Complementary Role of [ 68 Ga]Ga-DOTA-3P-TATE-RGD PET/CT in Discriminating Non-Small Cell From Small Cell Lung Cancer

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• 18F-FDG PET/CT is a standard tool for lung cancer management but struggles with histologic heterogeneity.
• Differentiating synchronous primary lung cancers can be challenging, impacting treatment strategies.

Purpose of the Study:

• To present a case where advanced PET/CT imaging identified synchronous primary lung cancers with differing responses to treatment.
• To highlight the utility of dual-targeted PET/CT in guiding precise biopsy and personalized therapy for complex lung cancer cases.

Main Methods:

• A patient with a pulmonary mass initially diagnosed as small-cell lung cancer (SCLC) underwent chemotherapy.
• Post-treatment imaging utilized both 18F-FDG PET/CT and a novel dual-targeted tracer PET/CT ([68Ga]Ga-DOTA-3P-TATE-RGD).
• Discordant uptake patterns on dual-tracer PET/CT prompted a rebiopsy of a satellite lesion.

Main Results:

• The primary SCLC lesion showed partial response to chemotherapy.
• A satellite lesion exhibited stable disease and demonstrated divergent tracer uptake on post-treatment PET/CT scans.
• Rebiopsy confirmed the satellite lesion as a synchronous primary squamous cell carcinoma, distinct from the initial SCLC diagnosis.

Conclusions:

• Advanced PET/CT imaging with dual-targeted tracers can reveal histologic heterogeneity and synchronous primary lung cancers.
• This precise diagnostic capability is crucial for guiding targeted biopsies and optimizing individualized treatment plans in complex oncology cases.
• The findings underscore the potential of novel PET/CT tracers in overcoming the limitations of standard imaging for complex lung cancer scenarios.