Download PDF
CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(02): 160-170
DOI: 10.4103/wjnm.wjnm_39_18
Original Article

Prevalence of hitherto unknown brain meningioma detected on 68Ga-DOTATATE positron-emission tomography/computed tomography in patients with metastatic neuroendocrine tumor and exploring potential of 177Lu-DOTATATE peptide receptor radionuclide therapy as single-shot treatment approach targeting both tumors

Rahul V. Parghane
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe; Homi Bhabha National Institute, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute; Department of Biostatistcs, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Sanjay Talole
2   Homi Bhabha National Institute; Department of Biostatistcs, Tata Memorial Hospital, Mumbai, Maharashtra, India
3   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe; Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Sandip Basu
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe; Homi Bhabha National Institute, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute; Department of Biostatistcs, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

There is a relative paucity of data in the literature regarding the prevalence of meningiomas and their detection in the clinical setting of neuroendocrine tumors (NETs). The primary aim of this study was to study incidentally detected meningiomas (on 68Ga-DOTATATE/18F fluorodeoxyglucose positron-emission tomography/computed tomography [18F-FDG PET/CT]) in metastatic NET patients referred for peptide receptor radionuclide therapy (PRRT). The secondary aims of this study were to evaluate the response rate of these incidentally detected meningiomas following PRRT and determine progression-free survival (PFS) in this group of patients. This was a retrospective analysis of 500 metastatic/advanced NET patients who had undergone 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT before PRRT workup. The case records were searched to identify cases of hitherto unknown meningiomas detected on PET images; subsequently, these patients underwent brain magnetic resonance imaging (MRI) for confirmation of diagnosis. Following 177Lu-DOTATATE PRRT, posttreatment functional and structural imaging response evaluation of the meningiomas were undertaken by 68Ga-DOTATATE PET/CT, MRI, or CT brain, respectively, along with clinical neurological evaluation. The patients were designated as responders and nonresponders based on predefined response assessment criteria. The PFS of these incidentally detected meningiomas following PRRT was estimated using the Kaplan–Meier product-limit method. Twelve NET patients were retrospectively identified with abnormal focal brain uptake on 68Ga-DOTATATE PET/CT. Of these, meningiomas were finally diagnosed on brain MRI examination in six patients (M: F =3:3; age range: 30–66 years; and mean age: 45 years), with a prevalence of 1.2%. Standardized uptake value (SUVmax) of meningiomas on 68Ga-DOTATATE and 18F-FDG PET/CT ranged from 7.0 to 22.0 (average 17.0) and 10.19–13.70 (mean: 12.10), respectively, and lesion-to-normal brain parenchyma SUVmax ratio ranged from 140 to 400 (mean: 340) and 1.02–1.07 (mean: 1.04), respectively. Of six patients with incidentally detected meningiomas, one patient died within 1 month and five patients received 177Lu-DOTATATE PRRT, the number of cycles ranging from two to six (average: 4) and cumulative therapeutic dose ranging from 13.28 to 29.97GBq (average dose: 19.86GBq). Follow-up in these patients ranged from 8 to 36 months (mean: 19.4 months) after the first dose of PRRT. Complete disappearance of neurological symptoms was found in two of five patients (40%), partial response in one of five (20%), and worsening of symptoms in two of five patients (40%). The overall “responder” and “nonresponder” of the meningiomas after PRRT were three patients (60%) and two patients (40%), respectively. Two patients (40%) died of advanced NET at the time of analysis of these data. The observed mean PFS of the meningioma lesions following PRRT was 26.25 months (95% confidence interval, 16.65–35.84 months).No major hematological and renal toxicity were documented in any of these patients. To conclude, 68Ga-DOTATATE PET/CT imaging is an effective technique for the incidental identification of meningioma in NET patients. Considering the limited therapeutic options in the palliative setting of advanced or metastatic NET patients and morbidity associated with the therapeutic procedures, PRRT could be a promising targeted therapeutic approach for such cases of incidentally detected meningiomas, which is also helpful in stabilizing the disease process without any significant toxicity.

Keywords

177Lu-DOTATATE - 68Ga DOTATATE - fluorodeoxyglucose positron-emission tomography/computed tomography - meningioma - neuroendocrine tumor - peptide receptor radionuclide therapy - somatostatin receptor imaging

Financial support and sponsorship

Nil.




