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Open Access 01-12-2012 | Research

Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma

Authors: Michael C Kreissl, Heribert Hänscheid, Mario Löhr, Frederik A Verburg, Markus Schiller, Michael Lassmann, Christoph Reiners, Samuel S Samnick, Andreas K Buck, Michael Flentje, Reinhart A Sweeney

Published in: Radiation Oncology | Issue 1/2012

Abstract

Background

External beam radiotherapy (EBRT) is the treatment of choice for irresectable meningioma. Due to the strong expression of somatostatin receptors, peptide receptor radionuclide therapy (PRRT) has been used in advanced cases. We assessed the feasibility and tolerability of a combination of both treatment modalities in advanced symptomatic meningioma.

Methods

10 patients with irresectable meningioma were treated with PRRT (¹⁷⁷Lu-DOTA0,Tyr3 octreotate or - DOTA0,Tyr3 octreotide) followed by external beam radiotherapy (EBRT). EBRT performed after PRRT was continued over 5–6 weeks in IMRT technique (median dose: 53.0 Gy). All patients were assessed morphologically and by positron emission tomography (PET) before therapy and were restaged after 3–6 months. Side effects were evaluated according to CTCAE 4.0.

Results

Median tumor dose achieved by PRRT was 7.2 Gy. During PRRT and EBRT, no side effects > CTCAE grade 2 were noted. All patients reported stabilization or improvement of tumor-associated symptoms, no morphologic tumor progression was observed in MR-imaging (median follow-up: 13.4 months). The median pre-therapeutic SUV_max in the meningiomas was 14.2 (range: 4.3–68.7). All patients with a second PET after combined PRRT + EBRT showed an increase in SUV_max (median: 37%; range: 15%–46%) to a median value of 23.7 (range: 8.0–119.0; 7 patients) while PET-estimated volume generally decreased to 81 ± 21% of the initial volume.

Conclusions

The combination of PRRT and EBRT is feasible and well tolerated. This approach represents an attractive strategy for the treatment of recurring or progressive symptomatic meningioma, which should be further evaluated.

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Nicolato A, Foroni R, Alessandrini F, Maluta S, Bricolo A, Gerosa M: The role of Gamma Knife radiosurgery in the management of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys. 2002, 53: 992-1000. 10.1016/S0360-3016(02)02802-X.CrossRefPubMed

Flickinger JC, Kondziolka D, Maitz AH, Lunsford LD: Gamma knife radiosurgery of imaging-diagnosed intracranial meningioma. Int J Radiat Oncol Biol Phys. 2003, 56: 801-806. 10.1016/S0360-3016(03)00126-3.CrossRefPubMed

Spiegelmann R, Cohen ZR, Nissim O, Alezra D, Pfeffer R: Cavernous sinus meningiomas: a large LINAC radiosurgery series. J Neurooncol. 2010, 98: 195-202. 10.1007/s11060-010-0173-1.CrossRefPubMed

Milosevic MF, Frost PJ, Laperriere NJ, Wong CS, Simpson WJ: Radiotherapy for atypical or malignant intracranial meningioma. Int J Radiat Oncol Biol Phys. 1996, 34: 817-822. 10.1016/0360-3016(95)02166-3.CrossRefPubMed

Hug EB, Devries A, Thornton AF, Munzenride JE, Pardo FS, Hedley-Whyte ET, Bussiere MR, Ojemann R: Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol. 2000, 48: 151-160. 10.1023/A:1006434124794.CrossRefPubMed

Chamberlain MC, Barnholtz-Sloan JS: Medical treatment of recurrent meningiomas. Expert Rev Neurother. 2011, 11: 1425-1432. 10.1586/ern.11.38.CrossRefPubMed

Arena S, Barbieri F, Thellung S, Pirani P, Corsaro A, Villa V, Dadati P, Dorcaratto A, Lapertosa G, Ravetti JL, et al: Expression of somatostatin receptor mRNA in human meningiomas and their implication in in vitro antiproliferative activity. J Neurooncol. 2004, 66: 155-166.CrossRefPubMed

Henze M, Schuhmacher J, Hipp P, Kowalski J, Becker DW, Doll J, Macke HR, Hofmann M, Debus J, Haberkorn U: PET imaging of somatostatin receptors using [68GA]DOTA-D-Phe1-Tyr3-octreotide: first results in patients with meningiomas. J Nucl Med. 2001, 42: 1053-1056.PubMed

Sweeney RA, Bale RJ, Moncayo R, Seydl K, Trieb T, Eisner W, Burtscher J, Donnemiller E, Stockhammer G, Lukas P: Multimodality cranial image fusion using external markers applied via a vacuum mouthpiece and a case report. Strahlenther Onkol. 2003, 179: 254-260. 10.1007/s00066-003-1031-2.CrossRefPubMed

10.

