Somatostatin receptor-targeted radionuclide therapy for progressive meningioma: benefit linked to 68Ga-DOTATATE/-TOC uptake.
The prognosis of patients with progressive meningioma after failure of surgery and radiotherapy is poor.



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).



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 pretherapeutic68Ga-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.



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.
Department 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.).
Katharina
K
Seystahl
Department 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.).
Veit
V
Stoecklein
Department 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.).
Ulrich
U
Schüller
Department 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.).
Elisabeth
E
Rushing
Department 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.).
Guillaume
G
Nicolas
Department 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.).
Niklaus
N
Schäfer
Department 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.).
Harun
H
Ilhan
Department 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.).
Athina
A
Pangalu
Department 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.).
Michael
M
Weller
Department 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.).
Jörg-Christian
JC
Tonn
Department 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.).
Michael
M
Sommerauer
Department 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.).
Nathalie L
NL
Albert
D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005710:Gallium Radioisotopes / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D017481:Receptors, Somatostatin / Q000528:radiation effects*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D005710:Gallium Radioisotopes; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C513399:gallium Ga 68 dotatate; C496730:90Y-octreotide, DOTA-Tyr(3)-; C447941:lutetium Lu 177 dotatate; D015282:Octreotide
PET; meningioma; radionuclide; somatostatin receptors