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Long-term follow-up and role of FDG PET in advanced pancreatic neuroendocrine patients treated with 177Lu-D OTATATE

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

An Erratum to this article was published on 02 November 2016

Abstract

Purpose

Lu-DOTATATE (Lu-PRRT) is a valid therapeutic option in differentiated pancreatic neuroendocrine tumors (P-NETs). FDG PET seems to be an important prognostic factor in P-NETs. We evaluated the efficacy of Lu-PRRT and the role of FDG PET in 60 patients with advanced P-NETs.

Methods

From March 2008 to June 2011, 60 consecutive patients with P-NETs were enrolled in the study. Follow-up lasted until March 2016. Eligible patients were treated with two different total cumulative activities (18.5 or 27.8 GBq in 5 cycles every 6–8 weeks), according to kidney and bone marrow parameters.

Results

Twenty-eight patients received a mean full activity (FA) of 25.9 GBq and 32 a mean reduced activity (RA) of 18.5 GBq. The disease control rate (DCR), defined as the sum of CR+PR+SD was 85.7 % in the FA group and 78.1 % in the RA group. Median progression-free survival (mPFS) was 53.4 months in the FA group and 21.7 months in the RA group (P = 0.353). Median overall survival (mOS) was not reached (nr) in FA patients and was 63.8 months in the RA group (P = 0.007). Fifty-five patients underwent an FDG PET scan before Lu-PRRT, 32 (58 %) showing an increased FDG uptake in tumor sites. mPFS was 21.1 months in FDG PET-positive patients and 68.7 months in the FDG PET-negative group (P < 0.0002), regardless of the total activity administered.

Conclusion

Both FA and RA are active in patients undergoing Lu-PRRT. However, an FA of 27.8 GBq of Lu-PRRT prolongs PFS and OS compared to an RA of 18.5 GBq. Our results indicate that FDG PET is an independent prognostic factor in this patient setting.

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Acknowledgments

The authors thank Cristiano Verna for editorial assistance. We also thank Monica Golinucci and the other members of the Nuclear Medicine and Radiometabolic Medicine Unit team for support and assistance.

Authors’ contributions

Study concept and design: Maddalena Sansovini

Provision of study materials or patients: Sansovini Maddalena, Severi Stefano, Ianniello Annarita, Nicolini Silvia, Alberto Bongiovanni, Sara Cingarlini, Chiara Grana, Lisa Bodei

Collection and assembly of data: From March 2008 to June 2011

Diagnostic and therapeutic imaging: Lorenzo Fantini, Fabio Ferroni

Quality control and gamma camera calibration: Emilio Mezzenga

Data management: Manuela Monti

Analysis and interpretation of data: Giovanni Paganelli, Emanuela Scarpi, Maddalena Sansovini

Drafting of manuscript: Maddalena Sansovini

Critical revision of the manuscript for important intellectual content: Giovanni Paganelli, Lisa Bodei

All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Maddalena Sansovini, Stefano Severi, Annarita Ianniello, Silvia Nicolini, Lorenzo Fantini & Giovanni Paganelli

  2. Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Emilio Mezzenga

  3. Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Fabio Ferroni

  4. Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Emanuela Scarpi & Manuela Monti

  5. Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Alberto Bongiovanni

  6. Department of Oncology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, Verona, Italy

    Sara Cingarlini

  7. Division of Nuclear Medicine, European Institute of Oncology Milan (IEO), Milan, Italy

    Chiara Maria Grana & Lisa Bodei

Authors
  1. Maddalena Sansovini
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  2. Stefano Severi
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  9. Manuela Monti
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  11. Sara Cingarlini
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  14. Giovanni Paganelli
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Corresponding author

Correspondence to Giovanni Paganelli.

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Funding

This study was partially supported by AIRC – Associazione Italiana per la Ricerca sul Cancro (grant number: IG10679).

Conflict of interest

None.

Ethical approval

The protocol was approved by the Ethics Committee of Area Vasta Romagna and by the competent Italian regulatory authorities. The study was performed in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki.

Informed consent

All patients gave their written informed consent.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00259-016-3558-3.

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Sansovini, M., Severi, S., Ianniello, A. et al. Long-term follow-up and role of FDG PET in advanced pancreatic neuroendocrine patients treated with 177Lu-D OTATATE. Eur J Nucl Med Mol Imaging 44, 490–499 (2017). https://doi.org/10.1007/s00259-016-3533-z

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  • DOI: https://doi.org/10.1007/s00259-016-3533-z

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