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Impact of 68Ga-DOTA-Peptide PET/CT on the Management of Gastrointestinal Neuroendocrine Tumour (GI-NET): Malaysian National Referral Centre Experience

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Abstract

Purpose

The National Cancer Institute is the only referral centre in Malaysia that provides 68Ga-DOTA-peptide imaging. The purpose of this study is to determine the impact of 68Ga-DOTA-peptide PET/CT on the management of gastrointestinal neuroendocrine tumours (GI-NET).

Materials and Methods

A cross-sectional study was performed to review the impact of 68Ga-DOTA-peptide (68Ga-DOTATATE or 68Ga-DOTATOC) PET/CT on patients with biopsy-proven GI-NET between January 2011 and December 2015. Suspected NET was excluded. Demographic data, tumoral characteristics, change of disease stage, pre-PET intended management and post-PET management were evaluated.

Results

Over a 5-year period, 82 studies of 68Ga-DOTA-peptide PET/CT were performed on 44 GI-NET patients. The most common primary site was the rectum (50.0%) followed by the small bowel, stomach and colon. Using WHO 2010 grading, 40.9% of patients had low-grade (G1) tumour, 22.7% intermediate (G2) and 4.5% high (G3). Of ten patients scheduled for pre-operative staging, 68Ga-DOTA-peptide PET/CT only led to therapeutic change in three patients. Furthermore, false-negative results of 68Ga-DOTA-peptide PET/CT were reported in one patient after surgical confirmation. However, therapeutic changes were seen in 20/36 patients (55.6%) scheduled for post-surgical restaging or assessment of somatostatin analogue (SSA) eligibility. When 68Ga-DOTA-peptide PET/CT was used for monitoring disease progress during systemic treatment (sandostatin, chemotherapy, everolimus and PRRT) in metastatic disease, impact on management modification was seen in 19/36 patients (52.8%), of which 84.2% had inter-modality change (switch to everolimus, chemotherapy or PRRT) and 15.8% had intra-modality change (increased SSA dosage).

Conclusions

68Ga-DOTA-peptide PET/CT has a significant impact on management decisions in GI-NET patients as it can provide additional information on occult metastasis/equivocal lesions and supply the clinician an opportunity to select patients for targeted therapy.

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Acknowledgments

We are grateful to Dr. Asmayani Khalib and all our staff for their assistance in this study. We also thank the Director General of the Ministry of Health of Malaysia for permission to publish this paper.

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Authors and Affiliations

  1. Nuclear Medicine Centre, Sunway Medical Centre, No 5, Jalan Lagoon Selatan, 74500, Bandar Sunway, Selangor, Malaysia

    Teik Hin Tan

  2. Department of Nuclear Medicine, National Cancer Institute, No 4, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia

    Ching Yeen Boey & Boon Nang Lee

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  1. Teik Hin Tan
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  2. Ching Yeen Boey
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Correspondence to Teik Hin Tan.

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Conflicts of Interest

Teik Hin Tan, Ching Yee Boey and Boon Nang Lee declare that they have no conflicts of interest.

Ethics Statement

Informed consent was obtained from all patients for being included in the study. This study is approved by the local ethics committee.

Ethics Approval

All procedures performed in studies were in accordance with the ethical standards of the national Medical Research and Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

This retrospective study was approved by the national ethics committee, and the requirement to obtain informed consent was waived.

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Tan, T.H., Boey, C.Y. & Lee, B.N. Impact of 68Ga-DOTA-Peptide PET/CT on the Management of Gastrointestinal Neuroendocrine Tumour (GI-NET): Malaysian National Referral Centre Experience. Nucl Med Mol Imaging 52, 119–124 (2018). https://doi.org/10.1007/s13139-017-0496-3

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  • DOI: https://doi.org/10.1007/s13139-017-0496-3

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