Twelve-Year Follow-up After Peptide Receptor Radionuclide Therapy
Twelve-Year Follow-up After Peptide Receptor Radionuclide Therapy
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DOI：
10.2967/jnumed.118.215376
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发表时间：
2019-04-01
影响因子：
9.3
通讯作者：
Virgolini, Irene J.
中科院分区：
文献类型：
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作者：
Gabriel, Michael;Nilica, Bernhard;Virgolini, Irene J.
肽受体放射性核素治疗（PRRT）已被用于超过20年的全身治疗方法在不可手术或转移性生长抑素受体阳性肿瘤。本研究的目的是分析PRRT与最常用的放射性药物Y-90-DOTATOC和Lu-177-DOTATATE的长期结局。研究方法：这项回顾性临床研究共包括44例（27名男性）晚期肿瘤和生长抑素受体表达增强的连续患者。初次诊断时的平均年龄为60岁（标准差，11.3岁;范围，40-84岁）。中位随访时间为80个月。对于Lu-177-PRRT，每例患者的平均给药周期数为5.3 +/- 2.5，平均活性为27.2 +/- 14.9 GBq。对于Y-90-PRRT，每例患者的平均给药周期数为5.5 +/- 2.6，平均活性为14.7 +/- 7.3 GBq。总体而言，共进行了378个周期（平均每例患者8.6 +/- 3.4个周期），总体累积活性为1，514.1 GBq。结果：中位总生存期为79个月。27名男性中的21名（77.8%）和17名女性中的9名（52.9%）在PRRT开始后12年死亡。病程最短8个月，最长155个月。严重的副作用（世界卫生组织III级和IV级）在14名仍然活着的患者中有9名。在9例有严重副作用的患者中，慢性肾脏病合并贫血是最常见的结果。与初始PRRT后累积疾病控制的患者相比，发现那些显示疾病进展的患者预后较差（对数秩，P < 0.001），而女性和肿瘤部位不超过2个的患者似乎特别受益于PRRT（未达到显著性水平）。结论：PRRT在长期结果方面令人鼓舞。32%（14/44例）的转移性或不可手术的患者在放射性核素治疗开始后仍存活超过12年。有利结局的可能预测因素是对PRRT有初始反应、受影响部位数量少以及女性。
Peptide receptor radionuclide therapy (PRRT) has been used for more than 20 y as a systemic treatment approach in inoperable or metastatic somatostatin receptor-positive tumors. The purpose of this study was to analyze the long-term outcome of PRRT with regard to the most commonly used radiopharmaceuticals, Y-90-DOTATOC and Lu-177-DOTATATE. Methods: This retrospective clinical study included a total of 44 consecutive patients (27 men) with advanced tumors and enhanced somatostatin receptor expression. Mean age at initial diagnosis was 60 y (SD, 11.3 y; range, 40-84 y). Median follow-up was 80 mo. For Lu-177-PRRT, the mean number of cycles administered was 5.3 +/- 2.5 and the mean activity was 27.2 +/- 14.9 GBq per patient. For Y-90-PRRT, the mean number of cycles administered was 5.5 +/- 2.6 and the mean activity was 14.7 +/- 7.3 GBq per patient. Overall, 378 cycles were administered (mean, 8.6 +/- 3.4 cycles per patient), with an overall cumulative activity of 1,514.1 GBq. Results: Median overall survival was 79 mo. Twenty-one (77.8%) of the 27 men and 9 (52.9%) of the 17 women had died 12 y after commencement of PRRT. The shortest duration of illness was 8 mo and the longest 155 mo. Severe side effects (World Health Organization grades III and IV) were seen in 9 of the 14 patients still alive. Chronic kidney disease in combination with anemia was the most common finding in the 9 patients with severe side effects. A poor prognosis was found for those patients who showed progressive disease, in comparison with patients with cumulative disease control after initial PRRT (log rank, P < 0.001), whereas women and patients with no more than 2 tumor sites seemed to especially benefit from PRRT (not reaching significance levels). Conclusion: PRRT is encouraging in terms of long-term outcome. Thirty-two percent (14/44 patients) of the patients with metastatic or inoperable disease were still alive more than 12 y after the beginning of radionuclide therapy. Possible predictors for favorable outcome are having an initial response to PRRT, having a low number of affected sites, and being female.