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Updated: Aug 20, 2026
A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy (PRRT): 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods
Published on: April 24, 2020
Peptide receptor radionuclide therapy for non-radioiodine-avid differentiated thyroid carcinoma
Jaap J M Teunissen1, Dik J Kwekkeboom, Peter P M Kooij
1Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. j.teunissen@erasmusmc.nl
Unlabelled:
In patients with progressive metastatic (or recurrent) differentiated thyroid carcinoma (DTC) who do not respond to radioiodine therapy or do not show uptake on radioiodine scintigraphy, treatment options are few. Because these tumors may express somatostatin receptors, peptide receptor radionuclide therapy might be effective. We evaluated the therapeutic efficacy of the radiolabeled somatostatin analog (177)Lu-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid(0) (DOTA), Tyr(3)-octreotate ((177)Lu-DOTATATE) in patients with DTC. The uptake of radioactivity in tumors was also studied in relation to treatment outcome.
Methods:
Five patients with DTC (3 with Hurthle cell thyroid carcinoma [HCTC], 1 with papillary thyroid carcinoma [PTC], and 1 with follicular thyroid carcinoma [FTC]) were treated with 22.4-30.1 GBq of (177)Lu-DOTATATE. Response to therapy was evaluated with CT. Uptake on (177)Lu-DOTATATE scintigraphy (24 h after treatment), expressed as percentage of injected dose, was compared with uptake on pretherapy (111)In-octreotide scintigraphy (24 h after injection).
Results:
After the last treatment with (177)Lu-DOTATATE, 1 patient with HCTC had stable disease as a maximum response, 1 patient with HCTC had minor remission (tumor shrinkage between 25% and 50%), and 1 patient with HCTC had partial remission (shrinkage > or =50%). The responses in PTC and FTC were stable disease and progressive disease, respectively. A decrease in serum thyroglobulin level was found in patients with HCTC. Patients with minor and partial remissions had the highest (177)Lu-DOTATATE-to-(111)In-diethylenetriamine pentaacetic acid(0)-octreotide ((111)In-octreotide) uptake ratios (3.2 and 2.4, respectively) whereas the other patients had uptake ratios smaller than 1.5.
Conclusion:
(177)Lu-DOTATATE therapy can be effective in patients with progressive DTC who have no therapeutic options and sufficient uptake of (111)In-octreotide in tumor lesions as shown on (111)In-octreotide scintigraphy. This finding is especially important in patients with HCTC, because they cannot benefit from radioiodine therapy because of non-iodine-avid lesions at diagnosis.
Insights
Peptide receptor radionuclide therapy with lutetium-177-DOTATATE shows promise for advanced differentiated thyroid carcinoma. This treatment is particularly beneficial for Hurthle cell thyroid carcinoma patients unresponsive to radioiodine therapy.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmacology
Background:
- Differentiated thyroid carcinoma (DTC) that is metastatic or recurrent and unresponsive to radioiodine therapy has limited treatment options.
- Tumors expressing somatostatin receptors may be candidates for peptide receptor radionuclide therapy (PRRT).
Purpose of the Study:
- To evaluate the therapeutic efficacy of lutetium-177-labeled somatostatin analog (177)Lu-DOTATATE in patients with progressive DTC.
- To investigate the relationship between tumor radioactivity uptake and treatment outcomes.
Main Methods:
- Five patients with DTC (3 Hurthle cell, 1 papillary, 1 follicular) received (177)Lu-DOTATATE therapy (22.4–30.1 GBq).
- Therapeutic response was assessed using CT scans.
- Tumor uptake of (177)Lu-DOTATATE was compared to pre-therapy (111)In-octreotide uptake.
Main Results:
- One patient with Hurthle cell thyroid carcinoma (HCTC) achieved stable disease, one had minor remission, and one had partial remission.
- Papillary thyroid carcinoma showed stable disease, while follicular thyroid carcinoma showed progressive disease.
- Patients with minor and partial remissions exhibited higher (177)Lu-DOTATATE to (111)In-octreotide uptake ratios (>2.4).
Conclusions:
- (177)Lu-DOTATATE therapy is a viable option for progressive DTC patients lacking other treatment choices, provided sufficient tumor uptake of (111)In-octreotide is present.
- This therapy is particularly significant for HCTC patients with non-iodine-avid lesions, who do not benefit from radioiodine therapy.
