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


METHODS
10 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.


RESULTS
Median 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 SUV(max) 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 SUV(max) (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.


CONCLUSIONS
The 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.
Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
Michael C
MC
Kreissl
Heribert
H
Hänscheid
Mario
M
Löhr
Frederik A
FA
Verburg
Markus
M
Schiller
Michael
M
Lassmann
Christoph
C
Reiners
Samuel S
SS
Samnick
Andreas K
AK
Buck
Michael
M
Flentje
Reinhart A
RA
Sweeney
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D008579:Meningioma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D018000:Receptors, Peptide / Q000378:metabolism / Q000627:therapeutic use
D018000:Receptors, Peptide; D015282:Octreotide