Mamulashvili Bessac Darejan, Baltzinger Philippe, Poterszman Nathan, Pham Van Floriane, Collen Cedric, Malouf Gabriel G, Ouvrard Eric, Kaseb Ashjan, Porot Clemence, Ben Abdelghani Meher, Addeo Pietro, Mertz Luc, Goichot Bernard, Imperiale Alessio
Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France.
Endocrinology, Diabetology, Nutrition, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France.
Endocrine. 2025 Mar;87(3):1333-1341. doi: 10.1007/s12020-024-04138-y. Epub 2024 Dec 23.
To evaluate organ-specific response to [Lu]DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) in patients with small intestine neuroendocrine tumor (SiNET) through [Ga]DOTATOC PET/CT, and to analyze tumor uptake and functional volume variations at different metastatic sites in relation to disease progression during clinical follow-up after treatment.
A retrospective analysis was conducted on 33 metastatic patients. PET/CT were performed pre-treatment (PET0), mid-treatment after two PRRT cycles (PET2), and post-treatment (PET4). SUV and somatostatin receptor-expressing tumor volume (SRETV) were measured in liver, lymph node, peritoneum/mesentery, and bone metastases.
Liver metastases showed significant reduction in both SUV and SRETV from PET0 to PET4, with early response evident after two PRRT cycles. Nodal lesions exhibited a delayed response, with significant reductions at PET4. Peritoneal and bone metastases showed a continuous decline in SUV, but no significant changes in SRETV. Objective response rates were highest in liver metastases after treatment completion with lesser responses in nodal, peritoneal, and bone lesions. At a median follow-up of 24.3 months, 70% of patients experienced disease progression, while 30% did not. Liver metastases showed no significant changes in SUV or SRETV regardless of progression. Conversely, in non-progressing patients, peritoneal/mesenteric lesions showed a significant reduction in SUV, with unchanged SRETV, and nodal metastases exhibited reduced SRETV. Bone lesions in non-progressing patients showed significant decreases in both SUV and SRETV.
[Lu]DOTATATE PRRT effectively reduces tumor functional activity in patients with SiNETs, with organ-specific responses highlighting the need for personalized treatment strategies to optimize efficacy and minimize toxicity.
通过[Ga]DOTATOC PET/CT评估小肠神经内分泌肿瘤（SiNET）患者对[Lu]DOTATATE肽受体放射性核素治疗（PRRT）的器官特异性反应，并分析治疗后临床随访期间不同转移部位的肿瘤摄取及功能体积变化与疾病进展的关系。
对33例转移性患者进行回顾性分析。在治疗前（PET0）、两个PRRT周期后的治疗中期（PET2）和治疗后（PET4）进行PET/CT检查。测量肝脏、淋巴结、腹膜/肠系膜和骨转移灶的标准化摄取值（SUV）和表达生长抑素受体的肿瘤体积（SRETV）。
从PET0到PET4，肝转移灶的SUV和SRETV均显著降低，两个PRRT周期后早期反应明显。淋巴结病变反应延迟，PET4时显著降低。腹膜和骨转移灶的SUV持续下降，但SRETV无显著变化。治疗完成后，肝转移灶的客观缓解率最高，淋巴结、腹膜和骨病变的缓解率较低。中位随访24.3个月时，70%的患者疾病进展，30%未进展。无论疾病是否进展，肝转移灶的SUV或SRETV均无显著变化。相反，在疾病未进展的患者中，腹膜/肠系膜病变的SUV显著降低，SRETV不变，淋巴结转移灶的SRETV降低。疾病未进展患者的骨病变SUV和SRETV均显著降低。
[Lu]DOTATATE PRRT可有效降低SiNET患者的肿瘤功能活性，器官特异性反应突出了个性化治疗策略以优化疗效和最小化毒性的必要性。
