Theragnostic Use of Radiolabelled Dota-Peptides in Meningioma: From Clinical Demand to Future Applications

Abstract

Meningiomas account for approximately 30% of all new diagnoses of intracranial masses. The 2016 World Health Organization’s (WHO) classification currently represents the clinical standard for meningioma’s grading and prognostic stratification. However, watchful waiting is frequently the chosen treatment option, although this means the absence of a certain histological diagnosis. Consequently, MRI (or less frequently CT) brain imaging currently represents the unique available tool to define diagnosis, grading, and treatment planning in many cases. Nonetheless, these neuroimaging modalities show some limitations, particularly in the evaluation of skull base lesions. The emerging evidence supporting the use of radiolabelled somatostatin receptor analogues (such as dota-peptides) to provide molecular imaging of meningiomas might at least partially overcome these limitations. Moreover, their potential therapeutic usage might enrich the current clinical offering for these patients. Starting from the strengths and weaknesses of structural and functional neuroimaging in meningiomas, in the present article we systematically reviewed the published studies regarding the use of radiolabelled dota-peptides in surgery and radiotherapy planning, in the restaging of treated patients, as well as in peptide-receptor radionuclide therapy of meningioma.

Clinical Significance of Somatostatin Receptor (SSTR) 2 in Meningioma

“…SSTR2-directed peptide receptor radionuclide therapy (PRRT) has also exhibited their potential therapeutic use for patients with meningiomas. Beta-emitters 90-yttrium ( 90 Y) and 177-lutetium ( 177 Lu) are the most widely used radiometals in PRRT at present (98). Certain amounts of clinical studies (Table 4) have investigated the therapeutic effect of SSTR2-targeted PRRT in treating meningioma patients.…”

“…The selective accumulation of radiolabeled somatostatin analogs in meningioma cells enhances the efficacy while reducing the toxicity of PRRT. Nevertheless, because these traces are mainly excreted by the kidney, renal toxicity seems inevitable, which may limit the application of PRRT (98,106,107). Generally, in patients with recurrent or complex unresectable meningiomas, especially in those where standard treatments have failed, the use of SSTR2-targeted PRRT should be considered; for those who accept PRRT, we should pay close attention to their renal function, and renal protection should be provided.…”

Shortened Tracer Uptake Time in GA-68-DOTATOC-PET of Meningiomas Does Not Impair Diagnostic Accuracy and PET Volume Definition

“…Therefore, the resulting high lesion-to-background ratio enables precise lesion detection and demarcation against the surrounding tissue [ 8 ]. As a result, PET/MRI with somatostatin analogs can be used for initial diagnosis, treatment planning (i.e., before resection, radiotherapy, Lu177-DOTATOC/TATE therapy) as well as for follow-up examinations [ 9 , 10 ].…”

What Is the Role of Imaging in Cancers?

“…Table 1 shows a summary of the topics and the papers included for each topic [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. The majority of papers are focused on prostate cancer (PCa) and radiomics.…”

“…The residual papers focused on different topics by analyzing diverse imaging modalities from preclinical [ 17 ], to gold nanoparticles for CT imaging [ 3 , 4 ], to specific pathologies (i.e., breast cancer [ 1 , 2 ] or pancreas [ 13 , 14 ] or meningioma [ 10 ]), to multicenter trials [ 8 , 22 ]. The common conclusion of these contributions is the current and future support that medical imaging can add to clinical information.…”