PRRT evidence for neuroendocrine tumours — NETTER-1 / NETTER-2 / NETTER-P / first-line questions. Curated daily from Europe PMC (PubMed + PMC + preprints) and OpenAlex — free-full-text link on each open-access paper.
Peptide Receptor Radionuclide Therapy (PRRT) Lu-177 DOTATATE resistance in well-differentiated Grade 3 Neuroendocrine Tumors (NETs) is a type of acquired therapeutic resistance in well differentiated tumors involving downregulation of SSTR2 receptors on their surface rendering Lu-177 DOTATATE therapy ineffective as Lu-177 DOTATATE specifically targets SSTR2 receptor mostly over…
The application of artificial intelligence (AI) in positron emission tomography (PET)-based internal dosimetry in radiopharmaceutical therapy (RPT), with an emphasis on the paradigm shift from resource-consuming multi-time-point acquisition protocols toward efficient data-driven dosimetric frameworks. Machine learning (ML) models capable of determining organ- and patient-specif…
Leonardo Lampertico, Gaia Muti, C. Carbonini, Chiara Romanò et al.
The accuracy of quantitative lutetium-177 single-photon emission computed tomography/computed tomography (¹⁷⁷Lu SPECT/CT) depends on the imaging system, acquisition protocol, reconstruction algorithm, and calibration strategy. This study aimed to develop and evaluate a practical commissioning workflow to optimize ¹⁷⁷Lu imaging across different commercial scanner–reconstruction …
Nationwide real-world data on neuroendocrine tumors (NETs) remain limited in Japan because of their heterogeneous clinical presentation and indolent disease course. Over the past decade, treatment strategies for NETs have expanded substantially, encompassing somatostatin analogs, molecular targeted agents, cytotoxic chemotherapy, and radioligand therapy. Large-scale administrat…
Christopher Montemagno, Benjamín Serrano, Benoît Paulmier
Theranostics occupies a unique position in oncology because the same molecular target simultaneously enables disease visualization and therapeutic delivery. Unlike most anticancer strategies, where biomarkers primarily determine treatment eligibility, theranostic targets directly connect molecular imaging with targeted radionuclide therapy, making them the biological foundation…
Daniela Di Carlo, Giulia Fichera, Benoît Dumont, Enrico Pozzo et al.
Pediatric very rare tumors (VRTs) are a highly heterogeneous group of neoplasms defined by an annual incidence of <2 cases per million children under 18 years. Their rarity precludes prospective clinical trials, resulting in limited evidence-based guidelines and largely individualized treatment approaches. Olfactory neuroblastoma (ON) is an exceptionally rare pediatric VRT aris…
Our results show the exposures throughout the course of treatment are well below the Nuclear Regulatory Commission release criteria of 500 mrem. Thus, patients pose little risk in terms of radiation safety to staff and the public during and after their infusions.
Aramis Raiola, Fabio Acerbi, Cyril Martin Alispach, Domenico della Volpe et al.
Abstract Background The POSiCS camera is a handheld and wireless, small field-of-view gamma camera developed for use in radio-guided surgery (RGS), with sentinel lymph node biopsy (SLNB) as its benchmark application. This compact and lightweight detector (about $$350\,\textrm{g}$$ ) maps tissues labeled with a $${^{99m}\hbox {Tc}}$$ radiotracer to highlight target lesions. By e…
Al-Ramadhani AQM, Şenışık AM, Kovan B, Mutlu E et al.
Quantitative post-therapy 177Lu SPECT depends on reliable attenuation correction. For centers without SPECT/CT, CT-free Chang attenuation correction is feasible, but its dependence on emission-derived body-contour thresholding requires validation. Twenty patients treated with 177Lu-DOTATATE underwent SPECT/CT at 4, 24, 48, and 96 h, with three consecutive SPECT acquisitions per…
Peptide receptor radionuclide therapy (PRRT) is an emerging and promising targeted treatment for aggressive pituitary neuroendocrine tumours (PitNETs) and pituitary carcinomas refractory to conventional therapies. Its use is supported by the frequent expression of somatostatin receptors (SSTR), predominantly SSTR2, in pituitary tumour cells, enabling selective delivery of β-emi…
Bakr H, Al-Awar A, Spetz JK, Forssell-Aronsson EB.
Gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are the most common subtype of NETs, and their incidence continues to increase worldwide. Many NETs express somatostatin receptors (SSTRs), enabling molecular imaging and treatment with radiolabeled somatostatin analogs (SSTAs). [177Lu]Lu-DOTATATE is an established treatment for advanced SSTR-positive NETs, but complete …
PurposeTo evaluate the feasibility, safety and preliminary efficacy of dual-targeted radioligand therapy combining [177Lu]Lu-DOTATATE and [177Lu]Lu-DOTA-IBA in patients with bone metastases from neuroendocrine neoplasms (NENs).MethodsThis prospective, single-center, single-arm study enrolled 30 patients with bone metastases from NENs to receive combined [177Lu]Lu-DOTATATE and […
Warfvinge CF, Kapidzic SC, Gustafsson J, Jessen L et al.
[177Lu]Lu-DOTATATE is an established treatment for metastasized neuroendocrine tumors (NETs). It is postulated that a higher tumor absorbed dose (AD) improves clinical efficacy. The aim of this study was to assess the average AD of the entire tumor burden and analyze its effect on survival outcomes. Methods: This post hoc analysis included 81 patients with metastasized grade 1 …
Schwengber WK, Sanders J, Pinteric A, Armitage L et al.
Radiopharmaceutical therapy (RPT) uses radionuclides linked to targeting ligands to bind tumor-associated receptors or antigens and deliver ionizing radiation to malignant cells. Approved agents include [177Lu]Lu-DOTATATE for gastroenteropancreatic neuroendocrine tumors, [177Lu]Lu-PSMA-617 for metastatic castration-resistant prostate cancer, and 223Ra-dichloride for bone-predom…
The aim of this retrospective study is to analyze the outcome and survival of patients with well-differentiated metastatic neuroendocrine neoplasm (NEN) treated with peptide receptor radionuclide therapy (PRRT). The treatment was applied to 32 subjects, 18 men and 14 women, aged 39-79 years (median 65 years). The dominant grade of the tumor according to the Ki-67 index was G2 (…
Bagasariya R, Parghane RV, Shetty N, Gala K et al.
BackgroundGastroenteropancreatic neuroendocrine tumors (GEP-NETs) demonstrating liver-dominant inoperable metastatic diseases or locally advanced inoperable tumors may at times show reduced efficacy for intravenous peptide receptor radionuclide therapy (PRRT).Aims and objectivesTo determine and compare the outcome of intra-arterial [ 177 Lu]Lu-DOTATATE PRRT in GEP-NET with loca…
GateWay Community College's Bachelor of Applied Science in Nuclear Medicine Technology and Computed Tomography program developed a simulation-based curriculum framework in response to clinical partner feedback on entry-level preparation gaps in radiopharmaceutical therapy. Part 1 of this series described the outreach process and the themes that emerged from the 6 respondents, d…
The β--emitter 161Tb is emerging as a promising radionuclide for radiopharmaceutical therapy because of its increased yield of low-energy electrons compared with 177Lu. This results in an increased localized absorbed dose, potentially influencing nephrotoxicity with 161Tb. Because of the excretion and reabsorption in specific kidney tissues of radiopharmaceuticals, substructure…
BackgroundNeuroblastoma is an aggressive paediatric malignancy with poor outcomes in high-risk patients despite multimodal therapy. [177Lu]Lu-DOTATATE, targeting somatostatin receptor 2 (SSTR2), is under clinical investigation for neuroblastoma. Terbium-161 (161Tb) shares chemical characteristics and a similar half-life with lutetium-177 (177Lu) but offers advantages through it…
Objective¹⁷⁷Lu is an approved radionuclide for targeted radionuclide therapy (TRT), first established with ¹⁷⁷Lu-DOTATATE for neuroendocrine tumors, and subsequently with PSMA-targeted therapy. The widespread adoption of these therapies is expected to substantially increase radioactive waste generation. The long-lived isomer ¹⁷⁷ᵐLu, present as an impurity in ¹⁷⁷Lu preparations,…
Ytterbrink C, Pettersson D, Shubbar E, Helou K et al.
Patients with neuroendocrine tumours may receive higher total amount of [177Lu]Lu-DOTA-(Tyr3)-octreotate and achieve better tumor control if the risk of kidney toxicity could be predicted individually for each patient. One strategy for such a prediction includes the evaluation of early responding biomarkers for kidney damage during treatment to decide the number of treatment cy…
Hernandez-Felix JH, Golagha M, Jha A, Varghese D et al.
Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors of neural crest origin that exhibit wide clinical and biological heterogeneity. While surgical resection remains the only curative option, many patients have unresectable or metastatic progressive disease and/or with uncontrolled secretion requiring alternative management strategies. Advances in genetic…
Hernandez-Felix JH, Lagana M, Cosentini D, Tacchetti MC et al.
