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. 2025 Mar;87(3):1333-1341.
doi: 10.1007/s12020-024-04138-y. Epub 2024 Dec 23.

Organ-specific response to [177Lu]DOTATATE peptide receptor radionuclide therapy (PRRT) assessed by sequential [68Ga]DOTATOC PET/CT in patients with metastatic small intestine neuroendocrine tumors

Darejan Mamulashvili Bessac  1 , Philippe Baltzinger  2 , Nathan Poterszman  1 , Floriane Pham Van  1   3 , Cedric Collen  3 , Gabriel G Malouf  4 , Eric Ouvrard  1 , Ashjan Kaseb  1   5 , Clemence Porot  6 , Meher Ben Abdelghani  7 , Pietro Addeo  8 , Luc Mertz  9 , Bernard Goichot  2 , Alessio Imperiale  10   11
Affiliations

Organ-specific response to [177Lu]DOTATATE peptide receptor radionuclide therapy (PRRT) assessed by sequential [68Ga]DOTATOC PET/CT in patients with metastatic small intestine neuroendocrine tumors

Darejan Mamulashvili Bessac et al. Endocrine. 2025 Mar.

Abstract

Purpose: To evaluate organ-specific response to [177Lu]DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) in patients with small intestine neuroendocrine tumor (SiNET) through [68Ga]DOTATOC PET/CT, and to analyze tumor uptake and functional volume variations at different metastatic sites in relation to disease progression during clinical follow-up after treatment.

Methods: A retrospective analysis was conducted on 33 metastatic patients. PET/CT were performed pre-treatment (PET0), mid-treatment after two PRRT cycles (PET2), and post-treatment (PET4). SUVmax and somatostatin receptor-expressing tumor volume (SRETV) were measured in liver, lymph node, peritoneum/mesentery, and bone metastases.

Results: Liver metastases showed significant reduction in both SUVmax and SRETV from PET0 to PET4, with early response evident after two PRRT cycles. Nodal lesions exhibited a delayed response, with significant reductions at PET4. Peritoneal and bone metastases showed a continuous decline in SUVmax, but no significant changes in SRETV. Objective response rates were highest in liver metastases after treatment completion with lesser responses in nodal, peritoneal, and bone lesions. At a median follow-up of 24.3 months, 70% of patients experienced disease progression, while 30% did not. Liver metastases showed no significant changes in SUVmax or SRETV regardless of progression. Conversely, in non-progressing patients, peritoneal/mesenteric lesions showed a significant reduction in SUVmax, with unchanged SRETV, and nodal metastases exhibited reduced SRETV. Bone lesions in non-progressing patients showed significant decreases in both SUVmax and SRETV.

Conclusion: [177Lu]DOTATATE PRRT effectively reduces tumor functional activity in patients with SiNETs, with organ-specific responses highlighting the need for personalized treatment strategies to optimize efficacy and minimize toxicity.

Keywords: PET; [177Lu]DOTATATE; [68Ga]DOTATOC; neuroendocrine; peptide receptor radionuclide therapy; small intestine.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki and was approved by local Institutional Review Board (IRB-2024-24). Informed consent: Informed consent was obtained from all individual participants included in the study.

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