Long-term follow-up and role of FDG PET in advanced pancreatic neuroendocrine patients treated with 177Lu-D OTATATE

Abstract

Both FA and RA are active in patients undergoing Lu-PRRT. However, an FA of 27.8 GBq of Lu-PRRT prolongs PFS and OS compared to an RA of 18.5 GBq. Our results indicate that FDG PET is an independent prognostic factor in this patient setting.

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

“…On the other hand, 18 F-FDG imaging (FDG-PET) has traditionally been used for staging poorly-differentiated G3 tumors, or to complement SRI in well-differentiated NET when Ki67 exceeds 10% 6. However, there are arguments for a wider use of dual-tracer imaging (SRI-PET + FDG-PET) in well-differentiated NET, as recent studies underscored the prognostic value of FDG-PET in these patients 10-15.…”

Reply to: Predicting the outcome of peptide receptor radionuclide therapy in neuroendocrine tumors: the importance of dual-tracer imaging

“…However, we believe that liver metastases, age and tumor burden carry greater weight as prognostic factors and predictors of response after PRRT than SRI uptake value [1]. Given that FDG PET and SRI may be discordant for some lesions, we agree that a divergence of tracer uptake in FDG PET and SRI must not be ignored.…”

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Dear Sir, We would like to thank Zanotti-Fregonara et al for their interesting letter about our recent study, BLong-term follow-up and role of FDG PET in advanced pancreatic neuroendocrine patients treated with 177Lu-DOTATATE^, published in the March 2017 issue [1]. In addition to the positive comments on the importance of dual-tracer imaging, Zanotti-Fregonara et al raise the question as to whether the uptake level in somatostatin receptor imaging (SRI) plays a role in predicting response to peptide receptor radionuclide therapy (PRRT).

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“…The statistical analysis of our data revealed that the uptake level of SRI was not significant in terms of progression-free survival (PFS) and so the SRI uptake value was not included in the univariate-multivariate analysis and thus not in the final paper (Tables 1 and 2) [1]. PFS was estimated using the Kaplan-Meier method and survival curves were compared using the logrank test.…”

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

“…PROMID, CLARINET, RADIANT-4, NETTER-1, TELESTRA, and SPINET). Unfortunately, there are no results of prospective studies using PRRT in pancreatic NETs available yet; in some published studies on the effectiveness of PRRT in this group of patients, the observed PFS is 29.7-39 months, and OS is 53-70 months [242][243][244][245].…”