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Visual and whole-body quantitative analyses of 68 Ga-DOTATATE PET/CT for prognosis of outcome after PRRT with 177Lu-DOTATATE

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Abstract

Background

Somatostatin receptors (SSTR) represent an ideal target for nuclear theranostics applications in neuroendocrine tumors (NET). Studies suggest that high uptake on SSTR-PET is associated with response to SSTR peptide receptor radionuclide therapy (PRRT). The purpose of this study was to evaluate the role of baseline whole-body (WB) 68 Ga-DOTATATE PET/CT (SSTR-PET) quantitative parameters, and the presence of NET lesions without uptake on SSTR-PET, as outcome prognosticator in patients with NET treated with PRRT.

Methods

Patients with NET who underwent at least 4 177Lu-DOTATATE PRRT cycles between 07/2016 and 03/2021 were included in this retrospective analysis if they fulfilled the following inclusion criteria: SSTR-PET within 6 months of 1st PRRT cycle, follow-up CT and/or MRI performed > 6 months after the 4th cycle of PRRT. The SSTR-PET analysis consisted of a visual and a quantitative analysis done independently by two board-certified physicians. The visual analysis assessed the presence of NET lesions visible on the SSTR-PET co-registered CT. The quantitative analysis consisted in contouring all SSTR-avid lesions on SSTR-PET and extracting WB quantitative parameters: SUVmean (WB-SUVmean), SUVmax of the lesion with highest uptake (H-SUVmax), and tumor volume (WB-TV). WB-SSTR-PET parameters and the presence of SSTR-PET-negative lesions were correlated to radiologic response (assessed by RECIST 1.1 criteria) and progression-free survival (PFS). Fisher’s exact test, Mann–Whitney’s U test and Kaplan–Meier curves with Cox-regression analysis were used for the statistical analysis.

Results

Forty patients (F/M: 21/19; 34/40 with gastro-entero-pancreatic (GEP) NET, 6/40 with non-GEP NET) were included in the analysis. The median follow-up period after the 4th PRRT cycle was 25.7 months (range 15.2–59.1). Fourteen/40 (35%) patients showed radiologic response (RECIST PR). PFS event was observed in 17/40 (42.5%) patients. Thirteen/40 (32.5%) patients had SSTR-PET-negative lesions at baseline. Higher WB-SUVmean and H-SUVmax were associated with better response (p = 0.015 and 0.005, respectively). The presence of SSTR-PET-negative lesions and lower WB-SUVmean were associated with shorter PFS (p = 0.026 and 0.008, respectively).

Conclusion

Visual and quantitative analyses of baseline SSTR-PET can yield valuable information to prognosticate outcomes after 177Lu-DOTATATE PRRT.

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Author notes

  1. Masatoshi Hotta and Ida Sonni contributed equally to this work.

Authors and Affiliations

  1. Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA

    Masatoshi Hotta, Ida Sonni, Pan Thin, Kathleen Nguyen, Linda Gardner, Liliana Ciuca, Artineh Hayrapetian, Meredith Lewis, David Lubin & Martin Allen-Auerbach

  2. Department of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan

    Masatoshi Hotta

  3. Department of Radiological Sciences, University of California, Los Angeles, CA, USA

    Ida Sonni

  4. Department of Experimental and Clinical Medicine, University Magna Graecia, Catanzaro, Italy

    Ida Sonni

  5. Department of Radiology at, University of South Alabama Hospital, Mobile, South AL, USA

    Artineh Hayrapetian

  6. Department of Radiology at Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA

    Meredith Lewis

  7. Department of Radiology, Nuclear Medicine, University Hospital, SUNY Upstate, Syracuse, NY, USA

    David Lubin

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  1. Masatoshi Hotta
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Hotta, M., Sonni, I., Thin, P. et al. Visual and whole-body quantitative analyses of 68 Ga-DOTATATE PET/CT for prognosis of outcome after PRRT with 177Lu-DOTATATE. Ann Nucl Med 38, 296–304 (2024). https://doi.org/10.1007/s12149-023-01899-w

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