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

• Published in: Neurology India 2024-03, Vol.72 (2), p.278-284
• Main Authors: Puranik, Ameya D, Dev, Indraja D, Rangarajan Venkatesh, Kulkarni Suyash, Shetty Nitin, Gala Kunal, Sahu Arpita, Bhattacharya Kajari, Dasgupta Archya, Chatterjee Abhishek, Gupta Tejpal, Epari, Sridhar, Sahay Ayushi, Shetty Prakash, Singh, Vikas, Moiyadi Aliasgar, Menon Nandini, Purandare, Nilendu C, Agrawal Archi, Shah, Sneha, Choudhury Sayak, Ghosh Suchismita, Jha, Ashish Kumar
• Format: Article
• Language: English
• Subjects: Dosimetry
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/NI.Neurol-India-D-23-00252

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.