Targeted Alpha-Radionuclide Therapy of Functionally Critical Located Gliomas with 213Bismuth-DOTA-[Thi8,Met(O2)11]-Substance P - A Pilot Trial

Purpose: Functionally critical located gliomas represent a challenging subgroup of brain intrinsic neoplasms. Therapeutic standard recommendations often cannot be applied, because radical treatment and preservation of neurological function are contrary goals. The successful targeting of gliomas with locally injected beta-radiation emitting [90Yttrium]-DOTAGA substance P has been shown previously. However, in critically located tumors, the mean tissue range of 5 mm of 90Yttrium may seriously damage adjacent brain areas. In contrast, the alpha-radiation emitting radionuclide 213Bismuth with a mean tissue range of 81 µm may have a more favourable toxicity profile. Therefore we evaluated locally injected [213Bismuth]-DOTA substance P in patients with critically located gliomas as the primary therapeutic modality. Patients and procedures: In a pilot study, we included five patients with critically located gliomas (WHO grades II-IV). After diagnosis by biopsy, [213Bismuth]-DOTA substance P was locally injected, followed by serial SPECT/CT- and MR-imaging and blood sampling. Besides feasibility and toxicity, the functional outcome was evaluated. Results: Targeted radiopeptide therapy using [213Bismuth]-DOTA substance P was feasible and tolerated without additional neurological deficit. No local or systemic toxicity was observed. [213Bismuth]-DOTA substance P showed high retention at the target site. MR-imaging was suggestive of radiation-induced necrosis and demarcation of the tumors, which was validated by subsequent resection. Conclusion: This study provides proof of concept that targeted local radiotherapy using [213Bismuth]-DOTA substance P is feasible and may represent an innovative and effective treatment for critically located gliomas. Primarily non-operable gliomas may become resectable with this treatment, thereby possibly improving the prognosis.

CORDIER D.;  FORRER F.;  BRUCHERTSEIFER Frank;  MORGENSTERN Alfred;  APOSTOLIDIS Christos;  GOOD S.;  MÜLLER-BRAND J.;  MÄCKE H.;  REUBI Jean-Claude;  MERLO A.; 

2010-07-15

SPRINGER

JRC56637

1619-7070,   

https://publications.jrc.ec.europa.eu/repository/handle/JRC56637,   

10.1007/s00259-010-1385-5,