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Published in: Annals of Surgical Oncology 1/2015

01-01-2015 | Endocrine Tumors

Impact of 68Ga-DOTATATE PET/CT on the Surgical Management of Primary Neuroendocrine Tumors of the Pancreas or Ileum

Authors: Harun Ilhan, MD, Wolfgang P. Fendler, MD, Clemens C. Cyran, MD, Christine Spitzweg, MD, Christoph J. Auernhammer, MD, Franz-Josef Gildehaus, PhD, Peter Bartenstein, MD, Martin K. Angele, MD, Alexander R. Haug, MD

Published in: Annals of Surgical Oncology | Issue 1/2015

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Abstract

Background

Resection is the only curative treatment in patients suffering from neuroendocrine tumors (NETs) of the ileum or the pancreas. Accurate preoperative imaging is critical for surgical planning, as even findings of small and distant metastases may profoundly influence surgical management.

Methods

68Ga-DOTATATE PET/CT was performed preoperatively in 44 patients suffering from NET of the ileum (n = 26) or the pancreas (n = 18) before surgery at our University Hospital. Data were analyzed retrospectively by an interdisciplinary team of nuclear medicine and visceral surgery specialists. Intended surgical management was documented before and after availability of PET/CT findings. The team judged whether the imaging findings provided additional information relevant to surgical planning.

Results

Imaging results altered surgical management in 9 of 44 (20 %) patients, more specifically in 3 of 26 (12 %) patients with NET of the ileum and in 6 of 18 (33 %) patients with NET of the pancreas. PET/CT findings led to a more invasive surgical approach in 6 cases (3 each of ileum and pancreas) and to a less invasive strategy in 3 patients with NET of the pancreas. Although PET/CT results did not alter management in 35 of 44 patients, somatostatin receptor imaging still provided additional information for surgery planning in more than 95 % of the cases.

