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. 2012;2(5):448-58.
doi: 10.7150/thno.3931. Epub 2012 May 8.

Molecular Imaging Radiotherapy: Theranostics for Personalized Patient Management of Neuroendocrine Tumors (NETs)

Kjell Oberg  1
Affiliations

Molecular Imaging Radiotherapy: Theranostics for Personalized Patient Management of Neuroendocrine Tumors (NETs)

Kjell Oberg. Theranostics. 2012.

Abstract

Neuroendocrine tumors (NETs) possess unique features including expression of peptide hormone receptors as well as the capacity to concentrate and take up precursor forms of amines and peptides making hormones that are stored in secretory granules within the tumor cells (APUD). The expression of somatostatin receptors on tumor cells have been widely explored during the last two decades starting with (111)In-DTPA-Octreotide as an imaging agent followed by (68)Ga-DOTATOC/TATE positron emission tomography scanning. The new generation of treatment includes (90)Yttrium-DOTATOC/DOTATATE as well as (177)Lutetium-DOTATOC/DOTATATE/DOTANOC treatment of various subtypes of NETs. The objective response rate by these types of PRRT is in the range of 30-45% objective responses with 5-10% grade 3/4 toxicity mainly hematologic and renal toxicity. The APUD mechanism is another unique feature of NETs which have generated an interest over the last two decades to develop specific tracers including (11)C-5HTP, (18)F-DOPA and (11)C-hydroxyefedrin. These radioactive tracers have been developed in centres with specific interest in NETs and are not available everywhere. (111)In-DTPA-Octreotide is still the working horse in diagnosis and staging of metastatic NETs, but will in the future be replaced by (68)Ga-DOTATOC/DOTATATE PET/CT scanning which provide higher sensitivity and specificity and is also more convenient for the patient because it is a one-stop-procedure. Both (90)Yttrium-DOTATOC/DOTATATE as well as (177)Lutetium-DOTATOC/DOTATATE are important new therapies for malignant metastatic NETs. However, the precise role in the treatment algorithm has to be determined in forthcoming randomized trials.

Keywords: 111In-DTPA-Octreotide; 177Lutetium-DOTATOC/DOTATATE; 68Ga-DOTATOC/TATE; 90Yttrium-DOTATOC; PRRT; theranostics.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Functioning imaging of neuroendocrine tumors using [111In]DTPA-octreotide (SPECT) and CT scanning from a patient with a malignant metastatic pancreatic endocrine tumor.
Figure 2
Figure 2
68Ga-DOTA-Octreotide PET/CT scanning with a patient with malignant carcinoid tumor showing multiple lymph node metastases as well as large liver metastases.
Figure 3
Figure 3
FDG/PET of a patient with a high-grade neuroendocrine tumor (G3 tumor) with bone metastases as well as lymph node and liver metastases.
Figure 4
Figure 4
11C-5HTP PET/CT of a patient with a small intestinal neuroendocrine tumor (carcinoid) which was considered to be cured after surgery. A small lymph node, <1cm, showed abnormal tracer accumulation demonstrating a lymph node metastasis.
Figure 5
Figure 5
11C-5HTP scanning of a patient with midgut carcinoid tumor showing bone metastases that was not detected by standard radiology such as CT or MRI.
Figure 6
Figure 6
PET scanning with 11C-metomidate and 11C-hydroxyefedrine as tracers in a patient with a 2 cm incidentaloma of the adrenal gland. The tumor is accumulating 11C hydroxyefedrin indicating a pheochromocytoma, not an adrenocortical tumor.
Figure 7
Figure 7
Graphic presentation of 177Lutetium-DOTA, Tyr3-octreotate.
Figure 8
Figure 8
Treatment with 177Lutetium-DOTA, Tyr3-octreotate in a patient with rectal carcinoid demonstrating effect of treatment over time.
See this image and copyright information in PMC

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