02.03.2020 | Image of the Month
Post-therapy imaging of 225Ac-DOTATATE treatment in a patient with recurrent neuroendocrine tumor
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 11/2020
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Several somatostatin receptor-targeted alpha radionuclide treatments have been introduced, including 225Ac-DOTATATE for advanced progressive metastatic neuroendocrine tumors (NET) [1‐4]. Here we present a 70-year-old man with advanced gastric NET. The patient has a history of gastrectomy and previously treated with multiple cycles of 177Lu-DOTATATE in 7 years with a cumulative dose of 48 GBq. Disease responded partially to the previous 177Lu-DOTATATE treatments except the last cycle. Patient progressed under the sunitinib treatment and could not tolerate the evorolimus. Maximum intensity projection (MIP) and fusion image of 68Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) show a large mass lesion in the operative bed with high uptake, consistent with progressive disease. Patient was treated with 7 MBq 225Ac-DOTATATE. The post-therapy images were acquired 24 h after the therapy with single-photon emission computed tomography (SPECT)/CT system (Discovery 670, GE). High-energy general-purpose (HEGP) collimators were used for both whole-body and SPECT scan. Both scans were acquired by using 218-keV and 440-keV photon energies with 20% window width. SPECT/CT scan was acquired with 60 projections for 60 s by using 64 × 64 matrix. Whole-body and SPECT/CT images show increased accumulation of 225Ac-DOTATATE in the mass lesion, concordant with 68Ga-DOTATATE PET/CT. The patient responded to treatment clinically and melena stopped 1 week after the treatment. These are the first whole-body and SPECT/CT images which demonstrates high uptake of Ac-225-DOTATATE in tumor tissue. Although there is not enough experience published on use of Ac-225-DOTATATE treatment, these images encourage this type of treatment in patients with NETs. …Anzeige