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European Journal of Nuclear Medicine and Molecular Imaging

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01-06-2013 | Original Article

Role of ¹⁸FDG PET/CT in patients treated with ¹⁷⁷Lu-DOTATATE for advanced differentiated neuroendocrine tumours

Authors: Stefano Severi, Oriana Nanni, Lisa Bodei, Maddalena Sansovini, Annarita Ianniello, Stefania Nicoletti, Emanuela Scarpi, Federica Matteucci, Laura Gilardi, Giovanni Paganelli

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2013

Abstract

Purpose

The prognostic value of FDG PET for neuroendocrine tumours (NETs) has been reported. In this study we evaluated the role of FDG PET in predicting response and progression-free survival (PFS) after ¹⁷⁷Lu-DOTATATE peptide receptor radionuclide therapy (Lu-PRRT) in patients with advanced well-differentiated grade 1/2 NETs.

Methods

We retrospectively evaluated 52 patients with progressive advanced NETs overexpressing somatostatin receptors and treated with Lu-PRRT with a cumulative activity up to 27.7 GBq divided into five courses. According to WHO 2010/ENETS classification, patients were stratified into two groups: those with grade 1 tumour (Ki-67 index ≤2 %, 19 patients), and those with grade 2 tumour (Ki-67 index >3 % to <20 %, 33 patients). On the basis of the FDG PET scan, 33 patients were classified as PET-positive (PET+) and 19 as PET-negative (PET−).

Results

FDG PET was positive in 57 % of patients with grade 1 NET and in 66 % of patients with grade 2 NET, and the rates of disease control (DC, i.e. complete response + partial response + stable disease) in grade 1 and grade 2 patients were 95 % and 79 %, respectively (P = 0.232). In PET− and PET+ patients, the DC rates were 100 % and 76 % (P = 0.020) with a PFS of 32 and 20 months, respectively (P = 0.033). Of the PET+ patients with grade 1 NET, 91 % showed disease control, whereas about one in three PET+ patients with grade 2 NET (32 %) progressed after Lu-PRRT (DC rate 68 %).

Conclusion

These results suggest that FDG PET evaluation is useful for predicting response to Lu-PRRT in patients with grade 1/2 advanced NETs. Notably, none of PET− patients had progressed at the first follow-up examination after Lu-PRRT. Grade 2 NET and PET+ (arbitrary SUV cutoff >2.5) were frequently associated with more aggressive disease. PET+ patients with grade 2 NET, 32 % of whom did not respond to Lu-PRRT monotherapy, might benefit from more intensive therapy protocols, such as the combination of chemotherapy and PRRT.

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Title: Role of 18FDG PET/CT in patients treated with 177Lu-DOTATATE for advanced differentiated neuroendocrine tumours
Authors: Stefano Severi
Oriana Nanni
Lisa Bodei
Maddalena Sansovini
Annarita Ianniello
Stefania Nicoletti
Emanuela Scarpi
Federica Matteucci
Laura Gilardi
Giovanni Paganelli
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2013
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2369-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Role of ¹⁸FDG PET/CT in patients treated with ¹⁷⁷Lu-DOTATATE for advanced differentiated neuroendocrine tumours

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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