Theranostic implications of molecular imaging phenotype of well-differentiated pulmonary carcinoid based on 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT.

Published on Jan 1, 2021in European Journal of Nuclear Medicine and Molecular Imaging9.236
· DOI :10.1007/S00259-020-04915-7
Lamiaa Zidan1
Estimated H-index: 1
(Cairo University),
Amir Iravani18
Estimated H-index: 18
(University of Melbourne)
+ 3 AuthorsRodney J. Hicks91
Estimated H-index: 91
(University of Melbourne)
Sources
Abstract
This study aimed to analyse the molecular imaging (MI) phenotype of typical carcinoid (TC) and atypical carcinoid (AC) by 68Ga-DOTATATE (GaTATE) and 18F-FDG (FDG) PET/CT with the emphasis on its potential theranostic implications for peptide receptor radionuclide therapy (PRRT). Retrospective review of patients with biopsy-proven TC or AC undergoing both GaTATE and FDG PET/CT at presentation. Based on correlative CT or MRI, positive lesions on either scan were defined by uptake above liver parenchyma. Per patient MI phenotypic pattern was classified as score 1, if all lesions were negative on both scans; score 2, if all were GaTATE positive/FDG negative; score 3, if all lesions were GaTATE positive but some or all were also FDG positive and score 4, if there were any GaTATE negative/FDG positive lesions. Scores 1 and 4 were deemed unsuitable for PRRT. Of 56 patients (median age 66.5 years, 32 female), 22 had TC, and 34 had AC. Distant metastases were seen in 32% of TC and 94% of AC. At a median follow-up of 37 months for TC and 38 months for AC, 100% and 63% were alive, respectively. Median OS for AC was 56 months (95% CI 43, not reached [NR]), and TC was NR. On inter-patient dual-tracer analysis, scores 1, 2, 3 and 4 were 23%, 18%, 36% and 23% in TC and 3%, 15%, 32% and 50% in AC, respectively. In 16 patients (score 2, N = 3; score 3, N = 12; score 4, N = 1) who were treated with PRRT, disease control rate at 3 months and OS were, 85% and 54.6 months (95% CI 44–70), respectively. TC and AC showed a wide inter-patient phenotypic heterogeneity on GaTATE and FDG with around half of patients (46% TC and 53% AC) having an unsuitable phenotype for PRRT. Dual-tracer MI phenotype can be used to select the most suitable patients for PRRT.
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#1Thomas A. Hope (UCSF: University of California, San Francisco)H-Index: 39
#2Jeremie Calais (UCLA: University of California, Los Angeles)H-Index: 23
Last. Corina Millo (NIH: National Institutes of Health)H-Index: 23
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#1Luciano CarideoH-Index: 1
#2Daniela ProsperiH-Index: 11
Last. Alberto Signore (Sapienza University of Rome)H-Index: 58
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Gastro-entero-pancreatic neuroendocrine neoplasia (GEP-NENs) are rare tumors, but their frequency is increasing. Neuroendocrine tumors normally express somatostatin (SST) receptors (SSTR) on cell surface, especially G1 and G2 stage tumors, but they can show a dedifferentiation in their clinical history as they become more aggressive. Somatostatin receptor imaging has previously been performed with a gamma camera using [111In]In or [99mTc]Tc-labelled compounds, while [68Ga]Ga-labelled compounds a...
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#2Guozhu Hou (Peking Union Medical College Hospital)H-Index: 4
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#2Simona Grozinsky-Glasberg (HUJI: Hebrew University of Jerusalem)H-Index: 31
Last. Rodney J. Hicks (University of Melbourne)H-Index: 91
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Purpose Rectal neuroendocrine neoplasia (NEN) is more common than other NEN origins, but is less commonly metastatic. However, when present, distant disease carries a particularly poor prognosis. Evidence guiding optimal treatment of such patients is lacking. We assessed PRRT outcomes in patients with somatostatin receptor (SSTR) positive metastatic rectal NEN from two referral centres.
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#1David A. Pattison (Peter MacCallum Cancer Centre)H-Index: 15
#2Lisa L. MacFarlane (Peter MacCallum Cancer Centre)H-Index: 1
Last. Rodney J. Hicks (Peter MacCallum Cancer Centre)H-Index: 91
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Background Hyperglycaemia can influence 18F-fluorodeoxyglucose (FDG) uptake due to competition for glucose transport and phosphorylation by hexokinase. Major international nuclear medicine societies recommend blood glucose level (BGL) < 11.1 mmol/L (200 mg/dL) prior to performing FDG positron emission tomography/computed tomography (PET/CT). However, there is no consensus approach and complications of previously proposed insulin guidelines included significant hypoglycaemia, inconvenience and sk...
