The role of quantitative tumor burden based on [68 Ga]Ga-DOTA-NOC PET/CT in well-differentiated neuroendocrine tumors: beyond prognosis
- 1 October 2022
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Nuclear Medicine and Molecular Imaging
- Vol. 50 (2), 525-534
- https://doi.org/10.1007/s00259-022-05971-x
Abstract
Purpose We aimed to elucidate the role of quantitative tumor burden based on PET/CT of somatostatin receptors in well-differentiated neuroendocrine tumors (NETs). Methods This study enrolled patients with [68 Ga]Ga-DOTA-NOC PET/CT-positive advanced NETs who did not receive medical treatment prior to PET/CT. Tumor burden was calculated using methods based on the background threshold and relative fixed threshold values (30%, 40%, and 50%). The prognostic value of the measured tumor burden in reference to overall survival (OS) and progression-free survival (PFS) on treatment with octreotide long-acting repeatable (LAR) was assessed using Cox regression analysis, Harrell’s C-index, and survival analysis. A classification and regression tree (CART) was used to determine the optimal threshold for tumor burden. Results A total of 204 patients were included. Somatostatin receptor-expressing tumor volume (SRETV) and liver SRETV derived from a relative fixed threshold of 30% (SRETV30 and liver SRETV30) were statistically significantly associated with OS (C-index: 0.802 [95% confidence interval (CI), 0.658–0.946] and 0.806 [95% CI, 0.664–0.948], respectively). Extrahepatic tumor burden was not correlated with OS (hazard ratio: 0.617, 95% CI: 0.241–1.574, P = 0.312). Among 155 patients with non-functional NETs with a ki-67 index of ≤ 10%, those with a high SRETV30 (P = 0.016) or high liver SRETV30 (P = 0.014) showed statistically significantly worse PFS on treatment with octreotide LAR. Patients receiving a higher dose of octreotide LAR normalized by SRETV30 or liver SRETV30 (a normalized dose or a liver normalized dose) showed prolonged PFS on treatment with octreotide LAR and a prolonged OS. Conclusion Quantitative tumor burden based on [68 Ga]Ga-DOTA-NOC PET/CT was correlated with OS and PFS in patients with non-functional NETs with a ki-67 index of ≤ 10% who received octreotide LAR. Calculating normalized and liver normalized doses may help in selecting the starting dose of octreotide LAR.Keywords
Funding Information
- Basic and Applied Basic Research Foundation of Guangdong Province (2021A1515110241)
This publication has 18 references indexed in Scilit:
- Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United StatesJAMA Oncology, 2017
- Octreotide LAR Dosage and Survival Among Elderly Patients With Distant-Stage Neuroendocrine TumorsThe Oncologist, 2016
- ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary SiteNeuroendocrinology, 2016
- Gastrointestinal neuroendocrine tumors treated with high dose octreotide-LAR: A systematic literature reviewWorld Journal of Gastroenterology, 2015
- Free Somatostatin Receptor Fraction Predicts the Antiproliferative Effect of Octreotide in a Neuroendocrine Tumor Model: Implications for Dose OptimizationCancer Research, 2013
- Comparison of 68Ga-DOTANOC and 68Ga-DOTATATE PET/CT Within Patients with Gastroenteropancreatic Neuroendocrine TumorsJournal of Nuclear Medicine, 2013
- ENETS Consensus Guidelines for the Management of Patients with Liver and Other Distant Metastases from Neuroendocrine Neoplasms of Foregut, Midgut, Hindgut, and Unknown PrimaryNeuroendocrinology, 2012
- Placebo-Controlled, Double-Blind, Prospective, Randomized Study on the Effect of Octreotide LAR in the Control of Tumor Growth in Patients With Metastatic Neuroendocrine Midgut Tumors: A Report From the PROMID Study GroupJournal of Clinical Oncology, 2009
- From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid TumorsJournal of Nuclear Medicine, 2009
- 68Ga-DOTANOC: biodistribution and dosimetry in patients affected by neuroendocrine tumorsEuropean Journal of Nuclear Medicine and Molecular Imaging, 2007