A Prospective Registry Study of 68Ga-DOTATATE PET/CT Incorporation into Treatment Planning of Intracranial Meningiomas.
Academic Article
Overview
abstract
INTRODUCTION: The 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. METHODS: A 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. RESULTS: 60 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. CONCLUSION: This 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.
