A Potential Role of 68Ga-DOTATOC PET in Modifying Eligibility to Surgery in Patients with Recurrent Meningioma

Patients with meningioma usually undergo surgery with curative intent, based on conventional imaging techniques such as computer tomography and magnetic resonance imaging. However, unidentified tumor lesions at the time of surgery can render the surgery non-curative. In the last decade, positron emission tomography (PET) with somatostatin receptor ligand DOTA-D-Phy1 -Tyr3 -octreotide labeled with gallium-68 (68Ga-DOTATOC) has increasingly become an important tool in the management of meningiomas compared to conventional imaging. However, its indications are not well defined. We present a case of a 60-year old woman who presented with a recurrence of an anaplastic meningioma in the right occipital region, 29 months after the primary excision of an initial diagnosed atypical meningioma. Despite two subsequent surgical excisions and two courses of stereotactic radiation treatment over a period of 42 months, the tumor continued to recur at different sites. A PET scan performed with the tracer 68Ga-DOTATOC later revealed additionally small positive lesions, suggesting a meningioma composed of multiple foci. As meningioma recurrences, particularly with multiple foci, have a significant impact on determining treatment for the individual patient, a routine 68Ga-DOTATOC PET could help avoid non-curative surgery by identifying patients with multifocal disease.