The Impact of 68Ga-DOTATOC Positron Emission Tomography/Computed Tomography on the Multimodal Management of Patients With Neuroendocrine Tumors

Frilling, Andrea; Sotiropoulos, Georgios C.; Radtke, Arnold; Malagó, Massimo; Bockisch, Andreas; Kuehl, Hilmar; Li, Jun; Broelsch, Christoph E.

doi:10.1097/sla.0b013e3181fd37e8

Cited by 195 publications

(135 citation statements)

References 21 publications

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“…Thus, additional evidence of metastatic lesions was evident in O30%, particularly when localized within the skeletal system (Buchmann et al 2007), and localization of unknown primary NENs was established in 39% of cases (Prasad et al 2010). The superiority of 68 Ga-DOTA-based PET/CT over anatomic imaging using CT or MRI and its impact on treatment were demonstrated in a recent study on 52 NEN patients who underwent both standard morphological imaging and 68 Ga-DOTATOC PET/CT (Frilling et al 2010). The primary treatment decision, based solely on CT and/or MRI results, was altered in 59.6% of patients when 68 Ga-DOTATOC PET/CT results were considered.…”

Section: R166mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

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149

106

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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) represent a heterogenous group of tumors arising from a variety of neuroendocrine cell types. The incidence and prevalence of GEPNENs have markedly increased over the last three decades. Symptoms are often absent in early disease, or vague and nonspecific even in advanced disease. Delayed diagnosis is thus common. Chromogranin A is the most commonly used biomarker but has limitations as does the proliferative marker Ki-67%, which is often used for tumor grading and determination of therapy. The development of a multidimensional prognostic nomogram may be valuable in predicting tumor behavior and guiding therapy but requires validation. Identification of NENs that express somatostatin receptors (SSTR) allows for SSTR scintigraphy and positron emission tomography imaging using novel radiolabeled compounds. Complete surgical resection of limited disease or endoscopic ablation of small lesions localized in stomach or rectum can provide cure; however, the majority of GEP-NENs are metastatic (most frequently the liver and/or mesenteric lymph nodes) at diagnosis. Selected patients with metastatic disease may benefit from advanced surgical techniques including hepatic resection or liver transplantation. Somatostatin analogs are effective for symptomatic treatment and exhibit some degree of antiproliferative activity in small intestinal NENs. There is a place for streptozotocin, temozolomide, and capecitabine in the management of pancreatic NENs, while new agents targeting either mTOR (everolimus) or angiogenic (sunitinib) pathways have shown efficacy in these lesions.

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Section: R166mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

Self Cite

149

106

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“…Similarly, NETs are another subset of tumors that demonstrate this phenomenon of tumor heterogeneity. [ DOTA-TOC uptake) and an associated significant increase in glycolytic metabolism (leading to increased FDG uptake) [17][18][19][20][21]. Again, high FDG avidity in the tumors is usually associated with a worse patient prognosis [22,23].…”

Section: Classification and Clinical Examples Of Tumor Heterogeneity mentioning

confidence: 99%

Evolving role of molecular imaging with PET in detecting and characterizing heterogeneity of cancer tissue at the primary and metastatic sites, a plausible explanation for failed attempts to cure malignant disorders

Basu

Kwee

Gatenby

et al. 2011

Eur J Nucl Med Mol Imaging

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“…The superiority of 68 Ga-labeled somatostatin analogs in terms of specificity, sensitivity, staging accuracy, detection rate, quantification, and acquisition time over 18 F-FDG (5), 18 F-3,4-dihydroxyphenylalanine (6), 123 Imetaiodobenzylguanidine (7,8), 111 In-DTPA-pentetreotide (9), 18 F-NaF, and 99m Tc-dicarboxypropanediphosphonate (10) has been demonstrated. The high impact of 68 Ga PET/CT on patient management can be illustrated by the fact that the course of treatments was changed or adjusted in 50%-60% of cases on the basis of 68 Ga PET/CT results (11)(12)(13)(14)(15). Thorough analysis of the publications on 16 clinical studies involving 567 patients with suspected thoracic or gastroenteropancreatic NETs suggested PET/CT with 68 Galabeled somatostatin analogs as an independent first-line diagnostic imaging method for this category of patients (16).…”

