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Published on: April 17, 2019
Somatostatin receptor-targeted radionuclide therapy for progressive meningioma: benefit linked to 68Ga-DOTATATE/-TOC
Katharina Seystahl1, Veit Stoecklein1, Ulrich Schüller1
1Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland (K.S., M.W., M.S.); Department of Neurosurgery, University Hospital LMU Munich, Munich, Germany (V.S., J.-C.T.); Department of Neuropathology, University Hospital LMU Munich, Munich, Germany (U.S.); Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland (E.R.); Department of Nuclear Medicine, University Hospital Basel, Basel, Switzerland (G.N.); Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (N.S., M.S.); Department of Nuclear Medicine, University Hospital LMU Munich, Munich, Germany (H.I., N.L.A.); Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (A.P.).
Background:
The prognosis of patients with progressive meningioma after failure of surgery and radiotherapy is poor.
Methods:
We retrospectively evaluated the safety and efficacy of somatostatin-receptor (SSTR)-targeted radionuclide therapy (177Lu-DOTATATE [n = 16], 90Y-DOTATOC [n = 3], or both [n = 1]) in patients with progressive, treatment-refractory meningiomas (5 World Health Organization [WHO] grade I, 7 WHO grade II, 8 WHO grade III) and in part multifocal disease (17 of 20 patients).
Results:
SSTR radionuclide treatment (median of 3 treatment cycles, median administered dose/cycle 7400 MBq) led to a disease stabilization in 10 of 20 patients for a median time of 17 months. Stratification according to WHO grade showed a median progression-free survival (PFS) of 32.2 months for grade I tumors, 7.2 for grade II, and 2.1 for grade III. PFS at 6 months was 100% for grade I, 57% for grade II, and 0% for grade III. Median overall survival was 17.2 months in WHO grade III patients and not reached for WHO I and II at a median follow-up of 20 months. In the analysis of single meningioma lesions, maximal and mean standardized uptake values in pretherapeutic 68Ga-DOTATOC/-TATE PET/CT were significantly higher in those lesions with radiographic stability after 6 months. In line with this, high expression of SSTR via immunohistochemistry was associated with PFS >6 months.
Conclusions:
SSTR-targeted radionuclide treatment has activity in a subset of patients with meningioma. Expression of SSTR via immunohistochemistry or radionuclide uptake might serve as a predictive biomarker for outcome to facilitate individualized treatment optimization in patients with uni- and multifocal meningiomas.
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