TY - JOUR
T1 - Tumor response assessment to treatment with [ 177Lu-DOTA 0,Tyr 3]octreotate in patients with gastroenteropancreatic and bronchial neuroendocrine tumors
T2 - Differential response of bone versus soft-tissue lesions
AU - Van Vliet, Esther I.
AU - Hermans, John J.
AU - De Ridder, Maria A.
AU - Teunissen, Jaap J.
AU - Kam, Boen L.
AU - De Krijger, Ronald R.
AU - Krenning, Eric P.
AU - Kwekkeboom, Dik J.
PY - 2012/9/1
Y1 - 2012/9/1
N2 - We have noted that bone lesions on CT respond differently from soft-tissue lesions to treatment with [ 177Lu-DOTA 0,Tyr 3]octreotate ( 177Lu-octreotate). We therefore compared the response of bone lesions with that of soft-tissue lesions to treatment with 177Luoctreotate in patients with gastroenteropancreatic and bronchial neuroendocrine tumors (NETs). Methods: Forty-two patients with well-differentiated NETs who had bone metastases that were positive on [ 111In-DTPA 0]octreotide somatostatin receptor scintigraphy (SRS) before treatment, and who had soft-tissue lesions, were studied. All patients had had a minimum of 1 follow-up CT scan. Lesions were scored on CT and bone lesions also on SRS before and after treatment. Tumor markers (chromogranin A and 5-hydroxyindoleacetic acid) before and after treatment were compared. Results: Because bone lesions were not visible on CT before treatment in 11 of 42 patients (26%), bone and softtissue lesions were evaluated in 31 patients. Whereas bone lesions increased in size, soft-tissue lesions decreased in size. The percentage change in bone and soft-tissue lesions was significantly different at all time points up to 12 mo of follow-up (P < 0.001). The intensity or number of bone lesions on SRS decreased after treatment in 19 of 23 patients (83%) in whom SRS after treatment was available. The tumor markers also decreased significantly after treatment. In 1 patient, bone lesions became visible on CT after treatment, mimicking progressive disease with "new" bone lesions, although there was an overall treatment response. Conclusion: In patients with NETs, the apparent increase in size of bone lesions or the appearance of new bone lesions on CT after treatment with 177Lu-octreotate should be interpreted cautiously, as this finding may be therapy-related rather than indicative of tumor progression.
AB - We have noted that bone lesions on CT respond differently from soft-tissue lesions to treatment with [ 177Lu-DOTA 0,Tyr 3]octreotate ( 177Lu-octreotate). We therefore compared the response of bone lesions with that of soft-tissue lesions to treatment with 177Luoctreotate in patients with gastroenteropancreatic and bronchial neuroendocrine tumors (NETs). Methods: Forty-two patients with well-differentiated NETs who had bone metastases that were positive on [ 111In-DTPA 0]octreotide somatostatin receptor scintigraphy (SRS) before treatment, and who had soft-tissue lesions, were studied. All patients had had a minimum of 1 follow-up CT scan. Lesions were scored on CT and bone lesions also on SRS before and after treatment. Tumor markers (chromogranin A and 5-hydroxyindoleacetic acid) before and after treatment were compared. Results: Because bone lesions were not visible on CT before treatment in 11 of 42 patients (26%), bone and softtissue lesions were evaluated in 31 patients. Whereas bone lesions increased in size, soft-tissue lesions decreased in size. The percentage change in bone and soft-tissue lesions was significantly different at all time points up to 12 mo of follow-up (P < 0.001). The intensity or number of bone lesions on SRS decreased after treatment in 19 of 23 patients (83%) in whom SRS after treatment was available. The tumor markers also decreased significantly after treatment. In 1 patient, bone lesions became visible on CT after treatment, mimicking progressive disease with "new" bone lesions, although there was an overall treatment response. Conclusion: In patients with NETs, the apparent increase in size of bone lesions or the appearance of new bone lesions on CT after treatment with 177Lu-octreotate should be interpreted cautiously, as this finding may be therapy-related rather than indicative of tumor progression.
KW - [ Lu-DOTA ,Tyr ]octreotate
KW - Bonemetastases
KW - Neuroendocrine tumor
KW - Peptide receptor radionuclide therapy
KW - Treatment response
UR - http://www.scopus.com/inward/record.url?scp=84866177474&partnerID=8YFLogxK
U2 - 10.2967/jnumed.112.102871
DO - 10.2967/jnumed.112.102871
M3 - Article
C2 - 22782312
AN - SCOPUS:84866177474
SN - 0161-5505
VL - 53
SP - 1359
EP - 1366
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 9
ER -