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Effects of Therapy with [¹⁷⁷Lu-DOTA⁰, Tyr³]Octreotate in Patients with Paraganglioma, Meningioma, Small Cell Lung Carcinoma, and Melanoma

¹ Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; ² Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; and ³ Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands

View larger version (15K): [in a new window]   FIGURE 1.  Effects of therapy with 177Lu-octreotate in groups of tumors in relation to disease status before treatment. PD = progressive disease; SD = stable disease; MR = minor response; PR = partial remission; CR = complete remission.

View larger version (87K): [in a new window]   FIGURE 2.  MR image (T1 weighted) of cervicothoracic spine of patient with pheochromocytoma. (A) Baseline scan 3 mo before 177Lu-octreotate therapy shows tumor extending into spinal canal (arrow, *spinal cord). (B) Scan 3 mo after fourth cycle of 7.4 GBq 177Lu-octreotate shows reduction in tumor extension into spinal canal (arrow).

View larger version (75K): [in a new window]   FIGURE 3.  Example of patient with large, cranial meningioma. Patient already had undergone surgery 4 times and had had external beam radiotherapy before 177Lu-octreotate. (A) MR image 1 wk after first cycle of 177Lu-octreotate shows meningioma (arrow, curved arrow) with some extracranial involvement. (B) MR image 1 mo after final dose of 177Lu-octreotate. Intracranial part of meningioma has increased (arrows). Extracranial, exophytic parts have increased as well (arrowheads). (C) Photograph of patient 18 mo after last dose of 177Lu-octreotate (view from right, posterooblique). Patient had undergone surgery and had had external beam radiotherapy again and had just finished 6 cycles of cisplatin without therapeutic effect. Arrow indicates very large, extracranial part of meningioma with ulcerated skin.

View larger version (9K): [in a new window]   FIGURE 4.  -Glutamylpeptidase (-GT) in patients with SCLC or melanoma with hepatic metastases. *Third therapy could not be given.

View larger version (76K): [in a new window]   FIGURE 5.  Scintigraphy performed 4 d after administration of 7.4 GBq 177Lu-octreotate in patient with SCLC. (A) Scan (posterior chest) after first dose. Arrow indicates a cervical lesion. (B) Scan (posterior chest) after second and last dose 2 mo later. Several new lesions are visible (arrowheads). Uptake in lesions already present on first scan has increased (arrow).

View larger version (15K): [in a new window]   FIGURE 6.  Relation between uptake of 111In-octreotide on pretherapy somatostatin receptor scintigraphy and response to 177Lu-octreotate therapy. PD = progressive disease; SD = stable disease; MR = minor response; PR = partial remission; CR = complete remission.