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#1Rudolf A. Werner (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 25
#2Alexander Weich (University of Würzburg)H-Index: 6
Last. Constantin Lapa (University of Würzburg)H-Index: 11
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: More than 25 years after the first peptide receptor radionuclide therapy (PRRT), the concept of somatostatin receptor (SSTR)-directed imaging and therapy for neuroendocrine tumors (NET) is seeing rapidly increasing use. To maximize the full potential of its theranostic promise, efforts in recent years have expanded recommendations in current guidelines and included the evaluation of novel theranostic radiotracers for imaging and treatment of NET. Moreover, the introduction of standardized repo...
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#2Patrick M. Forde (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 35
Carcinoids of the lung and thymus are rare thoracic cancers. In general, lung carcinoid tumors have a favorable prognosis, particularly when diagnosed at an early stage and treated with surgical resection. Thymic neuroendocrine tumors may be associated with multiple endocrine neoplasia-1 syndrome, tend to have a more aggressive natural history, and relatively frequently secrete ectopic adrenocorticotropic hormone.
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Background Neuroendocrine tumours (nets) are classified by site of origin, with lung being the second most common primary site after the gastrointestinal tract. Lung nets are rare and heterogeneous, with varied pathologic and clinical features. Typical and atypical carcinoid tumours are low-grade lung nets which, compared with the more common high-grade nets, are associated with a more favourable prognosis. Still, optimal treatment strategies are lacking. Methods This review concentrates on clas...
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#1Amit Tirosh (TAU: Tel Aviv University)H-Index: 18
#2Georgios Z. Papadakis (FORTH: Foundation for Research & Technology – Hellas)H-Index: 17
Last. Electron Kebebew (GW: George Washington University)H-Index: 68
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Abstract Background & Aims Survival times vary among patients with neuroendocrine tumors (NETs)—even among those with the same site, stage, and grade of primary tumor. This makes it difficult to select treatment for patients with unresectable NETs, because some patients can survive decades without treatment. 68 Gallium-DOTATATE positron emission tomography with computed tomography ( 68 Ga-DOTATATE PET/CT) is a sensitive imaging technique for detection of NETs. We investigated the prognostic accu...
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Radiolabelled somatostatin analogues targeting somatostatin receptors (SSR) are well established for combined positron emission tomography/computer tomography (PET/CT) imaging of neuroendocrine tumours (NET). [18F]SiTATE has recently been introduced showing high image quality, promising clinical performance and improved logistics compared to the clinical reference standard 68Ga-DOTA-TOC. Here we present the first dosimetry and optimal scan time analysis. Eight NET patients received a [18F]SiTATE...
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#1Grace Kong (University of Melbourne)H-Index: 20
#2Rodney J. Hicks (University of Melbourne)H-Index: 91
Abstract Neuroendocrine neoplasms (NENs) represent a heterogeneous group of tumors. CT or MRI, whilst being the widely available, have recognized limitations for NENs. Consequently, molecular PET/CT imaging plays a fundamental role in NEN diagnosis, detection and characterisation, and has a high management impact, particularly on the selection of patients for radioligand therapy. 68Ga-labelled octreotide derivatives for somatostatin receptor (SSR) imaging are well established for NEN. 18F-FDG (F...
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#1Philippe ThuillierH-Index: 2
#2Virginia LiberiniH-Index: 5
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Aim: To evaluate if conventional Positron emission tomography (PET) parameters and radiomic features (RFs) extracted by 18F-FDG-PET/CT can differentiate among different histological subtypes of lung neuroendocrine neoplasms (Lu-NENs). Methods: Forty-four naive-treatment patients on whom 18F-FDG-PET/CT was performed for histologically confirmed Lu-NEN (n = 46) were retrospectively included. Manual segmentation was performed by two operators allowing for extraction of four conventional PET paramet...
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#2Gary A. Ulaner (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 16
Background: PET scans using [18F]FDG and somatostatin receptor imaging agents are both used in imaging of neuroendocrine neoplasms (NENs). We have suggested the "NETPET score", utilizing uptake of both PET tracers, as a prognostic biomarker in NENs. We previously demonstrated the effectiveness of the NETPET score in gastroenteropancreatic (GEP) NENs. Its prognostic relevance in bronchial NENs remains undetermined. Methods: This is a retrospective multicentre study (2011-2018) assessing patients ...
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