Abstract
IntroductionThe current standard for meningioma treatment planning involves MRI-based image guidance. SSTR ligands such as 68Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptor 1/2 in meningioma tissue. We hypothesize that 68Ga-DOTATATE PET-guided treatment management for meningioma patients will be safe, effective, and identify which patients benefit most from adjuvant radiotherapy. MethodsA single institution prospective registry study was created and included intracranial meningioma patients who received a 68Ga-DOTATATE PET scan to assist with radiation oncologist decision-making. Patients who received a PET scan from 1/1/2018-2/25/2022 were eligible for inclusion. Results60 patients were treated in this registry. 40%, 47%, and 5% of patients had WHO Grades 1, 2, and 3 meningiomas. 5 cases (8%) did not have a grade assigned. 22%, 72%, and 7% were categorized as RTOG 0539 high, intermediate, and low-risk, respectively. After completing their PET scan, 48, 11, and 1 patient(s) proceeded with RT, observation, or redo craniotomy. The median follow-up for the entire cohort was 19.5 months. 3 patients (5%) experienced local failure (LF) between 9.2-28.5 months after diagnosis. 2 patients with LF had PET-avid disease in their post-operative cavity and elected for observation prior to recurrence, and 1 high-risk patient with multifocal disease experienced LF 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. There was only one Grade 3 toxicity attributed to PET-guided radiation. ConclusionThis is one of the largest known population of intracranial meningioma patients followed by physicians who utilized 68Ga-DOTATATE PET guided therapy. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision-making and improve patient outcomes.
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More From: International Journal of Radiation Oncology, Biology, Physics
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