1. Safety and Effectiveness of 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy After Regional Hepatic Embolization in Patients With Somatostatin-Expressing Neuroendocrine Tumors
- Author
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Muzammil Ali, Izabela Tworowska, Mohammadali Hamiditabar, Ebrahim S. Delpassand, Luke Bolek, and Gelareh Vahdati
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Peptide receptor ,Adolescent ,Receptors, Peptide ,medicine.medical_treatment ,Neuroendocrine tumors ,Octreotide ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,177Lu-DOTATATE ,medicine ,Organometallic Compounds ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Embolization ,Receptor ,Child ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Gene Expression Regulation, Neoplastic ,Neuroendocrine Tumors ,Somatostatin ,Liver ,030220 oncology & carcinogenesis ,Radionuclide therapy ,Female ,Radiology ,business - Abstract
Peptide receptor radionuclide therapy (PRRT) with Lu-DOTATATE is shown to be an effective therapeutic option for somatostatin-expressing neuroendocrine neoplasms. Some concerns are raised over safety of this modality in patients with a history of regional chemoembolization and radionuclide hepatic embolization (CRHE) and is cause of reluctance among some physicians for suggesting Lu-DOTATATE in this patient population.We retrospectively reviewed 143 patients with somatostatin-expressing neuroendocrine tumors who underwent Lu-DOTATATE PRRT. Statistical analysis was performed on effect of Lu-DOTATATE in patients with and without prior CRHE using resampling procedures and correlation coefficient (r).Proportion of toxicity in patients with and without CRHE was comparable (P = 0.246). No statistically significant correlation (r) found between any toxicity and prior CRHE (r = -0.3 to -0.03) or time elapsed between embolization and the first cycle of PRRT (r = -0.59 to 0.17). Following PRRT, 76.5% of patients with CRHE experienced benefit (partial response + stable disease), whereas 23.4% experienced progressive disease. Patients with CRHE showed more stable disease (P = 0.048) and less progressive disease (P = 0.046) following PRRT compared with no CRHE. The CRHE and no-CRHE status shared same probability for developing partial response/complete response following PRRT (P = 0.50).Treatment with Lu-DOTATATE did not show clinically or statistically significant toxicity in CRHE patients regardless of frequency of embolization or time interval between embolization and first PRRT. Results suggested a statistically significant higher response rate in patients with a history of CRHE. A prior history of CRHE is not a contraindication to subsequent PRRT.
- Published
- 2017