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open access

Vol 71, No 3 (2020)
Original paper
Submitted: 2020-02-09
Accepted: 2020-03-15
Published online: 2020-03-26
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Effect of peptide receptor radionuclide therapy (PRRT) with tandem isotopes — [90Y]Y/[177Lu]Lu-DOTATATE in patients with disseminated neuroendocrine tumours depending on [18F]FDG PET/CT qualification in Polish multicentre experience — do we need [18F]FDG PET/CT for qualification to PRRT?

Anna Zemczak1, Maciej Kołodziej2, Paweł Gut3, Leszek Królicki4, Beata Kos-Kudła1, Grzegorz Kamiński2, Marek Ruchała3, Dariusz Pawlak5, Jolanta Kunikowska4
DOI: 10.5603/EP.a2020.0014
·
Pubmed: 32293704
·
Endokrynol Pol 2020;71(3):240-248.
Affiliations
  1. Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
  2. Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
  3. Department of Endocrinology, Metabolism, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
  4. Nuclear Medicine Department, Medical University of Warsaw, Poland
  5. Radioisotope Centre POLATOM, National Centre for Nuclear Research, Otwock–Swierk, Poland

open access

Vol 71, No 3 (2020)
Original Paper
Submitted: 2020-02-09
Accepted: 2020-03-15
Published online: 2020-03-26

Abstract

Introduction: Peptide receptor radionuclide therapy (PRRT) using radiolabelled somatostatin analogues is a treatment option for patients with disseminated neuroendocrine tumours (NET). The aim of the study was the evaluation of the role of [18F]FDG PET/CT in predicting response, progression-free survival (PFS) and overall survival (OS) after tandem therapy [90Y]Y/[177Lu]Lu-DOTATATE.

Material and methods: Seventy-five patients with histopathologically proven NET G1 and G2 were included in the study. Before treatment [68Ga]Ga-DOTATATE PET/CT and [18F]FDG PET/CT was performed. Patients were treated with [90Y]Y/[177Lu]Lu-DOTATATE (1:1) with mixed amino-acid infusion for kidney protection.

Results: Progression-free survival was 22.2 months for [18F]FDG-positive patients and 59.3 months for [18F]FDG-negative patients (p = 0.003). The OS from diagnosis (OS-D) and from the start of PRRT (OS-T) was not reached in [18F]FDG-negative patients, and in [18F]FDG-positive patients it was 71.8 months and 55.8 months, respectively. The observed overall one-year survival in [18F]FDG-positive vs. [18F]FDG-negative patients was 96.8% vs. 99.1%, two-year survival was 88.9% vs. 96%, and five-year survival was 58.8% vs. 88%, respectively. The one-year and two-year risk of progression was 15% vs. 58.9% in [18F]FDG-positive patients and 11% vs. 32% in [18F]FDG-negative patients. The objective response rate (ORR) [18F]FDG-positive vs. [18F]FDG-negative patients was 41.7% vs. 17%.

Conclusions: [18F]FDG-positive patients have statistically significant shorter survival parameters than [18F]FDG-negative patients. The risk of progression in [18F]FDG-positive vs. [18F]FDG-negative patients in one-year follow-up is comparable, whereas in two-year follow-up it is nearly two times higher for [18F]FDG PET/CT-positive patients. 

Abstract

Introduction: Peptide receptor radionuclide therapy (PRRT) using radiolabelled somatostatin analogues is a treatment option for patients with disseminated neuroendocrine tumours (NET). The aim of the study was the evaluation of the role of [18F]FDG PET/CT in predicting response, progression-free survival (PFS) and overall survival (OS) after tandem therapy [90Y]Y/[177Lu]Lu-DOTATATE.

Material and methods: Seventy-five patients with histopathologically proven NET G1 and G2 were included in the study. Before treatment [68Ga]Ga-DOTATATE PET/CT and [18F]FDG PET/CT was performed. Patients were treated with [90Y]Y/[177Lu]Lu-DOTATATE (1:1) with mixed amino-acid infusion for kidney protection.

Results: Progression-free survival was 22.2 months for [18F]FDG-positive patients and 59.3 months for [18F]FDG-negative patients (p = 0.003). The OS from diagnosis (OS-D) and from the start of PRRT (OS-T) was not reached in [18F]FDG-negative patients, and in [18F]FDG-positive patients it was 71.8 months and 55.8 months, respectively. The observed overall one-year survival in [18F]FDG-positive vs. [18F]FDG-negative patients was 96.8% vs. 99.1%, two-year survival was 88.9% vs. 96%, and five-year survival was 58.8% vs. 88%, respectively. The one-year and two-year risk of progression was 15% vs. 58.9% in [18F]FDG-positive patients and 11% vs. 32% in [18F]FDG-negative patients. The objective response rate (ORR) [18F]FDG-positive vs. [18F]FDG-negative patients was 41.7% vs. 17%.

Conclusions: [18F]FDG-positive patients have statistically significant shorter survival parameters than [18F]FDG-negative patients. The risk of progression in [18F]FDG-positive vs. [18F]FDG-negative patients in one-year follow-up is comparable, whereas in two-year follow-up it is nearly two times higher for [18F]FDG PET/CT-positive patients. 

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Keywords

PRRT; [90Y]Y/[177Lu]Lu-DOTATATE; [18F]FDG PET/CT; tandem therapy; neuroendocrine tumours

About this article
Title

Effect of peptide receptor radionuclide therapy (PRRT) with tandem isotopes — [90Y]Y/[177Lu]Lu-DOTATATE in patients with disseminated neuroendocrine tumours depending on [18F]FDG PET/CT qualification in Polish multicentre experience — do we need [18F]FDG PET/CT for qualification to PRRT?

Journal

Endokrynologia Polska

Issue

Vol 71, No 3 (2020)

Article type

Original paper

Pages

240-248

Published online

2020-03-26

Page views

1553

Article views/downloads

975

DOI

10.5603/EP.a2020.0014

Pubmed

32293704

Bibliographic record

Endokrynol Pol 2020;71(3):240-248.

Keywords

PRRT
[90Y]Y/[177Lu]Lu-DOTATATE
[18F]FDG PET/CT
tandem therapy
neuroendocrine tumours

Authors

Anna Zemczak
Maciej Kołodziej
Paweł Gut
Leszek Królicki
Beata Kos-Kudła
Grzegorz Kamiński
Marek Ruchała
Dariusz Pawlak
Jolanta Kunikowska

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