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Reviews in Endocrine and Metabolic Disorders

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Open Access 01-09-2021 | Positron Emission Tomography

PRRT: identikit of the perfect patient

Authors: M. Albertelli, A. Dotto, C. Di Dato, P. Malandrino, R. Modica, A. Versari, A. Colao, D. Ferone, A. Faggiano, on behalf of NIKE

Published in: Reviews in Endocrine and Metabolic Disorders | Issue 3/2021

Abstract

Peptide receptor radionuclide therapy (PRRT) has been strengthened since the publication of NETTER-1. Nevertheless, the correct positioning in the therapeutic algorithm is debated, and no optimal sequence has yet been standardized. Possible criteria to predict the response to PRRT in neuroendocrine tumors (NET) have been proposed. The aim of this review is to define the perfect identity of the eligible patient who can mostly benefit from this therapy. Possible predictive criteria which have been analysed were: primary tumor site, grading, tumor burden, FDG PET and ⁶⁸Ga-PET uptake. Primary tumor site and ⁶⁸Ga-PET uptake do not play a pivotal role in predicting the response, while tumor burden, FDG PET uptake and grading seem to represent predictive/prognostic factors for response to PRRT. The heterogeneity in trial designs, patient populations, type of radionuclides, previous therapies and measurement of outcomes, inevitably limits the strength of our conclusions, therefore care must be taken in applying these results to clinical practice. In conclusion, the perfect patient, selected by ⁶⁸Ga-PET uptake, will likely have a relatively limited liver tumor burden, a ki67 index <20% and will respond to PRRT irrespective to primary tumor. Nevertheless, we have mostly prognostic than predictive factors to predict the efficacy of PRRT in individual patients, while a promising tool could be the NETest. However, to date, the identikit of the perfect patient for PRRT is a puzzle without some pieces and still we cannot disregard a multidisciplinary discussion of the individual case to select the patients who will mostly benefit from PRRT.

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Title: PRRT: identikit of the perfect patient
Authors: M. Albertelli
A. Dotto
C. Di Dato
P. Malandrino
R. Modica
A. Versari
A. Colao
D. Ferone
A. Faggiano
on behalf of NIKE
Publication date: 01-09-2021
Publisher: Springer US
Keywords: Positron Emission Tomography
Radionuclide Therapy
Neuroendocrine Tumor
Published in: Reviews in Endocrine and Metabolic Disorders / Issue 3/2021
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI: https://doi.org/10.1007/s11154-020-09581-6

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