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Nuklearmedizin 2020; 59(05): 348-355
DOI: 10.1055/a-1200-0989
Original Article

Response assessment of somatostatin receptor targeted radioligand therapies for progressive intracranial meningioma

Ansprechen auf Somatostatinrezeptor-Radioligandentherapie bei intrakraniellen Meningeomen
Michael Müther‡
1   Department of Neurosurgery, University Hospital Münster, Germany
,
Wolfgang Roll‡
2   Department of Nuclear Medicine, University Hospital Münster, Germany
,
Benjamin Brokinkel
1   Department of Neurosurgery, University Hospital Münster, Germany
,
Bastian Zinnhardt
3   European Institute of Molecular Imaging, WWU, Münster, Germany
,
Peter B. Sporns
4   Institute of Clinical Radiology, University Hospital Münster, Germany
,
Robert Seifert
2   Department of Nuclear Medicine, University Hospital Münster, Germany
,
Michael Schäfers
3   European Institute of Molecular Imaging, WWU, Münster, Germany
,
Matthias Weckesser
2   Department of Nuclear Medicine, University Hospital Münster, Germany
,
Lars Stegger
2   Department of Nuclear Medicine, University Hospital Münster, Germany
,
Walter Stummer
1   Department of Neurosurgery, University Hospital Münster, Germany
,
Kambiz Rahbar
2   Department of Nuclear Medicine, University Hospital Münster, Germany
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Abstract

Background In somatostatin receptor (SSTR) expressing progressive meningioma, peptide receptor radionuclide therapy (PRRT) has shown effect in small clinical series. However, standardized treatment and response assessment protocols are lacking. We present our experience on PPRT with 177Lu-DOTATATE in progressive meningioma with a special emphasis on state-of-the-art response assessment.

Methods Retrospective analysis on PRRT with 177Lu-DOTATATE from 2015 to 2019. Pre- and post-therapy imaging was performed using MRI and 68Ga-DOTATATE-PET for standard bidimensional and volumetric analyses, respectively, following novel RANO guidelines.

Results Seven patients with progressive intracranial meningioma (median age 73 years, interquartile range 60–76; 5 WHO II, 2 WHO I; 5 multifocal) received a median of 4 cycles [2] [3] [4] of PRRT with 177Lu-DOTATATE in eight-week intervals. Three patients did not undergo post-therapy 68Ga-DOTATATE-PET due to early symptomatic progression and subsequent cessation of PRRT. After completion of 4 PRRT cycles volumetric PET imaging showed stable disease in two of four patients. According to bidimensional MRI response assessment, only one patient was stable. Progression free survival at six months was 42.9 %.

Conclusion In this heterogeneous collective of seven patients with progressive meningioma, 177Lu-DOTATATE therapies showed heterogeneous effectiveness. PET-based volumetric assessment should be used for response assessment in PRRT additionally to bidimensional imaging.

Zusammenfassung

Hintergrund Bei Somatostatinrezeptor (SSTR) -exprimierenden progredienten Meningeomen hat die Peptidrezeptor-Radionuklidtherapie (PRRT) in kleinen klinischen Serien einen positiven Effekt gezeigt. Es fehlen jedoch standardisierte Protokolle für die Behandlung und insbesondere für die Beurteilung des Ansprechens. Wir stellen unsere Erfahrungen mit der PPRT mit 177Lu-DOTATATE bei progressiven Meningeomen vor, mit besonderem Augenmerk auf die Beurteilung des Therapieansprechens mittels molekularer (PET) und morphologischer Bildgebung (MRT).

Methoden Retrospektive Analyse zur PRRT mit 177Lu-DOTATATE bei Patienten mit progredientem Meningeom von 2015 bis 2019. Die prä- und posttherapeutische Bildgebung wurde mit MRT und 68Ga-DOTATATE-PET/CT für standardmäßige 2-dimensionale bzw. volumetrische Analysen nach den neuartigen RANO-Richtlinien durchgeführt.

Ergebnisse Sieben Patienten mit progredientem intrakraniellem Meningeom (median: 73 Jahre, IQR: 60–76; 5 WHO II, 2 WHO I; 5 multifokal) erhielten im Median 4 Zyklen [2] [3] [4] der PRRT mit 177Lu-DOTATATE in einem Abstand von 8 Wochen. Bei 3 Patienten wurde auf die Durchführung der posttherapeutischen 68Ga-DATATAT-PET aufgrund eines bereits in der MRT belegten Progresses verzichtet. Nach Abschluss von 4 PRRT-Zyklen zeigte die volumetrische PET-Auswertung bei 2 von 4 Patienten eine stabile Erkrankung. Gemäß der Bewertung des 2-dimensionalen MRT-Ansprechens war nur bei einem Patienten die Erkrankung stabil. Das progressionsfreie Überleben nach 6 Monaten betrug 42,9 %.

Schlussfolgerung In diesem Kollektiv von 7 Patienten mit progressivem Meningeom zeigte die 177Lu-DOTATATE-Therapie eine heterogene Wirksamkeit. Die PET-basierte volumetrische Beurteilung sollte bei der PRRT zusätzlich zur 2-dimensionalen Bildgebung zur Beurteilung des Ansprechens verwendet werden.

Key Words

177Lu-DOTATATE - PRRT - meningioma

Schlüsselwörter

177Lu-DOTATATE - PRRT - Meningeom


Publication History

Received: 29 April 2020

Accepted: 14 June 2020

Article published online:
20 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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