Gehler B, Paulsen F, Oksuz MO, Hauser TK, Eschmann SM, Bares R, Pfannenberg C, Bamberg M, Bartenstein P, Belka C, Ganswindt U: [68 Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning. Radiat Oncol. 2009, 4: 56-10.1186/1748-717X-4-56.PubMedCentralCrossRefPubMed

11.

Kwekkeboom DJ, de Herder WW, Kam BL, van Eijck CH, van Essen M, Kooij PP, Feelders RA, van Aken MO, Krenning EP: Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0, Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol. 2008, 26: 2124-2130. 10.1200/JCO.2007.15.2553.CrossRefPubMed

12.

Imhof A, Brunner P, Marincek N, Briel M, Schindler C, Rasch H, Macke HR, Rochlitz C, Muller-Brand J, Walter MA: Response, survival, and long-term toxicity after therapy with the radiolabeled somatostatin analogue [90Y-DOTA]-TOC in metastasized neuroendocrine cancers. J Clin Oncol. 2011, 29: 2416-2423. 10.1200/JCO.2010.33.7873.CrossRefPubMed

13.

van Essen M, Krenning EP, Kooij PP, Bakker WH, Feelders RA, de Herder WW, Wolbers JG, Kwekkeboom DJ: Effects of therapy with [177Lu-DOTA0, Tyr3]octreotate in patients with paraganglioma, meningioma, small cell lung carcinoma, and melanoma. J Nucl Med. 2006, 47: 1599-1606.PubMed

14.

Sabet A, Ahmadzadehfar H, Herrlinger U, Wilinek W, Biersack HJ, Ezziddin S: Successful radiopeptide targeting of metastatic anaplastic meningioma: case report. Radiat Oncol. 2011, 6: 94-10.1186/1748-717X-6-94.PubMedCentralCrossRefPubMed

15.

Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, Baio SM, Arico D, Sansovini M, Paganelli G: Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging. 2009, 36: 1407-1416. 10.1007/s00259-009-1115-z.CrossRefPubMed

16.

Hofheinz F, Potzsch C, Oehme L, Beuthien-Baumann B, Steinbach J, Kotzerke J, van den Hoff J: Automatic volume delineation in oncological PET. Evaluation of a dedicated software tool and comparison with manual delineation in clinical data sets. Nuklearmedizin. 2012, 51: 9-16.CrossRefPubMed

17.

Boda-Heggemann J, Lohr F, Wenz F, Flentje M, Guckenberger M: kV cone-beam CT-based IGRT: a clinical review. Strahlenther Onkol. 2011, 187 (5): 284-291. 10.1007/s00066-011-2236-4.CrossRefPubMed

18.

Burdick MJ, Neumann D, Pohlman B, Reddy CA, Tendulkar RD, Macklis R: External beam radiotherapy followed by 90Y ibritumomab tiuxetan in relapsed or refractory bulky follicular lymphoma. Int J Radiat Oncol Biol Phys. , 79: 1124-1130.

19.

Israel I, Blass G, Reiners C, Samnick S: Validation of an amino-acid-based radionuclide therapy plus external beam radiotherapy in heterotopic glioblastoma models. Nucl Med Biol. 2011, 38: 451-460. 10.1016/j.nucmedbio.2010.12.002.CrossRefPubMed

20.

Samnick S, Romeike BF, Lehmann T, Israel I, Rube C, Mautes A, Reiners C, Kirsch CM: Efficacy of systemic radionuclide therapy with p-131I-iodo-L-phenylalanine combined with external beam photon irradiation in treating malignant gliomas. J Nucl Med. 2009, 50: 2025-2032. 10.2967/jnumed.109.066548.CrossRefPubMed

21.

Chamberlain MC, Glantz MJ, Fadul CE: Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology. 2007, 69: 969-973. 10.1212/01.wnl.0000271382.62776.b7.CrossRefPubMed

22.

Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W, Buckner JC: Phase II study of subcutaneous octreotide in adults with recurrent or progressive meningioma and meningeal hemangiopericytoma. Neuro Oncol. 2011, 13: 530-535. 10.1093/neuonc/nor044.PubMedCentralCrossRefPubMed

23.

