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Staging and treatment of differentiated thyroid carcinoma with radiolabeled somatostatin analogs
Jaap J M Teunissen1, Dik J Kwekkeboom, Eric P Krenning
1Department of Nuclear Medicine, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. j.teunissen@erasmusmc.nl
Abstract:
In patients with progressive metastatic (or recurrent) differentiated thyroid carcinoma that either do not take up radioiodine or are unresponsive to continued radioiodine therapy, staging is difficult and treatment options are few. However, in most of these patients uptake of radiolabeled somatostatin analogs is evident on somatostatin-receptor scintigraphy (SRS). Using SRS, patients with sufficient uptake of radiolabeled somatostatin analogs can be selected for high-dose peptide receptor radionuclide therapy (PRRT) as an alternative targeted-treatment option. PRRT with the beta-particle-emitting radionuclides (90)yttrium ((90)Y) and (177)lutetium ((177)Lu) gives the best results in terms of objective tumor response. Promising, novel, radiolabeled somatostatin analogs that have a broader receptor affinity profile and, thus, a potentially wider therapeutic range are being tested clinically.
Insights
For differentiated thyroid carcinoma unresponsive to radioiodine, somatostatin-receptor scintigraphy identifies patients eligible for peptide receptor radionuclide therapy (PRRT). This targeted therapy, particularly with Yttrium-90 or Lutetium-177, offers a viable treatment option.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiochemistry
Background:
- Differentiated thyroid carcinoma (DTC) poses treatment challenges when metastatic or recurrent and unresponsive to radioiodine.
- Limited staging and therapeutic options exist for radioiodine-refractory DTC.
- Somatostatin-receptor scintigraphy (SRS) reveals somatostatin analog uptake in most such patients.
Purpose of the Study:
- To evaluate peptide receptor radionuclide therapy (PRRT) as a targeted treatment for radioiodine-refractory differentiated thyroid carcinoma.
- To assess the utility of somatostatin-receptor scintigraphy (SRS) in patient selection for PRRT.
Main Methods:
- Utilizing somatostatin-receptor scintigraphy (SRS) to identify patients with sufficient radiolabeled somatostatin analog uptake.
- Administering high-dose peptide receptor radionuclide therapy (PRRT) using beta-particle-emitting radionuclides like Yttrium-90 ((90)Y) and Lutetium-177 ((177)Lu).
Main Results:
- SRS can effectively select patients with radioiodine-refractory DTC for PRRT.
- PRRT with (90)Y and (177)Lu demonstrates significant objective tumor response in selected patients.
- Novel somatostatin analogs with broader receptor affinity are under clinical investigation.
Conclusions:
- PRRT represents a promising targeted treatment alternative for patients with progressive, radioiodine-refractory differentiated thyroid carcinoma.
- SRS is a crucial tool for identifying suitable candidates for PRRT.
- Ongoing development of new somatostatin analogs may expand therapeutic applications.
