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Updated: Apr 11, 2026

A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy PRRT: 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods
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Patterns of Progression After Peptide Receptor Radiopharmaceutical Therapy.

Moein Moradpour1, Abuzar Moradi Tochayi1, Sina Houshmand1

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Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
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Most patients with neuroendocrine tumors (NETs) treated with peptide receptor radionuclide therapy (PRRT) continue to express somatostatin receptors (SSTRs) after progression. SSTR-negative disease is rare, suggesting continued eligibility for SSTR-targeted treatments.

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SSTR PETneuroendocrine tumorspeptide receptor radionuclide therapyradiopharmaceutical therapyretreatment

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiology

Background:

  • [177Lu]Lu-DOTATATE is approved for gastroenteropancreatic neuroendocrine tumors (NETs).
  • Disease progression in NETs may lead to somatostatin receptor (SSTR)-negative status.
  • Assessing SSTR expression post-treatment is crucial for guiding further therapy.

Purpose of the Study:

  • To evaluate progression patterns in NET patients after peptide receptor radionuclide therapy (PRRT).
  • To assess somatostatin receptor (SSTR) uptake in progressed lesions.
  • To determine the incidence of SSTR-negative disease after PRRT.

Main Methods:

  • Retrospective analysis of 195 NET patients treated with PRRT (2016-2024).
  • Review of imaging and medical records to identify disease progression.
  • Quantitative (SUVmax) and qualitative analysis of SSTR PET scans post-progression compared to baseline.

Main Results:

  • Progression occurred in 54.9% of patients, predominantly in the liver and bone.
  • Mean SUVmax decreased post-progression (54.3 to 46.0, P=0.02), but 77.9% showed equal or higher SSTR uptake.
  • SSTR-negative disease was rare (3.7%); SSTR PET detected progression missed by conventional imaging in 46.7%.

Conclusions:

  • Most NET patients maintain SSTR expression after PRRT progression, remaining candidates for retreatment.
  • SSTR-negative NET progression is uncommon.
  • SSTR PET is vital for detecting progression, especially in non-measurable lesions, guiding subsequent treatment decisions.