⁹⁰Y-DOTATOC as a Therapeutic Option for Complex Recurrent or Progressive Meningiomas

Abstract

The standard treatment of meningiomas is surgery or radiotherapy. Complex, especially recurrent or progressive cases, may exhibit tumor growth involving critical neurovascular structures or diffuse growth, resulting in limited efficacy and higher risk of standard treatment. We evaluated whether somatostatin receptor-targeted radionuclide therapy with 90 Y-DOTATOC may be a therapeutic option. Methods: Fifteen patients with recurrent or progressive meningiomas after multimodal pretreatment or unfavorable medical risk profile were treated with systemic 90 Y-DOTATOC. Endpoints were progression-free survival and toxicity. Results: Usually applied doses were 7,400 MBq/m 2 of 90 Y-DOTATOC in 2 fractions. Mean observation time was 49.7 mo (range, 12-137 mo). Overall median progression-free survival was at least 24 mo. Toxicity was moderate, mostly hematologic (n 5 8) and transient. Conclusion: 90 Y-DOTATOC therapy is feasible and may represent a promising second-or third-line option for complex meningiomas, which are progressive or otherwise not treatable with a reasonable risk-benefit ratio.

Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas

“…When used, re-irradiation for aggressive meningiomas is typically via EBRT, using fractionated x-rays or stereotaxy, either after resection or as monotherapy, 4,11,12,14,16,23,24,32 with some groups using protons, carbon ions, or other rarer treatments. 9,13 Data on outcomes after re-irradiation of a second (or more) recurrence in aggressive meningiomas is relatively scant, 1,4,11,12,14,16,22,41,43 and BT for aggressive recurrent meningiomas has been reported in just a few case series, 1,22,41 with all prior seed implantation series utilizing I-125. The largest BT series is from the University of California, San Francisco (UCSF), which was recently updated by Magill et al, 22 C = convexity; chemo = chemotherapy; CKRS = CyberKnife radiosurgery; Dx = diagnosis; FC/P = falx cerebri/parafalcine; GKRS = Gamma Knife radiosurgery; IMRT = intensity-modulated radiation therapy; LP = local progression of disease; NA = not applicable; R = resection; RT = radiation therapy; SB = skull base; SRS = stereotactic radiosurgery; SSR = same-site resection; TTP Pre/Post = time to progression before/after implantation of Cs-131 tiles; Tx = treatment.…”

Parasellar Meningiomas

“…PRRT is already being used with success in clinical practice for gastropancreatic neuroendocrine tumors, which present a similar pattern of growth than low-grade meningiomas. The literature results are promising for low-grade meningiomas [120][121][122][123][124]. The hematologic and renal toxicity seems acceptable.…”

Treatment of aggressive recurrent meningiomas: spinning towards peptide receptor radionuclide therapy

“…To date, the application of PRRT for meningiomas has been mainly used on a compassionate basis. Approximately 120 meningioma patients treated with PRRT have been reported [8][9][10][11][12][13][14][15].…”