Conclusions

Additional information provided by 68Ga-DOTATATE PET/CT in the preoperative workup significantly influences surgical management in one-fifth of our NET patients and, notably, one-third of those suffering from NET of the pancreas.
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Literature
1.
go back to reference Reubi JC. Peptide receptors as molecular targets for cancer diagnosis and therapy. Endocr Rev. 2003;24(4):389–427.PubMedCrossRef Reubi JC. Peptide receptors as molecular targets for cancer diagnosis and therapy. Endocr Rev. 2003;24(4):389–427.PubMedCrossRef
2.
go back to reference Pape UF, Perren A, Niederle B, et al. ENETS consensus guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology. 2012;95(2):135-56.PubMedCrossRef Pape UF, Perren A, Niederle B, et al. ENETS consensus guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology. 2012;95(2):135-56.PubMedCrossRef
3.
go back to reference Vinik AI, Woltering EA, Warner RR, et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. Pancreas. 2010;39(6):713-34.PubMedCrossRef Vinik AI, Woltering EA, Warner RR, et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. Pancreas. 2010;39(6):713-34.PubMedCrossRef
4.
go back to reference Gabriel M, Decristoforo C, Kendler D, et al. 68 Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 2007;48(4):508-18.PubMedCrossRef Gabriel M, Decristoforo C, Kendler D, et al. 68 Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 2007;48(4):508-18.PubMedCrossRef
5.
go back to reference Srirajaskanthan R, Kayani I, Quigley AM, Soh J, Caplin ME, Bomanji J. The role of 68 Ga-DOTATATE PET in patients with neuroendocrine tumors and negative or equivocal findings on 111In-DTPA-octreotide scintigraphy. J Nucl Med. 2010;51(6):875-82.PubMedCrossRef Srirajaskanthan R, Kayani I, Quigley AM, Soh J, Caplin ME, Bomanji J. The role of 68 Ga-DOTATATE PET in patients with neuroendocrine tumors and negative or equivocal findings on 111In-DTPA-octreotide scintigraphy. J Nucl Med. 2010;51(6):875-82.PubMedCrossRef
6.
go back to reference Hill JS, McPhee JT, McDade TP, et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer. 2009;115(4):741-51.PubMedCrossRef Hill JS, McPhee JT, McDade TP, et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer. 2009;115(4):741-51.PubMedCrossRef
7.
go back to reference Pavel M, Baudin E, Couvelard A, et al. ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2012;95(2):157-76.PubMedCrossRef Pavel M, Baudin E, Couvelard A, et al. ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology. 2012;95(2):157-76.PubMedCrossRef
8.
go back to reference Krenning EP, Kwekkeboom DJ, Bakker WH, et al. Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med. 1993;20(8):716-31.PubMedCrossRef Krenning EP, Kwekkeboom DJ, Bakker WH, et al. Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med. 1993;20(8):716-31.PubMedCrossRef
9.
go back to reference Rindi G, Kloppel G, Alhman H, et al. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virch Arch. 2006;449(4):395-401.CrossRef Rindi G, Kloppel G, Alhman H, et al. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virch Arch. 2006;449(4):395-401.CrossRef
10.
go back to reference Rindi G, Kloppel G, Couvelard A, et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virch Arch. 2007;451(4):757-62.CrossRef Rindi G, Kloppel G, Couvelard A, et al. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virch Arch. 2007;451(4):757-62.CrossRef
11.
go back to reference Breeman WA, de Jong M, de Blois E, Bernard BF, Konijnenberg M, Krenning EP. Radiolabelling DOTA-peptides with 68 Ga. Eur J Nucl Med Mol Imaging. 2005;32(4):478-85.PubMedCrossRef Breeman WA, de Jong M, de Blois E, Bernard BF, Konijnenberg M, Krenning EP. Radiolabelling DOTA-peptides with 68 Ga. Eur J Nucl Med Mol Imaging. 2005;32(4):478-85.PubMedCrossRef
12.
go back to reference Jensen RT, Cadiot G, Brandi ML, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95(2):98-119.PubMedCentralPubMedCrossRef Jensen RT, Cadiot G, Brandi ML, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95(2):98-119.PubMedCentralPubMedCrossRef
13.
go back to reference Hofman MS, Kong G, Neels OC, Eu P, Hong E, Hicks RJ. High management impact of Ga-68 DOTATATE (GaTate) PET/CT for imaging neuroendocrine and other somatostatin expressing tumours. J Med Imaging Rad Oncol. 2012;56(1):40-7.CrossRef Hofman MS, Kong G, Neels OC, Eu P, Hong E, Hicks RJ. High management impact of Ga-68 DOTATATE (GaTate) PET/CT for imaging neuroendocrine and other somatostatin expressing tumours. J Med Imaging Rad Oncol. 2012;56(1):40-7.CrossRef
14.
go back to reference Frilling A, Sotiropoulos GC, Radtke A, et al. The impact of 68 Ga-DOTATOC positron emission tomography/computed tomography on the multimodal management of patients with neuroendocrine tumors. Ann Surg. 2010;252(5):850-6.PubMedCrossRef Frilling A, Sotiropoulos GC, Radtke A, et al. The impact of 68 Ga-DOTATOC positron emission tomography/computed tomography on the multimodal management of patients with neuroendocrine tumors. Ann Surg. 2010;252(5):850-6.PubMedCrossRef
15.
go back to reference Haug AR, Cindea-Drimus R, Auernhammer CJ, et al. The role of 68 Ga-DOTATATE PET/CT in suspected neuroendocrine tumors. J Nucl Med. 2012;53(11):1686-92.PubMedCrossRef Haug AR, Cindea-Drimus R, Auernhammer CJ, et al. The role of 68 Ga-DOTATATE PET/CT in suspected neuroendocrine tumors. J Nucl Med. 2012;53(11):1686-92.PubMedCrossRef
16.
go back to reference Kayani I, Bomanji JB, Groves A, et al. Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) and 18F-FDG. Cancer. 2008;112(11):2447-55.PubMedCrossRef Kayani I, Bomanji JB, Groves A, et al. Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) and 18F-FDG. Cancer. 2008;112(11):2447-55.PubMedCrossRef
17.
go back to reference Armani C, Catalani E, Balbarini A, Bagnoli P, Cervia D. Expression, pharmacology, and functional role of somatostatin receptor subtypes 1 and 2 in human macrophages. J Leukoc Biol. 2007;81(3):845-55.PubMedCrossRef Armani C, Catalani E, Balbarini A, Bagnoli P, Cervia D. Expression, pharmacology, and functional role of somatostatin receptor subtypes 1 and 2 in human macrophages. J Leukoc Biol. 2007;81(3):845-55.PubMedCrossRef
18.
go back to reference Prasad V, Ambrosini V, Hommann M, Hoersch D, Fanti S, Baum RP. Detection of unknown primary neuroendocrine tumours (CUP-NET) using (68)Ga-DOTA-NOC receptor PET/CT. Eur J Nucl Med Mol Imaging. 2010;37(1):67–77.PubMedCrossRef Prasad V, Ambrosini V, Hommann M, Hoersch D, Fanti S, Baum RP. Detection of unknown primary neuroendocrine tumours (CUP-NET) using (68)Ga-DOTA-NOC receptor PET/CT. Eur J Nucl Med Mol Imaging. 2010;37(1):67–77.PubMedCrossRef
19.
go back to reference Naswa N, Sharma P, Kumar A, et al. Gallium-68-DOTA-NOC PET/CT of patients with gastroenteropancreatic neuroendocrine tumors: a prospective single-center study. AJR Am J Roentgenol. 2011;197(5):1221-8.PubMedCrossRef Naswa N, Sharma P, Kumar A, et al. Gallium-68-DOTA-NOC PET/CT of patients with gastroenteropancreatic neuroendocrine tumors: a prospective single-center study. AJR Am J Roentgenol. 2011;197(5):1221-8.PubMedCrossRef
20.
go back to reference Strosberg JR, Weber JM, Feldman M, Coppola D, Meredith K, Kvols LK. Prognostic validity of the American Joint Committee on Cancer staging classification for midgut neuroendocrine tumors. J Clin Oncol. 2013;31(4):420-5.PubMedCrossRef Strosberg JR, Weber JM, Feldman M, Coppola D, Meredith K, Kvols LK. Prognostic validity of the American Joint Committee on Cancer staging classification for midgut neuroendocrine tumors. J Clin Oncol. 2013;31(4):420-5.PubMedCrossRef
21.
go back to reference Triponez F, Goudet P, Dosseh D, et al. Is surgery beneficial for MEN1 patients with small (<or = 2 cm), nonfunctioning pancreaticoduodenal endocrine tumor? An analysis of 65 patients from the GTE. World J Surg. 2006;30(5):654-62; discussion 663-54. Triponez F, Goudet P, Dosseh D, et al. Is surgery beneficial for MEN1 patients with small (<or = 2 cm), nonfunctioning pancreaticoduodenal endocrine tumor? An analysis of 65 patients from the GTE. World J Surg. 2006;30(5):654-62; discussion 663-54.
Metadata
Title
Impact of 68Ga-DOTATATE PET/CT on the Surgical Management of Primary Neuroendocrine Tumors of the Pancreas or Ileum
Authors
Harun Ilhan, MD
Wolfgang P. Fendler, MD
Clemens C. Cyran, MD
Christine Spitzweg, MD
Christoph J. Auernhammer, MD
Franz-Josef Gildehaus, PhD
Peter Bartenstein, MD
Martin K. Angele, MD
Alexander R. Haug, MD
Publication date
01-01-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 1/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3981-2

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