PRRT with Lu-177 DOTATATE in Treatment-Refractory Progressive Meningioma: Initial Experience from a Tertiary-Care Neuro-Oncology Center

Author:

Puranik Ameya D1,Dev Indraja D1,Rangarajan Venkatesh1,Kulkarni Suyash2,Shetty Nitin2,Gala Kunal2,Sahu Arpita2,Bhattacharya Kajari2,Dasgupta Archya3,Chatterjee Abhishek3,Gupta Tejpal3,Sridhar Epari4,Sahay Ayushi4,Shetty Prakash5,Singh Vikas5,Moiyadi Aliasgar5,Menon Nandini6,Purandare Nilendu C1,Agrawal Archi1,Shah Sneha1,Choudhury Sayak1,Ghosh Suchismita1,Jha Ashish Kumar1

Affiliation:

1. Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

2. Department of Radiodiagnosis, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

3. Department of Radiation Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

4. Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

5. Department of Neurosurgery, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

6. Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Abstract

Purpose: Refractory and/or recurrent meningiomas have poor outcomes, and the treatment options are limited. Peptide receptor radionuclide therapy (PRRT) has been used in this setting with promising results. We have documented our experience of using intravenous (IV) and intra-arterial (IA) approaches of Lu-177 DOTATATE PRRT. Methods: Eight patients with relapsed/refractory high-grade meningioma received PRRT with Lu-177 DOTATATE by IV and an IA route. At least 2 cycles were administered. Time to progression was calculated from the first PRRT session to progression. The response was assessed on MRI using RANO criteria, and visual analysis of uptake was done on Ga-68 DOTANOC PET/CT. Post-therapy dosimetry calculations for estimating the absorbed dose were performed. Results: Median time to progression was 8.9 months. One patient showed disease progression, whereas seven patients showed stable disease at 4 weeks following 2 cycles of PRRT. Dosimetric analysis showed higher dose and retention time by IA approach. No significant peri-procedural or PRRT associated toxicity was seen. Conclusion: PRRT is a safe and effective therapeutic option for relapsed/refractory meningioma. The IA approach yields better dose delivery and should be routinely practised.

Publisher

Medknow

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