Theranostics in Neuroendocrine Neoplasms: The Multifaceted Aspects Integrating Imaging, Therapy, and Dosimetry

The advent of theranostics-integrating molecular functional imaging with targeted radionuclide therapy-has revolutionized the management of Neuroendocrine neoplasms (NENs), particularly through peptide receptor radionuclide therapy. This comprehensive review examines the current state of theranostics in NENs, encompassing the molecular basis of somatostatin receptors (SSTR) targeting, diagnostic imaging modalities, therapeutic radiopharmaceuticals, dosimetry methodologies, patient selection criteria, treatment outcomes, toxicity profiles, and emerging innovations including α-emitting radionuclides and SSTR antagonists. By integrating these multifaceted aspects, this review aims to provide clinicians and researchers with a holistic understanding of theranostics in NENs and its transformative impact on precision oncology.