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1 47 症例報告 * 1 * 1 * 2 * 2 * 2 * 1 * 1 * 1 * 1 要旨 60 stable disease (PRRT) 10 PRRT 18 PRRT 111 In- PRRT 51: 47 53, 2014 I. 緒言 (neuroendocrine tumor, NET) WHO 2010 NET NET 1) * 1 * (peptide receptor radionuclide therapy, PRRT) 2) 46% 3) PRRT PRRT

48 核医学 51 2 2014 PRRT II. 症例 60 2010 5 X CT (Fig. 1) 50% mindbomb E3 ubiquitin protein ligase 1 (MIB1) 6 10% 18 F-FDG PET/CT (Fig.

1 Contrast-enhanced thoracic transaxial computed tomography image shows a soft-tissue density mass in the anterior mediastinum. Fig.

The images show intense accumulations in the anterior mediastinum, ribs, spinal vertebrae, and bilateral femurs, indicating a mediastinal lesion

2 48 核医学 PRRT II. 症例 X CT (Fig. 1) 50% mindbomb E3 ubiquitin protein ligase 1 (MIB1) 6 10% 18 F-FDG PET/CT (Fig. 2) Response Evaluation Criteria in Solid Tumors Fig. 1 Contrast-enhanced thoracic transaxial computed tomography image shows a soft-tissue density mass in the anterior mediastinum. Fig. 2 Maximum intensity projection images from an 18 F-FDG PET/CT scan. The images show intense accumulations in the anterior mediastinum, ribs, spinal vertebrae, and bilateral femurs, indicating a mediastinal lesion with multiple bone metastases. Fig. 3 Planar anterior and posterior scintigrams of 111 In-octreotide obtained before peptide receptor radionuclide therapy show high and specific accumulations in the mediastinal mass, whereas no remarkable abnormal accumulations can be seen in the bony metastatic lesions or the left supraclavicular lymphadenopathies.

3 49 Fig. 4 Magnetic resonance imaging (fat-suppressed, gadolinium-enhanced, T1-weighted images) shows well-enhanced masses at the left cavernous sinus (arrow) and bilateral transverse processes of the atlas (arrowheads). (RECIST) SD 4 PRRT In- (Fig. 3) PRRT Lu-[tetraazacyclododecanetetraacetic acid (DOTA), Tyr 3 ]octreotide (DOTATOC) (200 mci, 7.40 GBq) 111 In Y-DOTATOC (180 mci, 6.66 GBq) Lu-DOTATOC (200 mci, 7.40 GBq) RECIST SD mg/ 10 mg/ 4 3 RECIST SD F-FDG PET/ CT MRI (Fig. 4) 3 (IMRT) PRRT 111 In- PRRT IMRT 40 Gy/20 fr

50 核医学 51 2 2014 Fig. 5 Isodose distributions of the external radiotherapy. The white and thick contours represent the 100% isodose lines of the prescribed dose.

4 50 核医学 Fig. 5 Isodose distributions of the external radiotherapy. The white and thick contours represent the 100% isodose lines of the prescribed dose. 50 Gy/25 fr (Fig. 5) Varian Clinac ix 10MVX 10 mg Gy/10 fr PRRT 1 III. 考察 mammalian target of rapamycin (mtor) (PRRT) 111 In- β 177 Lu 90 Y DOTATOC DOTATATE 4,5) PRRT PRRT PRRT

5 51 MIRD 6) Cremonesi 7) receptor density, vascularization, dimension, kinetics, specific radiosensitivity PRRT PRRT PRRT 8) PRRT 111 In- SPECT/CT PRRT 9,10) Kreissl 177 Lu-DOTATOC/DOTATATE PRRT 10) 177 Lu γ PRRT SPECT/CT PRRT PRRT PRRT SPECT/CT 68 Ga-DOTATOC PET/CT 11) 177 Lu- DOTATOC 90 Y-DOTATOC 177 Lu-DOTATOC 3 PRRT 177 Lu β (0.5 MeV) 90 Y β (2.27 MeV) β 2.1 mm 12.0 mm 12) PRRT 90 Y PRRT PRRT

