title: Peptide receptor radionuclide therapy for aggressive atypical pituitary adenoma/carcinoma: variable clinical response in preliminary evaluation.
abstract: OBJECTIVE
  There are limited treatment options for progressive atypical pituitary adenomas and carcinomas. Peptide receptor radionuclide therapy that targets somatostatin receptors has recently been proposed as a potential treatment option. The theoretical rationale for efficacy is elegant but evaluation of outcomes in the first patients treated for this indication is required to assess whether further study is warranted.
  
  
  METHODS
  We performed a case review of the three pituitary patients we have treated with (177)Lutetium DOTATATE in our institution (two atypical adenomas, one carcinoma) and dosimetric analysis of the radiation uptake in one patient.
  
  
  RESULTS
  Treatment was well tolerated. One patient with slowly progressive pituitary carcinoma has stable disease 40 months after completing the planned 4 cycles of treatment. Two patients with rapidly progressive atypical adenomas terminated treatment early due to continued disease progression. Dosimetric evaluation revealed inhomogenous uptake across the tumour (1.3-11.9 Gy with one cycle).
  
  
  CONCLUSIONS
  We have found mixed results in our first 3 patients with stable disease achieved only in the patient with the more slowly progressive tumour. As only a limited number of centres offer Peptide receptor radionuclide therapy, a formal study with prospective data collection may be feasible and if carried out should include dosimetric evaluation of absorbed dose.
authors: University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK, jillianmaclean@nhs.net.
authors: Jillian
authors: J
authors: Maclean
authors: Matthew
authors: M
authors: Aldridge
authors: Jamshed
authors: J
authors: Bomanji
authors: Susan
authors: S
authors: Short
authors: Naomi
authors: N
authors: Fersht
mesh_terms: D000328:Adult; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000532:radiotherapy; D006801:Humans; D008187:Lutetium; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000532:radiotherapy*; D049268:Positron-Emission Tomography; D015175:Prolactinoma / Q000532:radiotherapy; D011868:Radioisotopes / Q000627:therapeutic use*; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018000:Receptors, Peptide / Q000378:metabolism*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D009942:Organometallic Compounds; D011868:Radioisotopes; D019275:Radiopharmaceuticals; D018000:Receptors, Peptide; D008187:Lutetium; C513399:gallium Ga 68 dotatate; C447941:lutetium Lu 177 dotatate; D015282:Octreotide