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Gordon S, Chan DLH, Bernard EJ, Eslick ME, Willowson KP, Roach PJ, Engel AF, Maher R, Clarke SJ, Agarwal V, Yasmin L, De Silva M, Mascall S, Conner A, Nevell D, Pavlakis N, Bailey DL. Single-centre experience with peptide receptor radionuclide therapy for neuroendocrine tumours (NETs): results using a theranostic molecular imaging-guided approach. J Cancer Res Clin Oncol 2023; 149:7717-7728. [PMID: 37004598 PMCID: PMC10374703 DOI: 10.1007/s00432-023-04706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
AIM To summarise our centre's experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy. METHODS We describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks. RESULTS In the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28-87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence. CONCLUSIONS LUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.
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Affiliation(s)
- S Gordon
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia
| | - D L H Chan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - E J Bernard
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - M E Eslick
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - K P Willowson
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - P J Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - A F Engel
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, Australia
| | - R Maher
- Department of Medical Imaging, Royal North Shore Hospital, Sydney, Australia
| | - S J Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - V Agarwal
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia
| | - L Yasmin
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - M De Silva
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - S Mascall
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - A Conner
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - D Nevell
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
| | - N Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - D L Bailey
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia.
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia.
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
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