）治疗神经内分泌肿瘤（NET）已经探索了近二十年，但仍有少数试验专门研究来自呼吸树的高分化和中度分化的NET。因此，本研究的目的是探讨PRRT后支气管肺类癌（BPC）患者的预后。方法回顾性分析1997年至2012年在米兰欧洲肿瘤研究所连续接受PRRT治疗的114例晚期BPC患者，随访至2014年10月。对客观反应、总生存期（OS）和无进展生存期（PFS）进行了评分，并比较了三种不同的PRRT方案（Y-90-DOTATOC vs. Lu-177-DOTATATE vs. Y-90-DOTATOC + Lu-177-DOTATATE）的疗效和耐受性。结果114例患者中94例的中位OS为58.8个月。中位PFS为28.0个月。Lu-177-DOTATATE方案的5年OS最高（61.4%）。形态学反应（部分反应+次要反应）在26.5%的队列中获得，并与更长的OS和PFS相关。Y-90-DOTATOC + Lu-177-DOTATATE协议提供了最高的响应率（38.1%）。大多数患者的不良事件较轻。然而，血液学毒性对生存有负面影响。未见严重（3/4级）血清肌酐升高。单独使用Y-90-DOTATOC治疗的患者更经常出现轻度/中度肾功能下降。在PRRT之前接受化疗的患者OS和PFS较短，发生肾毒性的风险较高。结论：在“真实世界”中接受治疗的晚期BPC患者的大型队列中，随访中位数为45.1个月（范围2 - 191个月），PRRT被证明在延长生存期和延缓疾病进展方面有希望。尽管存在潜在的选择偏差，但考虑到风险-收益比，Lu-177-DOTATATE单药治疗似乎是PRRT的最佳选择。我们的结果表明，在疾病的早期阶段使用PRRT可以提供更有利的结果。
Purpose Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT.Methods We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols (Y-90-DOTATOC vs. Lu-177-DOTATATE vs. Y-90-DOTATOC + Lu-177-DOTATATE) were compared with regard to their efficacy and tolerability.Results The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The Lu-177-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The Y-90-DOTATOC + Lu-177-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with Y-90-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity.Conclusion In a large cohort of patients with advanced BPC treated in a "real-world" scenario and followed up for a median of 45.1 months (range 2 - 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite the potential selection biases, considering the risk-benefit ratio, Lu-177-DOTATATE monotherapy seems the best option for PRRT. Our results indicate that the use of PRRT in earlier stages of the disease could provide a more favorable outcome.