Radiolabelled somatostatin analogue treatment in gastroenteropancreatic neuroendocrine tumours: factors associated with response and suggestions for therapeutic sequence

• Published in: European journal of nuclear medicine and molecular imaging 2013-08, Vol.40 (8), p.1197-1205
• Main Authors: Campana, Davide, Capurso, Gabriele, Partelli, Stefano, Nori, Francesca, Panzuto, Francesco, Tamburrino, Domenico, Cacciari, Giulia, Delle Fave, Gianfranco, Falconi, Massimo, Tomassetti, Paola
• Format: Article
• Language: English
• Subjects: Aged; Cardiology; Drug therapy; Female; Gastrointestinal diseases; Humans; Imaging; Intestinal Neoplasms - radiotherapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroendocrine Tumors - radiotherapy; Nuclear Medicine; Octreotide - analogs & derivatives; Octreotide - therapeutic use; Oncology; Organometallic Compounds - therapeutic use; Original Article; Orthopedics; Pancreatic cancer; Pancreatic Neoplasms - radiotherapy; Radiology; Radiopharmaceuticals - therapeutic use; Somatostatin - analogs & derivatives; Stomach Neoplasms - radiotherapy; Treatment Outcome; Tumors; Yttrium Radioisotopes - therapeutic use
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-013-2402-2

Purpose Peptide receptor radionuclide therapy (PRRT) is a relatively new treatment modality for patients with unresectable or metastatic gastroenteropancreatic neuroendocrine tumours (GEP NETs). The aim of this study was to determine the time to progression of patients treated with PRRT and to identify the prognostic factors related to treatment response. Methods Patients with sporadic GEP NETs prospectively treated with PRRT were retrospectively analysed. The primary end point was progression-free survival (PFS). Results A total of 69 patients (37 men and 32 women; 45 with pancreatic and 24 with gastrointestinal lesion; 22 NET G1 and 41 NET G2) were treated with 90 Y or 177 Lu. The objective response rate was 27.5 % (partial response, PR), while 50.7 % had stable disease and 23.2 % had progressive disease. Significant differences in PFS were observed in relationship to the stage of the disease (44 months for stage III, 23 months for stage IV), the evidence of a PR 6 months after the end of the PRRT (39 months in patients with a PR, 22 months in patients without a PR) and previous transarterial chemoembolization (TACE, yes 13 months vs no 31 months). Stage IV, NET G2 and previous TACE were found to be significant factors for tumour progression at multivariate analysis. Conclusion Low tumour burden and a low proliferation index represent independent prognostic factors for long PFS, while previous chemoembolization techniques represent independent prognostic factors for early tumour progression and shorter PFS. Our data suggest that chemoembolization techniques to reduce the hepatic tumour burden should be avoided.