The significance of incidental brain uptake on 68Ga-DOTATATE PET-CT in neuroendocrine tumour patients

Cleary, Jon O.; Yeung, Jason; McMeekin, Helena; Wilhelm, Thomas; Wagner, Thomas

doi:10.1097/mnm.0000000000000571

Cited by 16 publications

(19 citation statements)

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“…In the literature, there has been limited data available on the prevalence of incidental meningiomas, especially in the patient population of NETs. Due to the high diagnosis rate of 68 Ga-labelled SSTR analog based positron-emission tomography (PET)/computed tomography (CT) to detect meningiomas,[27] we sought to determine the rate of probable meningiomas, in the setting of metastatic/advanced NET patients undergoing molecular imaging before PRRT therapy in a tertiary care NET center. The present study also aimed to determine the response rate of incidentally detected meningiomas in cases who underwent PRRT, by clinical symptomatology and objective response using molecular and structural imaging and also determine PFS related to meningioma lesions in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of hitherto unknown brain meningioma detected on 68Ga-DOTATATE positron-emission tomography/computed tomography in patients with metastatic neuroendocrine tumor and exploring potential of 177Lu-DOTATATE peptide receptor radionuclide therapy as single-shot treatment approach targeting both tumors

2019

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There is a relative paucity of data in the literature regarding the prevalence of meningiomas and their detection in the clinical setting of neuroendocrine tumors (NETs). The primary aim of this study was to study incidentally detected meningiomas (on 68 Ga-DOTATATE/ 18 F fluorodeoxyglucose positron-emission tomography/computed tomography [ 18 F-FDG PET/CT]) in metastatic NET patients referred for peptide receptor radionuclide therapy (PRRT). The secondary aims of this study were to evaluate the response rate of these incidentally detected meningiomas following PRRT and determine progression-free survival (PFS) in this group of patients. This was a retrospective analysis of 500 metastatic/advanced NET patients who had undergone 68 Ga-DOTATATE PET/CT and 18 F-FDG PET/CT before PRRT workup. The case records were searched to identify cases of hitherto unknown meningiomas detected on PET images; subsequently, these patients underwent brain magnetic resonance imaging (MRI) for confirmation of diagnosis. Following 177 Lu-DOTATATE PRRT, posttreatment functional and structural imaging response evaluation of the meningiomas were undertaken by 68 Ga-DOTATATE PET/CT, MRI, or CT brain, respectively, along with clinical neurological evaluation. The patients were designated as responders and nonresponders based on predefined response assessment criteria. The PFS of these incidentally detected meningiomas following PRRT was estimated using the Kaplan–Meier product-limit method. Twelve NET patients were retrospectively identified with abnormal focal brain uptake on 68 Ga-DOTATATE PET/CT. Of these, meningiomas were finally diagnosed on brain MRI examination in six patients (M: F =3:3; age range: 30–66 years; and mean age: 45 years), with a prevalence of 1.2%. Standardized uptake value (SUVmax) of meningiomas on 68 Ga-DOTATATE and 18 F-FDG PET/CT ranged from 7.0 to 22.0 (average 17.0) and 10.19–13.70 (mean: 12.10), respectively, and lesion-to-normal brain parenchyma SUVmax ratio ranged from 140 to 400 (mean: 340) and 1.02–1.07 (mean: 1.04), respectively. Of six patients with incidentally detected meningiomas, one patient died within 1 month and five patients received 177 Lu-DOTATATE PRRT, the number of cycles ranging from two to six (average: 4) and cumulative therapeutic dose ranging from 13.28 to 29.97GBq (average dose: 19.86GBq). Follow-up in these patients ranged from 8 to 36 months (mean: 19.4 months) after the first dose of PRRT. Complete disappearance of neurological symptoms was found in two of five patients (40%), partial response in one of five (20%), and worsening of symptoms in two of five patients (40%). The overall “responder” and “nonresponder” of the meningiomas after PRRT were three patients (60%) and two patients (40%), respectively. Tw...

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Section: Introductionmentioning

confidence: 99%

Prevalence of hitherto unknown brain meningioma detected on 68Ga-DOTATATE positron-emission tomography/computed tomography in patients with metastatic neuroendocrine tumor and exploring potential of 177Lu-DOTATATE peptide receptor radionuclide therapy as single-shot treatment approach targeting both tumors

2019

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“…Even though SST is a key molecule of NETs, it is not exclusively expressed in NETs alone. There have been a few reports about incidental DOTATOC or DOTA-TATE uptake in tumors other than NETs [6][7][8]. In particular, the somatostatin analogue is known to show remarkably increased uptake in meningioma [9].…”

