^(177)Lu-DOTA-TATE肽受体放射性核素治疗晚期嗜铬细胞瘤和副神经节瘤的疗效和安全性  

Safety and efficacy of peptide receptor radionuclide therapy with 177Lu-DOTA-TATE in patients with advanced pheochromocytoma and paraganglioma

作　　者：张晋滔 丁泓尹 李腾飞 闫远卓 陈跃 Zhang Jintao;Ding Hongyin;Li Tengfei;Yan Yuanzhuo;Chen Yue(Department of Nuclear Medicine,the Affiliated Hospital of Southwest Medical University,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province,Institute of Nuclear Medicine,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院核医学科、核医学与分子影像四川省重点实验室、西南医科大学核医学研究所,泸州646000

出　　处：《中华核医学与分子影像杂志》2025年第2期71-75,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：泸州市人民政府西南医科大学科技战略合作项目(2021LZXNYD-P03)。

摘　　要：目的评价177Lu-1,4,7,10-四氮杂环十二烷-1,4,7,10-四乙酸-D-苯丙氨酸1-酪氨酸3-苏氨酸8-奥曲肽(DOTA-TATE)在晚期嗜铬细胞瘤和副神经节瘤(PPGL)患者中的疗效和不良反应。方法回顾性纳入2020年4月至2023年12月间在西南医科大学附属医院接受177Lu-DOTA-TATE治疗的16例转移性PPGL患者,其中男9例,女7例,年龄44.5(26.5,51.0)岁。基于血儿茶酚胺水平变化和68Ga-DOTA-TATE PET/CT结果进行治疗反应评估,评估标准为实体瘤疗效评价标准(RECIST)1.1和改良PET/CT实体瘤疗效评价标准(PERCIST)1.0。治疗相关不良事件根据不良事件通用术语标准(CTCAE)5.0进行分级。治疗后患者均接受长期随访,终点是疾病进展或死亡。使用配对样本t检验比较治疗前后实验室指标的差异。结果16例患者177Lu-DOTA-TATE治疗周期数为3(3,4),每周期给药剂量为(7.51±0.67)GBq。1级血液毒性发生率为4/16,2级血液毒性发生率为2/16,主要表现为WBC减少和贫血。治疗后PLT(t=4.06,P=0.001)、Hb水平(t=2.85,P=0.012)轻微下降,WBC计数变化无统计学意义(t=1.57,P=0.137)。未观察到3、4级血液学、肾脏和肝脏毒性。治疗前后肾小球滤过率(t=-0.29,P=0.778)、肌酐水平(t=0.04,P=0.697)、丙氨酸氨基转移酶(t=0.08,P=0.938)、天冬氨酸氨基转移酶(t=0.08,P=0.463)和总胆红素(t=-0.37,P=0.719)差异均无统计学意义。基于RECIST 1.1,13例患者疾病稳定,2例部分缓解,1例疾病进展。基于改良PERCIST 1.0,疾病稳定11例,部分缓解3例,疾病进展2例。8/9的分泌型PPGL患者血去甲肾上腺素水平降低。中位随访时间为21.5(21.1,42.6)个月,中位无进展生存期为8.6(6.0,14.6)个月,随访期间无死亡报告。结论对于生长抑素受体表达升高的晚期PPGL患者,177Lu-DOTA-TATE是一种安全而有前景的治疗选择。ObjectiveTo evaluate the efficacy and adverse effects of 177Lu-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-D-Phel-Tyr3-Thr8-octreotide(DOTA-TATE)in patients with advanced pheochromocytoma and paraganglioma(PPGL).MethodsSixteen patients with metastatic PPGL,treated with 177Lu-DOTA-TATE in the Affiliated Hospital of Southwest Medical University between April 2020 and December 2023,were retrospectively included.Among these patients,nine were male and seven were female,with an a median age of 44.5(26.5,51.0)years.Treatment response was assessed based on changes in blood catecholamine level and 68Ga-DOTA-TATE PET/CT imaging.Evaluation criteria included the response evaluation criteria in solid tumors(RECIST)1.1 and the modified PET response criteria in solid tumors(PERCIST)1.0.Treatment-related adverse events were graded according to the common terminology criteria for adverse events(CTCAE)5.0.All patients received long-term follow-up after treatment,with endpoints including disease progression and death.Paired t-test was used to compare laboratory parameters before and after treatment.ResultsThe median number of treatment cycles of 177Lu-DOTA-TATE was 3(3,4)per patient,with an average dose of(7.51±0.67)GBq per cycle.Grade 1 hematologic toxicity was observed in 4 patients(4/16),while grade 2 hematologic toxicity occurred in 2 patients(2/16),primarily manifesting as leukopenia and anemia.A slight decrease was noted post-treatment in PLT(t=4.06,P=0.001)and Hb levels(t=2.85,P=0.012),while WBC counts showed no statistically significant change(t=1.57,P=0.137).No grade 3 or 4 hematologic,renal,or hepatic toxicities were observed.The glomerular filtration rate(t=-0.29,P=0.778),creatinine(t=0.04,P=0.697),alanine transaminase(t=0.08,P=0.938),aspartate transaminase(t=0.08,P=0.463),and total bilirubin(t=-0.37,P=0.719)after treatment were not significantly different from those before treatment.According to RECIST 1.1,13 patients achieved stable disease,2 patients showed partial response and 1 had progression disease

关 键 词：副神经节瘤 受体 生长抑素 同位素标记 镥 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R730.44[医药卫生—肿瘤] R736.6[医药卫生—临床医学]