Role of 18FDG PET/CT in patients treated with 177Lu-DOTATATE for advanced differentiated neuroendocrine tumours

Severi, Stefano; Nanni, Oriana; Bodei, Lisa; Sansovini, Maddalena; Ianniello, Annarita; Nicoletti, Stefania; Scarpi, Emanuela; Matteucci, Federica; Gilardi, Laura; Paganelli, Giovanni

doi:10.1007/s00259-013-2369-z

Cited by 131 publications

(95 citation statements)

References 27 publications

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“…However, it has been demonstrated that collection of 18 FGD in neoplastic foci is a negative prognostic factor [90]. The PET/CT scan with 18 FDG, and the assessment of somatostatin receptor expression in a 68 Ga-PET/CT is useful in qualification for radioisotope treatment, particularly in NENs G2 [94].…”

Section: F-fdgmentioning

confidence: 99%

Zalecenia ogólne dotyczące postępowania w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Kos–Kudła¹,

Blicharz-Dorniak²,

Strzelczyk³

et al. 2014

Endokrynologia Polska

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An increased interest in gastro-entero-pancreatic neuroendocrine neoplasms (GEP NENs) has recently been observed. These are rare neoplasms and their detection in recent years has improved. Over 50% of GEP NENs are carcinoids, and they are usually found incidentally during surgery in the small intestine and appendix and at diagnosis in distant metastases, mainly to the liver. There is a need for co-operation between specialists in various disciplines of medicine in order to work out the diagnostic and therapeutic guidelines. In this publication, we present general recommendations of the Polish Network of Neuroendocrine Tumours for the management of patients with GEP NENs, developed at the Consensus Conference which took place in Kamień Śląski in April 2013. Members of the guidelines working groups were assigned sections of the 2008 guidance to update. In the subsequent parts of this publication, we present the rules of diagnostic and therapeutic management of: -neuroendocrine neoplasms of the stomach and duodenum (including gastrinoma); -pancreatic neuroendocrine neoplasms; -neuroendocrine neoplasms of the small intestine and the appendix; -colorectal neuroendocrine neoplasms. The proposed recommendations by Polish and foreign experts representing different fields of medicine (endocrinology, gastroenterology, surgery, oncology, nuclear medicine and pathology) will be helpful in the diagnosis and treatment of GEP NENs patients.

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Section: F-fdgmentioning

confidence: 99%

Zalecenia ogólne dotyczące postępowania w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Kos–Kudła¹,

Blicharz-Dorniak²,

Strzelczyk³

et al. 2014

Endokrynologia Polska

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“…The role of 18 F-FDG PET for predicting treatment response was highlighted in a recent study which included G1 or G2 advanced NET, as none of the 18 F-FDG PET-negative patients had progressed at the first follow-up examination after 177 Lu-DOTA-TATE PRRT. In that study population, G2 NET and 18 F-FDG PET positivity were frequently associated with more aggressive disease course [18]. Finally, it seems that avid uptake in 18 F-FDG PET predicts survival.…”

Section: Overview Of Available Molecular Imaging Techniquesmentioning

confidence: 99%

Combination of Cross-Sectional and Molecular Imaging Studies in the Localization of Gastroenteropancreatic Neuroendocrine Tumors

et al. 2014

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Molecular imaging modalities exploit aspects of neuroendocrine tumors (NET) pathophysiology for both diagnostic imaging and therapeutic purposes. The characteristic metabolic pathways of NET determine which tracers are useful for their visualization. In this review, we summarize the diagnostic value of all available molecular imaging studies, present data about their use in daily practice in NET centers globally, and finally make recommendations about the appropriate use of those modalities in specific clinical scenarios. Somatostatin receptor scintigraphy (SRS) continues to have a central role in the diagnostic workup of patients with NET, as it is also widely available. However, and despite the lack of prospective randomized studies, many NET experts predict that Gallium-68 (⁶⁸Ga)-DOTA positron emission tomography (PET) techniques may replace SRS in the future, not only because of their technical advantages, but also because they are superior in patients with small-volume disease, in patients with skeletal metastases, and in those with occult primary tumors. Carbon-11 (¹¹C)-5-hydroxy-L-tryptophan (5-HTP) PET and ¹⁸F-dihydroxyphenylalanine (¹⁸F-DOPA) PET are new molecular imaging techniques of limited availability, and based on retrospective data, their sensitivities seem to be inferior to that of ⁶⁸Ga-DOTA PET. Glucagon-like-peptide-1 (GLP-1) receptor imaging seems promising for localization of the primary in benign insulinomas, but is currently available only in a few centers. Fluorine-18 (¹⁸F)-fluorodeoxyglucose (¹⁸F-FDG) PET was initially thought to be of limited value in NET, due to their usually slow-growing nature. However, according to subsequent data, ¹⁸F-FDG PET is particularly helpful for visualizing the more aggressive NET, such as poorly differentiated neuroendocrine carcinomas, and well-differentiated tumors with Ki67 values >10%. According to limited data, ¹⁸F-FDG-avid tumor lesions, even in slow-growing NET, may indicate a more aggressive disease course. When a secondary malignancy has already been established or is strongly suspected, combining molecular imaging techniques (e.g. ¹⁸F-FDG PET and ⁶⁸Ga-DOTA PET) takes advantage of the diverse avidities of different tumor types to differentiate lesions of different origins. All the above-mentioned molecular imaging studies should always be reviewed and interpreted in a multidisciplinary (tumor board) meeting in combination with the conventional cross-sectional imaging, as the latter remains the imaging of choice for the evaluation of treatment response and disease follow-up.

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“…Thus, somatostatin receptor imaging (SRI), particularly with 68 Ga-SMS-R-PET, alters management in >50 % and successfully predicts response to cold or radiolabeled analogues [10,11]. Although conventional 18 fludeoxyglucose (FDG) PET is not a primary diagnostic tool in NETs, standardized uptake value (SUV) assessment can provide predictive information in terms of progression-free survival and response to peptide receptor radiotherapy (PRRT) [12,13].…”

Section: Strength Of Each Techniquementioning

confidence: 99%

“…In parallel, its correlation with the tumor Ki67 index, the transcript proliferome or other indices of proliferation have not been adequately delineated. For example, 18 FDG is positive in a substantial percentage of slow-proliferating low grade (G1) tumors, confounding the generally accepted notion that it is only useful in the identification of rapidly proliferating and poorly differentiated tumors [13].…”

mentioning

confidence: 99%

The future of nuclear medicine imaging of neuroendocrine tumors: on a clear day one might see forever…

Bodei

Kidd

Prasad

et al. 2014

Eur J Nucl Med Mol Imaging

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Role of 18FDG PET/CT in patients treated with 177Lu-DOTATATE for advanced differentiated neuroendocrine tumours

Cited by 131 publications

References 27 publications

Zalecenia ogólne dotyczące postępowania w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Zalecenia ogólne dotyczące postępowania w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Combination of Cross-Sectional and Molecular Imaging Studies in the Localization of Gastroenteropancreatic Neuroendocrine Tumors

The future of nuclear medicine imaging of neuroendocrine tumors: on a clear day one might see forever…

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