Nucl Med Mol Imaging.  2018 Apr;52(2):119-124. 10.1007/s13139-017-0496-3.

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

Affiliations
  • 1Nuclear Medicine Centre, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia. teikhin.tan@gmail.com
  • 2Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia.

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-DOTApeptide 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.

Keyword

⁶⁸Ga-DOTA-peptide; ⁶⁸Ga-DOTA-TATE; PET/CT; Neuroendocrine tumour

MeSH Terms

Colon
Cross-Sectional Studies
Drug Therapy
Everolimus
Humans
Malaysia
National Cancer Institute (U.S.)
Positron-Emission Tomography and Computed Tomography*
Rectum
Referral and Consultation*
Somatostatin
Stomach
Everolimus
Somatostatin
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