![]() ![]() (PFS), and low G3 and G4 toxicities ( 15). Follow-up studies in much larger (500-600 patients, but single institution) cohorts continued to show favorable outcomes with 30% objective response rates, 40-month progression-free survival There are still some areas that are struggling with the availability of Ga68-DOTATATE locally, or insurance denials, but these issues will become less in the future.Įven very early prospective studies on 177Lu-DOTATATE with only 35-50 patients showed partial response rates of 10% to 25%, as well as improvements in QoL measures in those with metastatic NET who were refractory to traditional therapies ( 13, 14). In fact, in all key aspects (resolution, imaging time, radiation dose, sensitivity, and resultant change in clinical management), 68Ga-DOTATATE is superior to 111In-pentetreotide and should, therefore, be used whenever possible. Aside from the improved resolution of positron emission tomography (PET) over planar as well as SPECT gamma camera imaging, the imaging protocol is also much more favorable as the whole-body scan is done at 60 min post injection. In June 2016, 68Ga-DOTATATE (NetSpot, Advanced Accelerator Applications ) was FDA approved, thereby providing a PET-imaging alternative to the long-used 111In-pentetreotide ( Figs. Three peptides based on this concept include DOTA-TATE, DOTA-TOC, and DOTA-NOC. The next generation of imaging agents used the positron-emitting isotope Gallium-68 ( 68Ga) bound to either octreotide or octreotate using the DOTA-linker ( 6). Even further delayed imaging is sometimes necessary and the patient is requested to have regular bowel movements during this time (with the use of over-the-counter laxatives if needed) to increase the specificity of the scan. ![]() The imaging protocol is somewhat cumbersome as the radiopharmaceutical injection is followed 24 and (often) 48 h afterward with whole-body planar imaging with or without SPECT/CT. ![]() In-111 allows for gamma-imaging and this has been the mainstay of nuclear imaging of NETs since the 1980s. Women of child bearing potential must have a negative pregnancy test prior to scan.Historically, the first approach to both nuclear imaging and therapy of NETs was with Indium-111 DTPA-octreotide (or In111-pentetreotide Octreoscan TM) ( 5). Pregnant women and/or breastfeeding women.Participants who have undergone 68Ga-dotatate PET scan in the past.Participants with well-differentiated neuroendocrine tumors.(Of note, participants may sign consent for the study prior to scheduling of said CT, MRI or FDG-PET, but will be considered screen failures if the CT/MRI/FDG-PET does not reveal at least 3 tumors >1cm). CT, MRI or Fluorodeoxyglucose (FDG)-PET must have been performed within 2 months of the study scan. Evidence of measurable disease per RECIST 1.1 on another imagine modality (CT, MRI or FDGPET) with at least 3 tumors >1cm in largest diameter.Histologically confirmed diagnosis of poorly-differentiated neuroendocrine carcinoma of the gastroenteropancreatic tract or unknown primary.Stated willingness to comply with all study procedures and availability for the duration of the study.Provision of signed and dated informed consent form.Why Should I Register and Submit Results?. ![]()
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