6 52 核医学 PRRT PRRT 13) 14) 15) IV. 結語文 1) : (NET) WHO (2010) 2012; 29: ) Kulke MH, Siu LL, Tepper JE, Fisher G, Jaffe D, Haller DG, et al: Future directions in the treatment of neuroendocrine tumors: consensus report of the National Cancer Institute Neuroendocrine Tumor clinical trials planning meeting. J Clin Oncol 2011; 29: ) Kwekkeboom DJ, de Herder WW, Kam BL, van Eijck 献 CH, van Essen M, Kooij PP, et al: Treatment with the radiolabeled somatostatin analog [ 177 Lu-DOTA 0, Tyr 3 ] octreotate: toxicity, efficacy and survival. J Clin Oncol 2008; 26: ) Brans B, Linden O, Giammarile F, Tennvall J, Punt C: Clinical applications of newer radionuclide therapies. Eur J Cancer 2006; 42: ) Zaknun JJ, Bodei L, Mueller-Brand J, Pavel ME, Baum RP, Horsch D, et al: The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2013; 40: ) Carlsson J, Forssell Aronsson E, Hietala SO, Stigbrand T, Tennvall J: Tumour therapy with radionuclides: assessment of progress and problems. Radiother Oncol 2003; 66: ) Cremonesi M, Botta F, Di Dia A, Ferrari M, Bodei L, De Cicco C, et al: Dosimetry for treatment with radiorabelled somatostatin analogues. A review. QJ Nucl Med Mol Imaging 2010; 54: ) Kwekkeboom DJ, de Herder WW, van Eijck CH, Kam BL, van Essen M, Teunissen JJ, et al: Peptide receptor radionuclide therapy in patients with gastroenteropancreatic neuroendocrine tumors. Semin Nucl Med 2010; 40: ) Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, et al: Peptide receptor radionuclide therapy with 90 Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging 2009; 36: ) Kreissl MC, Hancheid H, Lohr M, Verburg FA, Schiller M, Lassmann M, et al: Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma. Radiat Oncol 2012; 7: ) Hanscheid H, Sweeney RA, Flentje M, Buck AK, Lohr M, Samnick S, et al: PET SUV correlates with radionuclide uptake in peptide receptor therapy in meningioma. Eur J Nucl Med Mol Imaging 2012; 39: ) de Jong M, Breeman WA, Valkema R, Bernard BF, Krenning EP: Combination radionuclide therapy using 177 Lu- and 90 Y-labeled somatostatin analogs. J Nucl Med 2005; 46: 13S 17S. 13) Fury MG, Lee NY, Sherman E, Ho AL, Rao S, Heguy A, et al: A phase 1 study of everolimus + weekly cisplatin + intensity modulated radiation therapy in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2013; 87: ) Ellard SL, Clemons M, Gelmon KA, Norris B, Kennecke H, Chia S, et al: Randomized phase II study comparing two schedules of everolimus in patients with recurrent/metastatic breast cancer: NCIC Clinical

7 53 Trials Group IND.163. J Clin Oncol 2009; 27: ) Miura Y, Suyama K, Shimomura A, Miyakawa J, Kobayashi H, Uki A, et al: Radiation-induced esophagitis exacerbated by everolimus. Case Rep Oncol 2013; 6: Summary Additional External Radiotherapy to Multiple Metastases Originating from Thymic Neuroendocrine Tumor Following Peptide Receptor Radionuclide Therapy: a Case Report Takatsugu Kawase* 1, Kazuo Kubota* 1, Yuichiro Takeda* 2, Hibiki Udagawa* 2, Haruhito Sugiyama* 2, Baku Sakashita* 1, Minako Uchino* 1, Tomoko Itazawa* 1 and Kanehiro Hasuo* 1 Departments of * 1 Radiology and * 2 Respiratory Medicine, National Center for Global Health and Medicine We describe the case of a 60-year-old man suffering from an advanced thymic neuroendocrine tumor with left supraclavicular lymph node and multiple bone metastases. The patient initially underwent systemic therapy with somatostatin analogues. Thereafter, peptide receptor radionuclide therapy (PRRT) was considered because the lesions had remained stable despite the pharmacological therapy. PRRT was performed 10 months after the initial treatment in a European hospital. Eighteen months after the treatment, cranial nerve palsy arising from skull base metastases and Hornerʼs syndrome induced by left supraclavicular lymph node metastases became exacerbated. Therefore, a course of external radiotherapy was performed with palliative intent in our hospital. During the radiotherapy planning, the biodistribution of 111 In-octreotide was examined to determine whether the absorbed dose of the previous PRRT was acceptable. As a result, external radiotherapy was performed, and an acute radiation reaction was observed; the severity of the reaction was typical of reactions to neck radio-therapy. The treatment course of the present case was considered to be instructive because PRRT cannot be performed in Japan at present. Key words: Peptide receptor radionuclide therapy; External radiotherapy; Neuroendocrine tumor; 111 Inoctreotide scintigraphy.

1_2.eps

1_2.eps 第32回日本頭頸部癌学会ランチョンセミナー6 Pre-Meeting Abstract FDG-PET の頭頸部癌における臨床的有用性司会長放射線治療センター長講演 1 耳鼻咽喉科部長講演 2 PETセンター長岡村光英先生日時 2008年6月13日金 12:00 13:00 会場ハイアットリージェンシー東京共催第32回日本頭頸部癌学会日本メジフィジックス株式会社 136-0075