Adrenal malignancies include adrenocortical carcinoma (ACC) and pheochromocytoma/paraganglioma (PPGL), rare endocrine tumors that share an adrenal or extra-adrenal location but differ substantially in origin, hormonal activity, molecular alterations, metastatic potential, and systemic treatment. In ACC, management is guided by stage, resectability, Ki-67, hormone secretion, tum…
ObjectiveAs the incidence of neuroendocrine tumors (NETs) increases, Lutetium-177 (Lu-177) DOTATATE targeted radionuclide therapy (TRT) has become a vital treatment strategy. However, its prolonged course makes early prediction of response challenging, and current predictive methods like dosimetry are complex. Therefore, a simpler, earlier prediction method is needed for timely…
Somatostatin receptor therapy (SSRT) with [177Lu]Lu-oxodotreotide is an established treatment for metastatic neuroendocrine tumours. However, radiation protection guidelines for patients with stomas remain insufficiently addressed, particularly regarding the handling and disposal of contaminated stoma pouches. In this prospective study, three patients with established stomas un…
Al-Ibraheem A, Moghrabi S, Al-Houwari RM, Al-Qasem S et al.
Radiotheranostics is reshaping precision oncology by integrating molecular imaging with targeted radionuclide therapy through matched diagnostic-therapeutic radiopharmaceutical pairs. Landmark clinical successes, including Lutetium-177-DOTATATE (177Lu-DOTATATE) and 177Lu-prostate-specific membrane antigen-617 (177Lu-PSMA-617), have validated this approach and accelerated the sh…
Shabestani Monfared A, Peer-Firozjaei M, Deevband MR, Amiri M et al.
Purpose.We aimed to evaluate the variability of tumor absorbed dose rate at 24 h post-injection across multiple cycles of177Lu-DOTATATE therapy. Using patient-specific Monte Carlo (MC) simulations, we quantified cycle-dependent variations in tumor absorbed dose rate and explicitly separated self- and cross-irradiation contributions.Methods.Five patients, with neuroendocrine tum…
BackgroundThe use of peptide receptor radionuclide therapy (PRRT) is well established in the treatment of advanced or unresectable neuroendocrine tumours (NETs) after progression on somatostatin analogues (SSA), with randomised clinical trials such as NETTER-1 and NETTER-2 showing improvement in progression free survival (PFS) as well as tumour response [12, 13]. Current landma…
Abstract Objective To identify factors associated with early achievement of radiation safety discharge criteria following Lu-177 DOTATATE therapy and to evaluate longitudinal changes in renal function and hematological parameters in clinical practice. Methods This retrospective single-center study included patients with neuroendocrine tumors who received Lu-177 DOTATATE therapy…
In the last decade, fibroblast activation protein-α inhibitors (FAPIs), which target the cancer-associated fibroblasts of the tumour microenvironment, have become a topic of great interest. In oncology, FAPI PET/CT imaging has repeatedly demonstrated a higher lesion detection rate than other conventional imaging modalities such as CT or 18F-FDG PET/CT for several tumours. In so…
Fotou E, Apostolopoulou A, Bika CG, Giannakopoulou M et al.
Brain tumor therapy remains limited by the blood-brain barrier (BBB), which restricts drug access. BBB-penetrating peptides offer a promising strategy for delivering therapeutic and diagnostic payloads. Angiopep-2 is a well-established vector, yet novel radioconjugates based on this vector remain of interest. We report the synthesis and evaluation of DOTA-Angiopep-2 for radiola…
AimTo evaluate and compare the diagnostic performance of [68Ga]Ga-DOTA-FAPI-04 with [18F]F-FDG and [68Ga]Ga-DOTATATE PET/CT for detecting recurrent disease in patients with medullary thyroid carcinoma (MTC) and additionally evaluate their role for prognostication and theranostics in management of MTC.MethodsIn this prospective single-centre study, 56 patients with suspected rec…
Both hardware and software developments have seen single photon emission CT (SPECT)/X-ray CT technology grow at a rapid rate. Such growth has been fuelled by the need for clinical applications and has provided inspiration for clinical developments, particularly with the expanding role of theranostics. Developments such as whole-body quantitative reconstructions, digital detecto…
The field of radiopharmaceuticals and therapies is currently rapidly increasing. However, there is no consensus about how to address the expected shortage of qualified personnel to deliver such therapies. This commentary gives an overview of the current situation in different exemplary jurisdictions and also tries to show possible paths forward and how to prepare the upcoming p…
BackgroundTerbium-161 (Tb-161) emits gamma rays and beta radiation, enabling both therapeutic and imaging applications. However, the multiple gamma emissions of 161Tb can affect image quality by increasing the scattering rate during SPECT imaging. To improve image quality, appropriate scatter correction methods, such as Dual-Energy Window (DEW) and Triple-Energy Window (TEW) ne…
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