From the Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, OR.
Department of Radiology, University of Pennsylvania, Philadelphia, PA.
Cancer J. 2024;30(3):185-193. doi: 10.1097/PPO.0000000000000723.
Neuroendocrine tumors (NETs) are rare tumors that develop from cells of the neuroendocrine system and can originate in multiple organs and tissues such as the bowels, pancreas, adrenal glands, ganglia, thyroid, and lungs. This review will focus on gastroenteropancreatic NETs (more commonly called NETs) characterized by frequent somatostatin receptor (SSTR) overexpression and pheochromocytomas/paragangliomas (PPGLs), which typically overexpress norepinephrine transporter. Advancements in SSTR-targeted imaging and treatment have revolutionized the management of patients with NETs. This comprehensive review delves into the current practice, discussing the use of the various Food and Drug Administration-approved SSTR-agonist positron emission tomography tracers and the predictive imaging biomarkers, and elaborating on 177Lu-DOTATATE peptide receptor radionuclide therapy including the evolving areas of posttherapy imaging practices and peptide receptor radionuclide therapy retreatment. SSTR-targeted imaging and therapy can also be used in patients with PPGL; however, this patient population has demonstrated the best outcomes from norepinephrine transporter-targeted therapy with 131I-metaiodobenzylguanidine. Metaiodobenzylguanidine theranostics for PPGL will be discussed, noting that in 2024 it became commercially unavailable in the United States. Therefore, the use and reported success of SSTR theranostics for PPGL will also be explored.
神经内分泌肿瘤（NETs）是一种罕见的肿瘤，起源于神经内分泌系统的细胞，可发生于多个器官和组织，如肠道、胰腺、肾上腺、神经节、甲状腺和肺。本篇综述将重点介绍胃肠胰神经内分泌肿瘤（通常称为 NETs），其特征为生长抑素受体（SSTR）过度表达和嗜铬细胞瘤/副神经节瘤（PPGLs），后者通常过度表达去甲肾上腺素转运体。SSTR 靶向成像和治疗的进步彻底改变了 NET 患者的管理方式。本综述深入探讨了当前的实践，讨论了各种获得美国食品和药物管理局批准的 SSTR 激动剂正电子发射断层扫描示踪剂和预测成像生物标志物的使用，并详细阐述了 177Lu-DOTATATE 肽受体放射性核素治疗，包括治疗后成像实践和肽受体放射性核素治疗再治疗的不断发展领域。SSTR 靶向成像和治疗也可用于 PPGL 患者；然而，该患者群体已从去甲肾上腺素转运体靶向治疗中 131I-间碘苄胍获得了最佳疗效。本文还将讨论用于 PPGL 的间碘苄胍放射性核素治疗，注意到间碘苄胍于 2024 年在美国已不再商业化供应。因此，本文也将探讨 SSTR 放射性核素治疗在 PPGL 中的应用和报道的成功案例。