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confidence: 99%

Quantitative and Qualitative Intrapatient Comparison of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Net Uptake Rate for Accurate Quantification

et al. 2013

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Quantitative imaging and dosimetry are crucial for individualized treatment during peptide receptor radionuclide therapy (PRRT). 177 Lu-DOTATATE and 68 Ga-DOTATOC/ 68 Ga-DOTATATE are used, respectively, for PRRT and PET examinations targeting somatostatin receptors (SSTRs) in patients affected by neuroendocrine tumors. The aim of the study was to quantitatively and qualitatively compare the performance of 68 Ga-DOTATOC and 68 Ga-DOTATATE in the context of subsequent PRRT with 177 Lu-DOTATATE under standardized conditions in the same patient as well as to investigate the sufficiency of standardized uptake value (SUV) for estimation of SSTR expression. Methods: Ten patients with metastatic neuroendocrine tumors underwent one 45-min dynamic and 3 whole-body PET/CT examinations at 1, 2, and 3 h after injection with both tracers. The number of detected lesions, SUVs in lesions and normal tissue, total functional tumor volume, and SSTR volume (functional tumor volume multiplied by mean SUV) were investigated for each time point. Net uptake rate (K i ) was calculated according to the Patlak method for 3 tumors per patient. Results: There were no significant differences in lesion count, lesion SUV, K i , functional tumor volume, or SSTR volume between 68 Ga-DOTATOC and 68 Ga-DOTATATE at any time point. The detection rate was similar, although with differences for single lesions in occasional patients. For healthy organs, marginally higher uptake of 68 Ga-DOTATATE was observed in kidneys, bone marrow, and liver at 1 h. 68 Ga-DOTATOC uptake was higher in mediastinal blood pool at the 1-h time point (P 5 0.018). The tumor-toliver ratio was marginally higher for 68 Ga-DOTATOC at the 3-h time point (P 5 0.037). Blood clearance was fast and similar for both tracers. SUV did not correlate with K i linearly and achieved saturation for a K i of greater than 0.2 mL/cm 3 /min, corresponding to an SUV of more than 25. Conclusion: 68 Ga-DOTATOC and 68 Ga-DOTATATE are suited equally well for staging and patient selection for PRRT with 177 Lu-DOTATATE. However, the slight difference in the healthy organ distribution and excretion may render 68 Ga-DOTATATE preferable. SUV did not correlate linearly with K i and thus may not reflect the SSTR density accurately at its higher values, whereas K i might be the outcome measure of choice for quantification of SSTR density and assessment of treatment outcome.

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The Impact of 68Ga-DOTATOC Positron Emission Tomography/Computed Tomography on the Multimodal Management of Patients With Neuroendocrine Tumors

Abstract: In this study, 68Ga-DOTATOC PET/CT proved clearly superior to CT and/or MRI for detection and staging of NET. More important, 68Ga-DOTATOC PET/CT impacted our treatment decision in more than every second patient.

Cited by 195 publications

References 21 publications

Neuroendocrine tumor disease: an evolving landscape

Neuroendocrine tumor disease: an evolving landscape

Evolving role of molecular imaging with PET in detecting and characterizing heterogeneity of cancer tissue at the primary and metastatic sites, a plausible explanation for failed attempts to cure malignant disorders

Quantitative and Qualitative Intrapatient Comparison of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Net Uptake Rate for Accurate Quantification

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The Impact of 68Ga-DOTATOC Positron Emission Tomography/Computed Tomography on the Multimodal Management of Patients With Neuroendocrine Tumors

Abstract: In this study, 68Ga-DOTATOC PET/CT proved clearly superior to CT and/or MRI for detection and staging of NET. More important, 68Ga-DOTATOC PET/CT impacted our treatment decision in more than every second patient.

Cited by 195 publications

References 21 publications

Neuroendocrine tumor disease: an evolving landscape

Neuroendocrine tumor disease: an evolving landscape

Evolving role of molecular imaging with PET in detecting and characterizing heterogeneity of cancer tissue at the primary and metastatic sites, a plausible explanation for failed attempts to cure malignant disorders

Quantitative and Qualitative Intrapatient Comparison of 68Ga-DOTATOC and 68Ga-DOTATATE: Net Uptake Rate for Accurate Quantification

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Quantitative and Qualitative Intrapatient Comparison of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Net Uptake Rate for Accurate Quantification