Intra-arterial peptide-receptor radionuclide therapy for neuro-endocrine tumour liver metastases: an in-patient randomised controlled trial (LUTIA)
Purpose Peptide receptor radionuclide therapy (PRRT) using [177Lu]Lu-DOTATATE has been shown to effectively prolong progression free survival in grade 1–2 gastroenteropancreatic neuroendocrine tumours (GEP-NET), but is less efficacious in patients with extensive liver metastases. The aim was to investigate whether tumour uptake in liver metastases can be enhanced by intra-arterial administration of [177Lu]Lu-DOTATATE into the hepatic artery, in order to improve tumour response without increasing toxicity. Methods Twenty-seven patients with grade 1–2 GEP-NET, and bi-lobar liver metastases were randomized to receive intra-arterial PRRT in the left or right liver lobe for four consecutive cycles. The contralateral liver lobe and extrahepatic disease were treated via a “second-pass” effect and the contralateral lobe was used as the control lobe. Up to three metastases (> 3 cm) per liver lobe were identified as target lesions at baseline on contrast-enhanced CT. The primary endpoint was the tumour-to-non-tumour (T/N) uptake ratio on the 24 h post-treatment [177Lu]Lu-SPECT/CT after the first cycle. This was calculated for each target lesion in both lobes using the mean uptake. T/N ratios in both lobes were compared using paired-samples t-test. Findings After the first cycle, a non-significant difference in T/N uptake ratio was observed: T/$ N_{IA} $ = 17·4 vs. T/$ N_{control} $ = 16·2 (p = 0·299). The mean increase in T/N was 17% (1·17; 95% CI [1·00; 1·37]). Of all patients, 67% (18/27) showed any increase in T/N ratio after the first cycle. Conclusion Intra-arterial [177Lu]Lu-DOTATATE is safe, but does not lead to a clinically significant increase in tumour uptake..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:51 |
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| Enthalten in: |
European journal of nuclear medicine and molecular imaging - 51(2023), 4 vom: 28. Okt., Seite 1121-1132 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ebbers, S. C. [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| Themen: |
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| Anmerkungen: |
© The Author(s) 2023 |
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| doi: |
10.1007/s00259-023-06467-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
SPR054847168 |
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| 100 | 1 | |a Ebbers, S. C. |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intra-arterial peptide-receptor radionuclide therapy for neuro-endocrine tumour liver metastases: an in-patient randomised controlled trial (LUTIA) |
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| 520 | |a Purpose Peptide receptor radionuclide therapy (PRRT) using [177Lu]Lu-DOTATATE has been shown to effectively prolong progression free survival in grade 1–2 gastroenteropancreatic neuroendocrine tumours (GEP-NET), but is less efficacious in patients with extensive liver metastases. The aim was to investigate whether tumour uptake in liver metastases can be enhanced by intra-arterial administration of [177Lu]Lu-DOTATATE into the hepatic artery, in order to improve tumour response without increasing toxicity. Methods Twenty-seven patients with grade 1–2 GEP-NET, and bi-lobar liver metastases were randomized to receive intra-arterial PRRT in the left or right liver lobe for four consecutive cycles. The contralateral liver lobe and extrahepatic disease were treated via a “second-pass” effect and the contralateral lobe was used as the control lobe. Up to three metastases (> 3 cm) per liver lobe were identified as target lesions at baseline on contrast-enhanced CT. The primary endpoint was the tumour-to-non-tumour (T/N) uptake ratio on the 24 h post-treatment [177Lu]Lu-SPECT/CT after the first cycle. This was calculated for each target lesion in both lobes using the mean uptake. T/N ratios in both lobes were compared using paired-samples t-test. Findings After the first cycle, a non-significant difference in T/N uptake ratio was observed: T/$ N_{IA} $ = 17·4 vs. T/$ N_{control} $ = 16·2 (p = 0·299). The mean increase in T/N was 17% (1·17; 95% CI [1·00; 1·37]). Of all patients, 67% (18/27) showed any increase in T/N ratio after the first cycle. Conclusion Intra-arterial [177Lu]Lu-DOTATATE is safe, but does not lead to a clinically significant increase in tumour uptake. | ||
| 650 | 4 | |a Neuroendocrine tumour |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a PRRT |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Intra-arterial |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Safety |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Efficacy |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Barentsz, M. W. |4 aut | |
| 700 | 1 | |a de Vries-Huizing, D. M. V. |4 aut | |
| 700 | 1 | |a Versleijen, M. W. J. |4 aut | |
| 700 | 1 | |a Klompenhouwer, E. G. |4 aut | |
| 700 | 1 | |a Tesselaar, M. E. T. |4 aut | |
| 700 | 1 | |a Stokkel, M. P. M. |4 aut | |
| 700 | 1 | |a Brabander, T. |4 aut | |
| 700 | 1 | |a Hofland, J. |4 aut | |
| 700 | 1 | |a Moelker, A. |4 aut | |
| 700 | 1 | |a van Leeuwaarde, R. S. |4 aut | |
| 700 | 1 | |a Smits, M. L. J. |4 aut | |
| 700 | 1 | |a Braat, A. J. A. T. |4 aut | |
| 700 | 1 | |a Lam, M. G. E. H. |4 aut | |
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