Publication History

Received: 00 00 2019

Accepted: 00 00 2019

Article published online:
22 April 2022

© 2019. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006-2010. Neuro Oncol 2013;15 Suppl 2:ii1-56.
  • 2 Mawrin C, Perry A. Pathological classification and molecular genetics of meningiomas. J Neurooncol 2010;99:379-91.
  • 3 Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol 2010;99:307-14.
  • 4 Saraf S, McCarthy BJ, Villano JL. Update on meningiomas. Oncologist 2011;16:1604-13.
  • 5 Zentner J, Meyer B, Vieweg U, Herberhold C, Schramm J. Petroclival meningiomas: Is radical resection always the best option? J Neurol Neurosurg Psychiatry 1997;62:341-5.
  • 6 O'Sullivan MG, van Loveren HR, Tew JM Jr. The surgical resectability of meningiomas of the cavernous sinus. Neurosurgery 1997;40:238-44.
  • 7 Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: Analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985;62:18-24.
  • 8 Jääskeläinen J, Haltia M, Servo A. Atypical and anaplastic meningiomas: Radiology, surgery, radiotherapy, and outcome. Surg Neurol 1986;25:233-42.
  • 9 Minutoli F, Amato E, Sindoni A, Cardile D, Conti A, Herberg A, et al. Peptide receptor radionuclide therapy in patients with inoperable meningiomas: Our experience and review of the literature. Cancer Biother Radiopharm 2014;29:193-9.
  • 10 Thapa P, Parghane R, Basu S.177 Lu-DOTATATE peptide receptor radionuclide therapy in metastatic or advanced and inoperable primary neuroendocrine tumors of rare sites. World J Nucl Med 2017;16:223-8.
  • 11 Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: Epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008;26:3063-72.
  • 12 Bombardieri E, Maccauro M, De Deckere E, Savelli G, Chiti A. Nuclear medicine imaging of neuroendocrine tumours. Ann Oncol 2001;12 Suppl 2:S51-61.
  • 13 Olsen JO, Pozderac RV, Hinkle G, Hill T, O'Dorisio TM, Schirmer WJ, et al. Somatostatin receptor imaging of neuroendocrine tumors with indium-111 pentetreotide (Octreoscan). Semin Nucl Med 1995;25:251-61.
  • 14 Briganti V, Sestini R, Orlando C, Bernini G, La Cava G, Tamburini A, et al. Imaging of somatostatin receptors by indium-111-pentetreotide correlates with quantitative determination of somatostatin receptor type 2 gene expression in neuroblastoma tumors. Clin Cancer Res 1997;3:2385-91.
  • 15 Chiti A, Briganti V, Fanti S, Monetti N, Masi R, Bombardieri E, et al. Results and potential of somatostatin receptor imaging in gastroenteropancreatic tract tumours. Q J Nucl Med 2000;44:42-9.
  • 16 Chiti A, Fanti S, Savelli G, Romeo A, Bellanova B, Rodari M, et al. Comparison of somatostatin receptor imaging, computed tomography and ultrasound in the clinical management of neuroendocrine gastroenteropancreatic tumours. Eur J Nucl Med 1998;25:1396-403.
  • 17 Krenning EP, Kwekkeboom DJ, Bakker WH, Breeman WA, Kooij PP, Oei HY, et al. Somatostatin receptor scintigraphy with [111In-DTPA-D-phe1]- and [123I-tyr3]-octreotide: The Rotterdam experience with more than 1000 patients. Eur J Nucl Med 1993;20:716-31.
  • 18 Seregni E, Chiti A, Bombardieri E. Radionuclide imaging of neuroendocrine tumours: Biological basis and diagnostic results. Eur J Nucl Med 1998;25:639-58.
  • 19 Jamar F, Fiasse R, Leners N, Pauwels S. Somatostatin receptor imaging with indium-111-pentetreotide in gastroenteropancreatic neuroendocrine tumors: Safety, efficacy and impact on patient management. J Nucl Med 1995;36:542-9.
  • 20 Lebtahi R, Cadiot G, Sarda L, Daou D, Faraggi M, Petegnief Y, et al. Clinical impact of somatostatin receptor scintigraphy in the management of patients with neuroendocrine gastroenteropancreatic tumors. J Nucl Med 1997;38:853-8.
