Long-term results of multimodal peptide receptor radionuclide therapy and fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma

Abstract

Background: The combination of somatostatin receptor-directed peptide receptor radionuclide therapy (PRRT) in combination with external beam radiotherapy (EBRT) might prove a feasible treatment option in patients with advanced meningioma.

Patients and methods: From May 2010 to May 2011, 10 patients with unresectable meningioma (6 × WHO grade I, 2 × WHO grade II, 2 × WHO grading not available) were treated with one cycle of PRRT followed by EBRT. Long-term toxicity and efficacy were assessed according to Common Terminology Criteria for Adverse Events version 5.0 and magnetic resonance imaging-based Response Assessment in Neuro-Oncology Working Group criteria, respectively.

Results: During long-term follow-up of a median of 105.0 months (range, 38.2-111.4 m), combined PRRT and EBRT was well-tolerated with no severe acute or chronic toxicity. Kidney or bone marrow function was not affected in any patient. Combination of PRRT and EBRT resulted in disease stabilization in 7 of the 10 patients with a median progression-free survival of 107.7 months (range, 47.2-111.4 m) vs. 26.2 months (range, 13.8-75.9 m) for the patients with meningioma progression.

Conclusions: The combination of PRRT and EBRT is a feasible and safe therapeutic option in meningioma patients. In this pilot cohort, the multimodality treatment demonstrated good disease stabilization.

Keywords: External beam radiotherapy; Meningioma; Multimodal treatment; Peptide receptor radionuclide therapy; Somatostatin receptor.

Fig. 1

Follow-up of patient #6 showing stable disease; a) baseline MRI, b) baseline PET/CT, c) baseline fusion of PET and MRI, d) last available MRI with comparable sequences (87 months after combined EBRT and PRRT).