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. 2012;2(5):459-71.
doi: 10.7150/thno.3594. Epub 2012 May 9.

Lessons on Tumour Response: Imaging during Therapy with (177)Lu-DOTA-octreotate. A Case Report on a Patient with a Large Volume of Poorly Differentiated Neuroendocrine Carcinoma

Ulrike Garske  1 , Mattias Sandström, Silvia Johansson, Dan Granberg, Hans Lundqvist, Mark Lubberink, Anders Sundin, Barbro Eriksson
Affiliations

Lessons on Tumour Response: Imaging during Therapy with (177)Lu-DOTA-octreotate. A Case Report on a Patient with a Large Volume of Poorly Differentiated Neuroendocrine Carcinoma

Ulrike Garske et al. Theranostics. 2012.

Abstract

Favourable outcomes of peptide receptor radiotherapy (PRRT) of neuroendocrine tumours have been reported during the last years. Still, there are uncertainties on the radionuclides to be used, the treatment planning, and the indication in patients with a high proliferation rate.This case report describes a patient with a high tumour burden of poorly differentiated neuroendocrine carcinoma of unknown primary with a proliferation rate in liver metastases up to 50%, undergoing fractionated treatment with 7 cycles of (177)Lu-DOTA-octreotate (7.4 GBq each) after disease progression on two different chemotherapy regiments. Based on initial staging scintigraphy, somatostatin receptor expression was very high.Longitudinal dosimetry studies during therapy indicated ongoing increases in tumour-to-organ ratios that coincided with an objective response.We conclude that fractionated therapy with (177)Lu-DOTA-octreotate should be considered a treatment option also for those patients with large tumours, high proliferation, and high receptor expression.

Keywords: 177Lu-DOTA-octreotate; Neuroendocrine tumour; PRRT; dosimetry.; radionuclide therapy.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
Somatostatin receptor scintigraphy (111In-DTPA-octreotide, OctreoScan®) in March 2009; Whole body scan, anterior and posterior view.
Figure 2
Figure 2
Glomerular filtration rate (GFR) according to the Cystatin C method, S-albumin and S-creatinine as a function of treatment.
Figure 3
Figure 3
Blood cell counts during therapy with 177Lu-DOTA-octreotate.
Figure 4
Figure 4
Diameters of the largest tumours, evaluated according to RECIST 1.1 criteria
Figure 5
Figure 5
Whole Body Scan 24 hrs after treatment. Upper row anterior view, lower row corresponding posterior view.
Figure 6
Figure 6
Sagittal views of SPECT-CT over the abdomen at the level of the right kidney, 24 hrs after infusion of 7.4 GBq of 177Lu-DOTA-octreotate. a) Cycle 1, May 2010 b) cycle 7, August 2011. Left upper corner in each image: attenuation correction CT, right upper corner attenuation corrected SPECT, left lower corner fused SPECT-CT, right lower corner maximum intensity projection (MIP). Note the position of the right kidney (arrow) and tracer distribution within the tumours.
Figure 7
Figure 7
Absorbed doses to kidneys, liver parenchyma, spleen and the two largest liver metastases, one for each lobe. Data from complete dosimetry at cycle 1 (May 2010) cycle 3 (October 2010) and cycle 6 (April 2011). Absorbed doses are calculated from SPECT-CT data according to the previously published method, using small volumes of interest (VOI) . Note the increase of tumour doses during therapy. At first cycle, the area of measurement was placed in the hot spot of either metastasis; in latter cycles, corresponding areas were identified and evaluated. Bone marrow dosimetry: Self-dose calculated from blood-activity curve, total absorbed dose in the bone marrow calculated from cross-fire dose and self-dose.
Figure 8
Figure 8
SPECT-CT images (left) and corresponding diagnostic CT (right) of largest liver metastasis in the right liver lobe at time of dosimetry at cycle 1, 3 and 6 (top to bottom). SPECT-CT images: left upper corner attenuation correction CT, right upper corner attenuation corrected SPECT, left lower corner fused SPECT-CT (all transversal views), right lower corner maximum intensity projection (MIP). Note the concentric shrinkage of the tumour and the increasing homogeneity of the uptake distribution.
Figure 9
Figure 9
SPECT-CT images (left) and corresponding diagnostic CT (right) of largest liver metastasis in the left liver lobe at time of dosimetry at cycle 1, 3 and 6 (top to bottom). SPECT-CT images: left upper corner attenuation correction CT, right upper corner attenuation corrected SPECT, left lower corner fused SPECT-CT (all transversal views), right lower corner maximum intensity projection (MIP). Note the concentric shrinkage of the tumour and the increasing homogeneity of the uptake distribution.
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