Abstract
IntroductionOne of the concepts of theranostics in nuclear medicine is peptide receptor radionuclide therapy (PRRT), whereby labeled somatostatin analogs are used for imaging and treating inoperable or disseminated neuroendocrine tumors (NET).AimThe aim of the study was to determine the therapeutic efficacy and toxicity of tandem 90Y /177Lu-DOTATATE in patients with disseminated NET in a multicenter trial.Materials and methods103 patients with NET G1/G2 treated with 90Y/177Lu-DOTATATE (1:1) with amino-acid infusion for nephroprotection were included in the study.ResultsOverall survival from the disease diagnosis (OS-D) was 127.4 months and from the time of PRRT (OS-T) was 89.5 months. Progression-free survival (PFS) was 29.9 months. An analysis based on the proliferation index revealed a statistically significant impact on PFS and OS-T (PFS G1 vs G2, 59.3 vs 24.3 months; OS-T G1 vs G2, not reached vs 79.9 months). The effect of the primary disease site was also analyzed. For pancreatic vs small bowel vs large bowel, the PFS was 30.8 vs 30.3 vs 40.6 months, the OS-T was 94 vs 61.9 vs 131.2 months and OS-D was 130.4 vs 89.2 vs not reached months, respectively. The 2-year risk of progression was 42%. The probability of 2-year and 5-year overall survival was 89% and 62%, respectively. PRRT was well tolerated by all patients. One patient (1%) developed myelodysplastic syndrome. No other grade 3 and 4 hematological or renal toxicity was observed.ConclusionsThis multicenter trial showed that tandem 90Y/177Lu-DOTATATE is highly effective and safe therapy for patients with disseminated NET.
Highlights
One of the concepts of theranostics in nuclear medicine is peptide receptor radionuclide therapy (PRRT), whereby labeled somatostatin analogs are used for imaging and treating inoperable or disseminated neuroendocrine tumors (NET)
The data of single center trial using simultaneous 90Y/177Lu-DOTATATE was published in 2017 [20]. These results enabled inclusion of PRRT using 90Y/177LuDOTATATE tandem therapy to the treatment protocols used in Poland and the recommendations of the Polish Network of Neuroendocrine Tumors [1, 2, 21]
Of 103 patients, 32 patients were diagnosed with a pancreatic neuroendocrine primary tumor, 29 with a tumor originating from small bowel, 20 with a tumor originating from large bowel, 4 with a bronchopulmonary tumor, 12 had tumors of unknown primary origin and 6 had tumors arising from other sites (1 epiglottis, 1 multiple endocrine neoplasia [MEN] type 1, 1 von Hippel-Lindau syndrome [VHL] with pancreatic tumor, 2 multiple paragangliomas, 1 retroperitoneal area). 39 patients had low grade tumor NET G1 and 64 had intermediate grade tumor G2 NET
Summary
One of the concepts of theranostics in nuclear medicine is peptide receptor radionuclide therapy (PRRT), whereby labeled somatostatin analogs are used for imaging and treating inoperable or disseminated neuroendocrine tumors (NET). One of the most successful examples of the theranostics concept in nuclear medicine is peptide receptor radionuclide therapy (PRRT) for imaging and treatment of well differentiated neuroendocrine tumors (NET). Neuroendocrine tumors are a heterogeneous group of neoplasms, arising from cells of the endocrine system, with various clinical behaviors They may show hormonal activity (known as hormonally active tumors), a significant proportion do not produce enough hormones and/or biogenic amines to cause clinical symptoms (classed as hormonally inactive tumors) [1,2,3,4]. Confirmation of somatostatin receptor overexpression by nuclear medicine imaging [1, 8] is a prerequisite for patient selection
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