Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1513
Peer-review started: December 8, 2019
First decision: January 9, 2020
Revised: March 6, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: April 7, 2020
The incidence and prevalence of neuroendocrine tumors are currently increasing, probably due to the extensive use of more developed routine radiological tests and endoscopic techniques. In patients with limited cytoreductive options, peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogues 177Lu-DOTA0-Tyr3-octreotate (177Lu-Dotatate) has been used successfully in patients diagnosed with metastatic gastroenteropancreatic somatostatin receptor positive tumors in the past two decades.
The aim of this study was to determine the impact of this treatment on patient’s quality of life, radiological and metabolic response, overall survival, prognostic factors and its toxicity.
The determination of prognostic factors that can modify the overall survival of these patients is of vital importance because it could allow a more specialized therapy and increase patient’s surveillance when required. This might be an interesting approach in future research.
This is a retrospective longitudinal observational study in which impact on quality of life, radiological and metabolic response, overall survival, prognostic factors and toxicity were evaluated in patients diagnosed with advanced tumors expressing somatostatin receptors treated with PRRT. The information pertinent to this cohort of patients was collected through the clinical history, obtaining information about clinical data, treatment response and disease state. These data were treated confidentially and in an encrypted form for analysis. Written consent was obtained from all patients.
In this cohort of patients, overall survival was inversely proportional with respect to toxicity in previous treatments (P < 0.05), tumor grade and the presence of bone lesions and was directly proportional to matching lesion findings between Octreoscan and computed tomography (CT) pre-PRRT (P < 0.01) andsurgery of the primary tumor or its metastasis. Also, we found that pseudo-progression is a common finding observed in the first stages of the treatment that should be taken into consideration by clinicians in daily practice. We consider that the matching lesions in CT and Octreoscan® before PRRT treatment could be a prognostic factor and should be studied with a greater cohort of patients. If corroborated, this finding could be considered in treatment decisions and may result in major patient surveillance.
Overall survival was inversely proportional with respect to toxicity in previous treatments (P < 0.05) and was directly proportional to matching lesion findings between Octreoscan and CT pre-PRRT. Matching lesion findings between Octreoscan and CT pre-PRRT should be taken into consideration when treating these patients.
This study reveals that prognostic factors should be taken into consideration because they modify the overall survival. Therefore, future research should focus on finding new prognostic factors that could allow specialized patient surveillance. In future studies, a larger number of patients should be included to extract more conclusive results that would allow the identification of new prognostic factors.