Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma

Abstract

BackgroundExternal beam radiotherapy (EBRT) is the treatment of choice for irresectable meningioma. Due to the strong expression of somatostatin receptors, peptide receptor radionuclide therapy (PRRT) has been used in advanced cases. We assessed the feasibility and tolerability of a combination of both treatment modalities in advanced symptomatic meningioma.Methods10 patients with irresectable meningioma were treated with PRRT (177Lu-DOTA0,Tyr3 octreotate or - DOTA0,Tyr3 octreotide) followed by external beam radiotherapy (EBRT). EBRT performed after PRRT was continued over 5–6 weeks in IMRT technique (median dose: 53.0 Gy). All patients were assessed morphologically and by positron emission tomography (PET) before therapy and were restaged after 3–6 months. Side effects were evaluated according to CTCAE 4.0.ResultsMedian tumor dose achieved by PRRT was 7.2 Gy. During PRRT and EBRT, no side effects > CTCAE grade 2 were noted. All patients reported stabilization or improvement of tumor-associated symptoms, no morphologic tumor progression was observed in MR-imaging (median follow-up: 13.4 months). The median pre-therapeutic SUVmax in the meningiomas was 14.2 (range: 4.3–68.7). All patients with a second PET after combined PRRT + EBRT showed an increase in SUVmax (median: 37%; range: 15%–46%) to a median value of 23.7 (range: 8.0–119.0; 7 patients) while PET-estimated volume generally decreased to 81 ± 21% of the initial volume.ConclusionsThe combination of PRRT and EBRT is feasible and well tolerated. This approach represents an attractive strategy for the treatment of recurring or progressive symptomatic meningioma, which should be further evaluated.

Somatostatin Receptor Imaging with68Ga DOTATATE PET/CT: Clinical Utility, Normal Patterns, Pearls, and Pitfalls in Interpretation

“…There is an increasing role for GaTate PET/CT or PET/MR imaging in improving the delineation of gross tumor volume for radiation treatment planning (43)(44)(45), often leading to a reduction in treatment volume compared with MR imaging or CT (46). There is also evidence that GaTate PET/CT can improve outcomes by helping identify patients who are likely to benefit from PRRT (47,48).…”

Peptide Receptor Radionuclide Therapy in Patients with Inoperable Meningiomas: Our Experience and Review of the Literature

“…2,[6][7][8] On the other hand, to the best of our knowledge, no clinical data are currently available about the use of 111 In-Pentetreotide. The aim of this study is to report our experience with 111 In-Pentetreotide therapy in patients with inoperable sstr + meningiomas.…”

Peptides in Receptor-Mediated Radiotherapy: From Design to the Clinical Application in Cancers

“…In line with this, the combination of peptide receptor-mediated radionuclide therapy using octreotate or octreotide somatostatin binding peptides with fractionated external beam radiotherapy has been recently evaluated in patients suffering of advanced symptomatic meningioma. All patients reported stabilization or improvement of tumor-associated symptoms, without any morphologic tumor progression (87). …”