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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
Is there a role for peptide receptor radionuclide therapy in medullary thyroid cancer?
Fernanda Vaisman1, Paulo Henrique Rosado de Castro, Flavia Paiva Proença Lobo Lopes
1From the *Endocrinology Service, and †Nuclear Medicine Service, Instituto Nacional de Câncer; ‡Endocrinology Service, Universidade Federal do Rio de Janeiro; §Radiology Service, and ∥Oncology Service, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Background:
Medullary thyroid cancer (MTC) is a rare but potentially life-threatening disease with limited therapeutic options. As a neuroendocrine tumor, MTC expresses somatostatin receptors, and therefore, somatostatin-labeled radiopharmaceuticals could be used to treat patients with MTC.
Objective:
The aims of this study were to evaluate tumor shrinkage after Lu-DOTATATE treatment, to analyze the impact on quality of life as accessed by the SF-36 questionnaire, and to demonstrate a possible prognostic role for In-DTPA-octreotide uptake in patients with MTC.
Patients And Methods:
Patients with progressive MTC underwent evaluation using In-DTPA-octreotide. Patients who demonstrated In-DTPA-octreotide uptake were treated with 4 cycles of 200 mCi of Lu-DOTATATE and were evaluated using CT scans over 8 to 12 months of treatment.
Results:
Of the 16 patients initially enrolled, 9 (56.25%) had lesions that were observed in the In-DTPA-octreotide scans and were eligible for therapy with Lu-DOTATATE. Three patients had a partial response, 3 patients were classified as having stable disease and, 1 patient had a progressive disease. All responders indicated improvement in quality of life 6 to 12 months after therapy.
Conclusions:
Treatment with Lu-DOTATATE seems to be an alternative therapy for somatostatin receptor-positive tumors, with very mild adverse effects and quality-of-life improvement, at least during a short-term period. Further studies are needed to determine long-term benefits and to identify which patients are more likely to respond to this modality of therapy.
Insights
Lutetium-177-DOTATATE (Lu-DOTATATE) shows promise for treating medullary thyroid cancer (MTC) by shrinking tumors and improving quality of life. Further research is needed to confirm long-term efficacy and identify optimal patient candidates for this therapy.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmaceutical Therapy
Background:
- Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor with limited treatment options.
- MTC expresses somatostatin receptors, making it a potential target for somatostatin-based radiopharmaceuticals.
- Radiopharmaceutical therapy offers a targeted approach for MTC treatment.
Purpose of the Study:
- To evaluate tumor shrinkage in MTC patients treated with Lutetium-177-DOTATATE (Lu-DOTATATE).
- To assess the impact of Lu-DOTATATE therapy on patient quality of life using the SF-36 questionnaire.
- To investigate the prognostic value of Indium-111-DTPA-octreotide (In-DTPA-octreotide) uptake in MTC.
Main Methods:
- Patients with progressive MTC underwent In-DTPA-octreotide imaging.
- Eligible patients received 4 cycles of Lu-DOTATATE (200 mCi each).
- Tumor response and quality of life were monitored via CT scans and SF-36 over 8-12 months.
Main Results:
- Of 16 patients, 9 (56.25%) showed positive In-DTPA-octreotide uptake and received Lu-DOTATATE therapy.
- Therapy resulted in partial response in 3 patients, stable disease in 3, and progressive disease in 1.
- All patients who responded to Lu-DOTATATE reported improved quality of life 6-12 months post-treatment.
Conclusions:
- Lu-DOTATATE therapy is a viable option for somatostatin receptor-positive MTC, demonstrating mild side effects and short-term quality-of-life improvements.
- Further studies are essential to establish long-term benefits and patient selection criteria for Lu-DOTATATE therapy.
- In-DTPA-octreotide uptake may serve as a prognostic indicator for Lu-DOTATATE treatment efficacy in MTC.
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