Wehrmann C, Senftleben S, Zachert C, Muller D, Baum RP: Results of individual patient dosimetry in peptide receptor radionuclide therapy with 177Lu DOTA-TATE and 177Lu DOTA-NOC. Cancer Biother Radiopharm. 2007, 22 (3): 406-416. 10.1089/cbr.2006.325.CrossRefPubMed

24.

Forrer F, Uusijarvi H, Waldherr C, Cremonesi M, Bernhardt P, Mueller-Brand J, Maecke HR: A comparison of (111)In-DOTATOC and (111)In-DOTATATE: biodistribution and dosimetry in the same patients with metastatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2004, 31: 1257-1262.CrossRefPubMed

25.

Esser JP, Krenning EP, Teunissen JJ, Kooij PP, van Gameren AL, Bakker WH, Kwekkeboom DJ: Comparison of [(177)Lu-DOTA(0), Tyr(3)]octreotate and [(177)Lu-DOTA(0), Tyr(3)]octreotide: which peptide is preferable for PRRT?. Eur J Nucl Med Mol Imaging. 2006, 33: 1346-1351. 10.1007/s00259-006-0172-9.CrossRefPubMed

26.

Valkema R, Pauwels SA, Kvols LK, Kwekkeboom DJ, Jamar F, de Jong M, Barone R, Walrand S, Kooij PP, Bakker WH, Lasher J, Krenning EP: Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0), Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate. J Nucl Med. 2005, 46 (Suppl 1): 83S-91S.PubMed

27.

Botta F, Mairani A, Battistoni G, Cremonesi M, Di Dia A, Fasso A, Ferrari A, Ferrari M, Paganelli G, Pedroli G, Valente M: Calculation of electron and isotopes dose point kernels with FLUKA Monte Carlo code for dosimetry in nuclear medicine therapy. Med Phys. 2011, 38: 3944-3954. 10.1118/1.3586038.CrossRefPubMed

28.

Astner ST, Theodorou M, Dobrei-Ciuchendea M, Auer F, Kopp C, Molls M, Grosu AL: Tumor shrinkage assessed by volumetric MRI in the long-term follow-up after stereotactic radiotherapy of meningiomas. Strahlenther Onkol. 2010, 186 (8): 423-429. 10.1007/s00066-010-2138-x.CrossRefPubMed

29.

Minniti G, Clarke E, Cavallo L, Osti MF, Esposito V, Cantore G, Cappabianca P, Enrici RM: Fractionated stereotactic conformal radiotherapy for large benign skull base meningiomas. Radiat Oncol. 2011, 6: 36-10.1186/1748-717X-6-36.PubMedCentralCrossRefPubMed

30.

Cremonesi M, Botta F, Di Dia A, Ferrari M, Bodei L, De Cicco C, Rossi A, Bartolomei M, Mei R, Severi S: Dosimetry for treatment with radiolabelled somatostatin analogues. A review. Q J Nucl Med Mol Imaging. 2010, 54: 37-51.PubMed

31.

Cremonesi M, Ferrari M, Di Dia A, Botta F, De Cicco C, Bodei L, Paganelli G: Recent issues on dosimetry and radiobiology for peptide receptor radionuclide therapy. Q J Nucl Med Mol Imaging. 2011, 55: 155-167.PubMed

32.

Strigari L, Benassi M, Chiesa C, Cremonesi M, Bodei L, D'Andrea M: Dosimetry in nuclear medicine therapy: radiobiology application and results. Q J Nucl Med Mol Imaging. 2011, 55: 205-221.PubMed

33.

Haug AR, Auernhammer CJ, Wangler B, Schmidt GP, Uebleis C, Goke B, Cumming P, Bartenstein P, Tiling R, Hacker M: 68 Ga-DOTATATE PET/CT for the early prediction of response to somatostatin receptor-mediated radionuclide therapy in patients with well-differentiated neuroendocrine tumors. J Nucl Med. 2010, 51: 1349-1356. 10.2967/jnumed.110.075002.CrossRefPubMed

Title: Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma
Authors: Michael C Kreissl
Heribert Hänscheid
Mario Löhr
Frederik A Verburg
Markus Schiller
Michael Lassmann
Christoph Reiners
Samuel S Samnick
Andreas K Buck
Michael Flentje
Reinhart A Sweeney
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-99

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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