Contrast-enhanced ultrasound monitoring of perfusion changes in hepatic neuroendocrine metastases after systemic versus selective arterial 177Lu/90Y-DOTATOC and 213Bi-DOTATOC radiopeptide therapy.

Abstract

AIM:

Radiopeptide therapy with beta emitter labeled (177)Lu/(90)Y- DOTA(0)-Phe(1)-Tyr(3)-octreotide (DOTATOC) and more recently also alpha emitting (213)Bi-DOTATOC are promising new treatments for neuroendocrine tumors. No early predictors for treatment response have been recognized and tumor-shrinkage after radiation therapy appears slowly. In some solid tumors a decline in tumor perfusion was found predictive of final treatment response but the gold standard multiphase computed tomography (CT) has a high radiation burden. Therefore we evaluated the ability of contrast-enhanced ultrasound (CEUS) to evaluate tumor perfusion as a response criteria.

MATERIALS AND METHODS:

14 patients with hepatic neuroendocrine tumor (NET) metastases were enrolled in the retrospective study. Eleven patients were treated with beta-emitting (177)Lu/(90)Y-DOTATOC, either intravenous (i.v.) (n = 5) or intra-arterial (i.a.) (n = 6) and three patients received alpha-emitting (213)Bi-DOTATOC (i.a.). CEUS and contrast-enhanced CT (CE-CT) were performed before and 3 months after treatment.

RESULTS:

CE-CT and CEUS presented comparable results in the baseline study and in the assessment of perfusion changes due to the different treatment regimes. A therapy related decrease in tumor perfusion is an early predictor of longterm morphologic response.

CONCLUSION:

CEUS is available and radiation free technique which showed comparable results for perfusion and diameter of liver metastases compared to CE-CT. Intensity reduction in an arterial phase CEUS can be seen as a positive sign indicating long term tumor response to treatment. Therefore CEUS may be considered as an imaging modality for monitoring early treatment after focal alpha and beta targeted therapy.

• Authors: F L Giesel, S Wulfert, C M Zechmann, U Haberkorn, C Kratochwil, P Flechsig, T Kuder, L H Schwartz, F Bruchertseifer
• Journal: Experimental oncology (Exp Oncol) Vol. 35 Issue 2 Pg. 122-6 (Jun 2013) ISSN: 1812-9269 [Print] Ukraine
• PMID: 23828389 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• 177Lu-octreotide, DOTA(0)-Tyr(3)-
• Contrast Media
• Radioisotopes
• 90Y-octreotide, DOTA-Tyr(3)-
• Octreotide
• Bismuth

Topics

• Bismuth
• Contrast Media
• Infusions, Intra-Arterial
• Liver Neoplasms (diagnostic imaging, pathology, radiotherapy)
• Neuroendocrine Tumors (diagnostic imaging, pathology, radiotherapy)
• Octreotide (analogs & derivatives, therapeutic use)
• Pancreatic Neoplasms (pathology, surgery)
• Perfusion Imaging
• Positron-Emission Tomography (methods)
• Radioisotopes (therapeutic use)
• Retrospective Studies
• Tomography, X-Ray Computed (methods)
• Treatment Outcome
• Ultrasonography