  • 21 Kowalski J, Henze M, Schuhmacher J, Mäcke HR, Hofmann M, Haberkorn U, et al. Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D phe(1)-tyr(3)-Octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol 2003;5:42-8.
  • 22 Kwekkeboom DJ, de Herder WW, van Eijck CH, Kam BL, van Essen M, Teunissen JJ, et al. Peptide receptor radionuclide therapy in patients with gastroenteropancreatic neuroendocrine tumors. Semin Nucl Med 2010;40:78-88.
  • 23 Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 trial of177 Lu-dotatate for midgut neuroendocrine tumors. N Engl J Med 2017;376:125-35.
  • 24 Dutour A, Kumar U, Panetta R, Ouafik L, Fina F, Sasi R, et al. Expression of somatostatin receptor subtypes in human brain tumors. Int J Cancer 1998;76:620-7.
  • 25 Schulz S, Pauli SU, Schulz S, Händel M, Dietzmann K, Firsching R, et al. Immunohistochemical determination of five somatostatin receptors in meningioma reveals frequent overexpression of somatostatin receptor subtype sst2A. Clin Cancer Res 2000;6:1865-74.
  • 26 Arena S, Barbieri F, Thellung S, Pirani P, Corsaro A, Villa V, et al. Expression of somatostatin receptor mRNA in human meningiomas and their implication inin vitro antiproliferative activity. J Neurooncol 2004;66:155-66.
  • 27 Cleary JO, Yeung J, McMeekin H, Wilhelm T, Wagner T. The significance of incidental brain uptake on 68Ga-DOTATATE PET-CT in neuroendocrine tumour patients. Nucl Med Commun 2016;37:1197-205.
  • 28 Starr CJ, Cha S. Meningioma mimics: Five key imaging features to differentiate them from meningiomas. Clin Radiol 2017;72:722-8.
  • 29 Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50 Suppl 1:122S-50S.
  • 30 Parghane RV, Talole S, Prabhash K, Basu S. Clinical response profile of metastatic/Advanced pulmonary neuroendocrine tumors to peptide receptor radionuclide therapy with 177Lu-DOTATATE. Clin Nucl Med 2017;42:428-35.
  • 31 Sindoni A. Somatostatin receptor-targeted radiopeptide therapy in patients with progressive unresectable meningioma. J Nucl Med 2016;57:1657.
  • 32 Brem SS, Bierman PJ, Brem H, Butowski N, Chamberlain MC, Chiocca EA, et al. Central nervous system cancers. J Natl Compr Canc Netw 2011;9:352-400.
  • 33 Kuyumcu S, Özkan ZG, Sanli Y, Yilmaz E, Mudun A, Adalet I, et al. Physiological and tumoral uptake of (68)Ga-DOTATATE: Standardized uptake values and challenges in interpretation. Ann Nucl Med 2013;27:538-45.
  • 34 Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007;357:1821-8.
  • 35 Mathiesen T, Kihlström L, Karlsson B, Lindquist C. Potential complications following radiotherapy for meningiomas. Surg Neurol 2003;60:193-8.
  • 36 Nishio S, Morioka T, Inamura T, Takeshita I, Fukui M, Sasaki M, et al. Radiation-induced brain tumours: Potential late complications of radiation therapy for brain tumours. Acta Neurochir (Wien) 1998;140:763-70.
  • 37 Marincek N, Radojewski P, Dumont RA, Brunner P, Müller-Brand J, Maecke HR, et al. Somatostatin receptor-targeted radiopeptide therapy with 90Y-DOTATOC and 177Lu-DOTATOC in progressive meningioma: Long-term results of a phase II clinical trial. J Nucl Med 2015;56:171-6.
  • 38 Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, et al. Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging 2009;36:1407-16.
  • 39 Gerster-Gilliéron K, Forrer F, Maecke H, Mueller-Brand J, Merlo A, Cordier D, et al. 90Y-DOTATOC as a therapeutic option for complex recurrent or progressive meningiomas. J Nucl Med 2015;56:1748-51.