Section: Introductionmentioning

confidence: 99%

A pan-cancer analysis of the clinical and genetic portraits of somatostatin receptor expressing tumor as a potential target of peptide receptor imaging and therapy

et al. 2020

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Purpose: Although somatostatin receptor (SST) is a promising theranostic target and is widely expressed in tumors of various organs, the indication for therapies targeting SST is limited to typical gastroenteropancreatic neuroendocrine tumors (NETs). Thus, broadening the scope of the current clinical application of peptide receptor radiotherapy (PRRT) can be supported by a better understanding of the landscape of SST-expressing tumors. Methods: SST expression levels were assessed in data from The Cancer Genome Atlas across 10,701 subjects representing 32 cancer types. As the major target of PRRT is SST subtype 2 (SST2), correlation analyses between the pan-cancer profiles, including clinical and genetic features, and SST2 level were conducted. The median SST2 expression level of pheochromocytoma and paraganglioma (PCPG) samples was used as the threshold to define "high-SST2 tumors." The prognostic value of SST2 in each cancer subtype was evaluated by using Cox proportional regression analysis. Results: We constructed a resource of SST expression patterns associated with clinicopathologic features and genomic alterations. It provides an interactive tool to analyze SST expression patterns in various cancer types. As a result, eight of the 31 cancer subtypes other than PCPG had more than 5% of tumors with high-SST2 expression. Low-grade glioma (LGG) showed the highest proportion of high-SST2 tumors, followed by breast invasive carcinoma (BRCA). LGG showed different SST2 levels according to tumor grade and histology. IDH1 mutation was significantly associated with high-SST2 status. In BRCA, the SST2 level was different according to the hormone receptor status. High-SST2 status was significantly associated with good prognosis in LGG patients. High-SST2 status showed a trend for association with poor prognosis in triple-negative breast cancer subjects. Conclusion: A broad range of SST2 expression was observed across diverse cancer subtypes. The SST2 expression level showed a significant association with genomic and clinical aspects across cancers, especially in LGG and BRCA. These findings extend our knowledge base to diversify the indications for PRRT as well as SST imaging.

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“…Even though SST is a key molecule of NETs, it is not exclusively expressed in NETs alone. There have been a few reports about incidental DOTATOC or DOTATATE uptake in tumors other than NETs [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A pan-cancer analysis of the clinical and genetic portraits of somatostatin receptor expressing-tumor as a potential target of peptide receptor imaging and therapy

Lee

Suh

Choi

et al. 2020

Preprint

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Purpose Although somatostatin receptor (SST) is a promising theranostics target and is widely expressed in tumors of various organs, the indication for therapies targeting SST is limited to typical gastroenteropancreatic neuroendocrine tumors (NETs). Thus, broadening the scope of the current clinical application of peptide receptor radiotherapy (PRRT) can be supported by a better understanding of the landscape of SST-expressing tumors. Methods SST expression levels were assessed in data from The Cancer Genome Atlas across 10,701 subjects representing 32 cancer types. As the major target of PRRT is SST subtype 2 (SST2), correlation analyses between the pan-cancer profiles, including clinical and genetic features, and SST2 level were conducted. The median SST2 expression level of pheochromocytoma and paraganglioma (PCPG) samples was used as the threshold to define ‘high-SST2 tumors’. The prognostic value of SST2 in each cancer subtype was evaluated by using Cox proportional regression analysis. Results We constructed a resource of SST expression patterns associated with clinicopathologic features and genomic alterations. It provides an interactive tool to analyze SST expression patterns in various cancer types. As a result, eight of the 31 cancer subtypes other than PCPG had more than 5% of tumors with high SST2 expression. Low-grade glioma (LGG) showed the highest proportion of high-SST2 tumors, followed by breast invasive carcinoma (BRCA). LGG showed different SST2 levels according to tumor grade and histology. IDH1 mutation was significantly associated with high-SST2 status. In BRCA, the SST2 level was different according to the hormone receptor status. High-SST2 status was significantly associated with good prognosis in LGG patients. High-SST2 status showed a trend for association with poor prognosis in triple-negative breast cancer subjects. Conclusion A broad range of SST2 expression was observed across diverse cancer subtypes. The SST2 expression level showed a significant association with genomic and clinical aspects across cancers, especially in LGG and BRCA. These findings extend our knowledge base to diversify the indications for PRRT as well as SST imaging.

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The significance of incidental brain uptake on 68Ga-DOTATATE PET-CT in neuroendocrine tumour patients

Cited by 16 publications

References 20 publications

A pan-cancer analysis of the clinical and genetic portraits of somatostatin receptor expressing tumor as a potential target of peptide receptor imaging and therapy

A pan-cancer analysis of the clinical and genetic portraits of somatostatin receptor expressing-tumor as a potential target of peptide receptor imaging and therapy

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