68Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors
68Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors
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DOI：
10.2967/jnumed.109.071712
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发表时间：
2010-05-01
影响因子：
9.3
通讯作者：
Fanti, Stefano
中科院分区：
文献类型：
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作者：
Ambrosini, Valentina;Campana, Davide;Fanti, Stefano
几位作者报道了Ga-68-DOTANOC PET/CT在评估神经内分泌肿瘤(Net)方面优于常规成像(CI)。然而，在检测到更多的病变后，并不一定要修改疾病的分期或治疗方法。本研究的目的是评估Ga-68-DOTANOC PET/CT对Net患者临床管理的影响。方法：本研究包括90例经病理证实的Net患者，在接受Ga-68-DOTANOC PET/CT检查后1个月内进行CT检查，并进行至少1年的随访期，将PET/CT结果与CI结果进行比较。作为最终评估PET结果的参考标准，使用了临床和影像随访数据。为了评估PET结果的临床影响，所有推荐的医生在PET后被联系，并询问患者是如何管理的。独立记录分期或治疗修改，如果PET结果影响治疗或引起疾病分期的变化，则逐个患者评估总体影响。结果：考虑到PET/CT与CI符合的病例(47/90例，占52.2%)，其中17例(36.2%)的PET表现影响了治疗。虽然PET不能改变疾病的分期，但GA-68-DOTANOC在大多数患者中检测到更多的病变数目。90例患者中有42例(46.7%)PET/CT与CI检查结果不一致，其中12例(28.6%)PET改变了分期，32例(76.2%)影响了治疗计划。1例(1/90)PET和CT均不明确。考虑到所有病例，GA-68-DOTANOC PET/CT对90例患者中的50例(55.5%)的分期或治疗有影响。对治疗影响最大的是多肽受体放射性核素治疗的开始或继续，其次是生长抑素类似物治疗的开始或继续(7例)和转诊至外科手术(6例)。在6名患者中，PET避免了不必要的手术，并排除了生长抑素类似物的治疗，2名净病变不表达生长抑素受体的患者。对治疗的影响较小，包括开始放射治疗(1例)、进一步诊断调查(1例)和肝移植(1例)。结论：GA-68-DOTANOC PET/CT在一半以上的患者中影响分期或引起治疗改进，从而证实了PET在治疗Net中的临床作用。
Several authors reported the superiority of Ga-68-DOTANOC PET/CT to conventional imaging (CI) for the assessment of neuroendocrine tumors (NET). However, the detection of a higher number of lesions is not necessarily followed by a modification of disease stage or therapeutic approach. The aim of this study was to assess the impact of Ga-68-DOTANOC PET/CT on the clinical management of NET patients. Methods: The study included 90 patients with pathologic confirmation of NET, CT performed within a month of Ga-68-DOTANOC PET/CT, and a follow-up period of at least 1 y. PET/CT results were compared with CI results. As a standard of reference to finally evaluate PET results, clinical and imaging follow-up data were used. To assess the clinical impact of PET findings, all referring physicians were contacted after PET and asked about how patients were managed. Stage or therapy modifications were independently recorded, and the overall impact was evaluated patient by patient if PET results either affected therapy or caused a change in disease stage. Results: Considering PET/CT and CI concordant cases (47/90 [52.2%]), PET findings affected the therapeutic management in 17 of 47 (36.2%) patients. Although PET did not result in modification of disease stage, Ga-68-DOTANOC detected a higher lesion number in most patients. PET/CT and CI findings were discordant in 42 of 90 (46.7%) patients: PET resulted in a modification of stage in 12 patients (28.6%) and affected the treatment plan in 32 patients (76.2%). PET and CT were both equivocal in 1 patient (1/90). Considering all cases, Ga-68-DOTANOC PET/CT affected either stage or therapy in 50 of 90 (55.5%) patients. The most frequent impact on management (27 patients) was the initiation or continuance of peptide receptor radionuclide therapy, followed by the initiation or continuance of somatostatin analog medical treatment (7 patients) and referral to surgery (6 patients). PET prevented unnecessary surgery in 6 patients and excluded from treatment with somatostatin analogs 2 patients with NET lesions that did not express somatostatin receptors. Less frequent impacts on management included the initiation of radiotherapy (1 patient), further diagnostic investigation (1 patient), and liver transplantation (1 patient). Conclusion: Ga-68-DOTANOC PET/CT either affected stage or caused a therapy modification in more than half the patients, thus confirming the clinical role of PET in the management of NET.