Post-therapy imaging of 225 Ac-DOTATATE treatment in a patient with recurrent neuroendocrine tumor
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IMAGE OF THE MONTH
Post-therapy imaging of 225Ac-DOTATATE treatment in a patient with recurrent neuroendocrine tumor Meltem Ocak 1
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Türkay Toklu 2
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Emre Demirci 2
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Nalan Selçuk 2
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Levent Kabasakal 2,3
Received: 17 December 2019 / Accepted: 14 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Several somatostatin receptor-targeted alpha radionuclide treatments have been introduced, including 225 AcDOTATATE for advanced progressive metastatic neuroendocrine tumors (NET) [1–4]. Here we present a 70year-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 This article is part of the Topical Collection on Image of the month * Levent Kabasakal [email protected] Meltem Ocak [email protected] Türkay Toklu [email protected] Emre Demirci [email protected] Nalan Selçuk [email protected] 1
Department of Pharmaceutical Technology, Pharmacy Faculty, Istanbul University, Süleymaniye, 7-1, Fatih, 34116 İstanbul, Turkey
2
Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University School of Medicine, Koşuyolu Mah. Koşuyolu Cad. No: 168, Kadıköy, 34718 İstanbul, Turkey
3
Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Aksaray Istanbul, Turkey
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 68GaDOTATATE 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 225 Ac-DOTATATE in the mass lesion, concordant with 68 Ga-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-225DOTATATE treatment, these images encourage this type of treatment in patients with NETs.
Eur J Nucl Med Mol Imaging
Compliance with ethical standards The authors declare that they have no conflict of interest. Written informed consent was obtained from the patient for the treatment procedure and for data publication. All procedures performed in studies involving human participants were in accordance with the ethical sta
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