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Meena Darden, MS4June 26, 2019
Diagnostic Radiology 4001 ElectiveDr. Lesley Flynt, Nuclear Medicine, MD Anderson
Meena Darden, MS4June 26, 2019
Diagnostic Radiology 4001 ElectiveDr. Lesley Flynt, Nuclear Medicine, MD Anderson
68Gallium-DOTATATE & Lutathera in Pancreatic Neuroendocrine Tumor
Imaging & Treatment
54 Y.O. MALEMETASTATIC GRADE 2 PANCREATIC NEUROENDOCRINE TUMOR
➔ 2012: Gemcitabine x Cisplatin➔ 2013: Nanoknife ablation➔ 2013: Capecitabine chemoradiation➔ 2013: Recurrent pancreatic mass +
porta hepatis lymph node➔ 2015: Enlarging precaval lymph
nodes adjacent to SMA➔ 2015: Ethanol ablation➔ 2015-16: Lanreotide➔ 2016: Ribociclib➔ 2018: Everolimus➔ 2018: Enlarging adenopathy➔ 2018: 177Lu-DOTATATE
HISTORY
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DIAGNOSIS
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IMAGING OPTIONS
Triple Phase CTDCE-CTMRIUSSSR Scintigraphy (Octreoscan)68Ga-DOTATATE18F-FDGPET/CT
DEFINITIONS
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68Gallium-DOTATATE (NETSPOT)- Positron-emitting analog of somatostatin that binds to SST receptors on NETs- Used during PET scans
177Lutetium-DOTATATE (Lutathera)- Peptide receptor radiotherapy (PRRT) for advanced, progressive, somatostatin-receptor-
positive midgut neuroendocrine tumors- Liver metastases
IMAGES
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Pre-Lutathera
IMAGES
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Pre-Lutathera
IMAGES
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Pre-Lutathera Post-Lutathera
IMAGES
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Post-Lutathera
PRE-LUTATHERA
- Primary mass: pancreatic head/body + lymphadenopathy- Liver metastasis- DOTATATE-avid lymph nodes in chest, abdomen, pelvis
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POST-LUTATHERAMarked changes in avidity most prominent in
liver metastasis and lymphadenopathy
FINDINGS
American College of Radiology ACR Appropriateness Criteria®: Staging of Pancreatic Ductal Adenocarcinoma
TAKE HOME POINTS
68Ga-DOTATATEPositron-emitting analog of somatostatin that binds to SST receptors on NETs
Radiolabeled SST analog used for peptide receptor radionuclide therapy
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177Lu-DOTATATE
The combination of these radiological technologies enables more accurate, less invasive, and more complete therapy targeting neuroendocrine tumors and other hormone-sensitive malignancies, thus altering the trajectory of cancer treatment and survival.
THERANOSTICS
REFERENCES
● 68Ga-DOTA-Tyr3-Octreotide PET in Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and CT, http://jnm.snmjournals.org/content/48/4/508.short
● American College of Radiology ACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma https://acsearch.acr.org/docs/3099847/Narrative/
● Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors https://www.nejm.org/doi/full/10.1056/NEJMoa1607427
● Recent developments in imaging of pancreatic neuroendocrine tumors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367208/
● The value of 68Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138137/pdf/ajnmmi0004-0426.pdf
● Update on pancreatic neuroendocrine tumors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244504/
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QUESTIONS?
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