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Open Access Research

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

Michael C Kreissl1, Heribert Hänscheid1, Mario Löhr3, Frederik A Verburg14, Markus Schiller1, Michael Lassmann1, Christoph Reiners1, Samuel S Samnick1, Andreas K Buck1, Michael Flentje2 and Reinhart A Sweeney2*

Author Affiliations

1 Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany

2 Department of Radiation Oncology, University Hospital Wuerzburg University of Wuerzburg, Josef-Schneider-Str. 11 97080, Wuerzburg, Germany

3 Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany

4 Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany

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Radiation Oncology 2012, 7:99  doi:10.1186/1748-717X-7-99

Published: 21 June 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 SUVmax 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 SUVmax (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.

Keywords:
PRRT; Peptide receptor radionuclide therapy; Meningioma; Radiotherapy; EBRT; Combination