90Y-DOTATOC as a therapeutic option for complex recurrent or progressive meningiomas

Abstract

The standard treatment of meningiomas is surgery or radiotherapy. Complex, especially recurrent or progressive cases, may exhibit tumor growth involving critical neurovascular structures or diffuse growth, resulting in limited efficacy and higher risk of standard treatment. We evaluated whether somatostatin receptor-targeted radionuclide therapy with90Y-DOTATOC may be a therapeutic option. Methods: Fifteen patients with recurrent or progressive meningiomas after multimodal pretreatment or unfavorable medical risk profile were treated with systemic90Y-DOTATOC. Endpoints were progression-free survival and toxicity. Results: Usually applied doses were 7,400 MBq/m2 of 90Y-DOTATOC in 2 fractions. Mean observation time was 49.7 mo (range, 12-137 mo). Overall median progression-free survival was at least 24 mo. Toxicity was moderate, mostly hematologic (n = 8) and transient. Conclusion:90Y-DOTATOC therapy is feasible and may represent a promising second-or third-line option for complex meningiomas, which are progressive or otherwise not treatable with a reasonable risk-benefit ratio.