68Ga-PSMA PET/CT in radioactive iodine-refractory differentiated thyroid cancer and first treatment results with 177Lu-PSMA-617

被引：73
作者：
de Vries, Lisa H. [1 ]
Lodewijk, Lutske [1 ]
Braat, Arthur J. A. T. [2 ]
Krijger, Gerard C. [2 ]
Valk, Gerlof D. [3 ]
Lam, Marnix G. E. H. [2 ]
Rinkes, Inne H. M. [1 ]
Vriens, Menno R. [1 ]
de Keizer, Bart [2 ]
机构：
[1] Univ Med Ctr Utrecht, Dept Surg, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Radiol & Nucl Med, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Dept Endocrine Oncol, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
来源：
EJNMMI RESEARCH | 2020年 / 10卷 / 01期
关键词：
Radioactive iodine-refractory differentiated thyroid carcinoma; Prostate-specific membrane antigen; Theranostic; Gallium; Lutetium; PET; CT; MEMBRANE ANTIGEN-EXPRESSION; PSMA EXPRESSION; CARCINOMA; GUIDELINES; MANAGEMENT; PAPILLARY; THERAPY;
D O I：
10.1186/s13550-020-0610-x
中图分类号：
R8 [特种医学]; R445 [影像诊断学];
学科分类号：
1002 ; 100207 ; 1009 ;
摘要：
Background Differentiated thyroid carcinoma (DTC) is the most common type of thyroid cancer. Treatment with surgery, radioactive iodine (RAI), and TSH suppression is effective in most patients. Five to 15% of patients become RAI refractory and need alternative therapy; however, treatment options are limited. Ga-68-PSMA PET/CT, originally developed for prostate cancer, is also applicable to other malignancies, including thyroid carcinoma. The uptake of PSMA in thyroid carcinoma gives opportunities for imaging and therapy of RAI-refractory DTC. The aim of this study was to analyze imaging on Ga-68-PSMA PET/CT and evaluate the response to Lu-177-PSMA-617 therapy in patients with RAI-refractory DTC. Materials and methods Five patients with RAI-refractory DTC underwent Ga-68-PSMA PET/CT to determine their eligibility for Lu-177-PSMA-617 therapy. Ga-68-PSMA PET/CTs were analyzed visually and quantitatively. Response to Lu-177-PSMA-617 therapy was evaluated using imaging and thyroglobulin (Tg) values. Results Tracer uptake suspicious for distant metastases was depicted in all Ga-68-PSMA PET/CTs. Based on tracer uptake, three patients were eligible for Lu-177-PSMA-617 therapy, of whom two were treated. One patient showed disease progression on imaging 1 month later, while her Tg values gradually increased from 18 to 63 mu g/L in the months after treatment. Another patient showed partial, temporary response of lung and liver metastases. Her Tg levels initially decreased from 17 to 9 mu g/L. However, 7 months after treatment, there was disease progression on imaging and Tg levels had increased to 14 mu g/L. Imaging with Ga-68-PSMA PET/CT could be compared to (18)FDG PET/CT in three patients. Two patients showed additional lesions on Ga-68-PSMA PET/CT, and one patient showed concordant imaging. Conclusion Ga-68-PSMA PET/CT appears to have added value in patients with RAI-refractory DTC, as it is able to detect various types of lesions, some of which were not picked up by (18)FDG PET/CT. Furthermore, Ga-68-PSMA PET/CT might be used to identify patients eligible for treatment with Lu-177-PSMA-617. One of the two patients who underwent Lu-177-PSMA-617 therapy showed a modest, temporary response. To draw conclusions about the effectiveness of this therapy, more research is needed.
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页数：8
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