Theranostics 2012; 2(5):448-458. doi:10.7150/thno.3931


Molecular Imaging Radiotherapy: Theranostics for Personalized Patient Management of Neuroendocrine Tumors (NETs)

Kjell Öberg1,2✉

1. Department of Medical Sciences, Uppsala University;
2. Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden

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Öberg K. Molecular Imaging Radiotherapy: Theranostics for Personalized Patient Management of Neuroendocrine Tumors (NETs). Theranostics 2012; 2(5):448-458. doi:10.7150/thno.3931. Available from

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Neuroendocrine tumors (NETs) possess unique features including expression of peptide hormone receptors as well as the capacity to concentrate and take up precursor forms of amines and peptides making hormones that are stored in secretory granules within the tumor cells (APUD). The expression of somatostatin receptors on tumor cells have been widely explored during the last two decades starting with 111In-DTPA-Octreotide as an imaging agent followed by 68Ga-DOTATOC/TATE positron emission tomography scanning. The new generation of treatment includes 90Yttrium-DOTATOC/DOTATATE as well as 177Lutetium-DOTATOC/DOTATATE/DOTANOC treatment of various subtypes of NETs. The objective response rate by these types of PRRT is in the range of 30-45% objective responses with 5-10% grade 3/4 toxicity mainly hematologic and renal toxicity. The APUD mechanism is another unique feature of NETs which have generated an interest over the last two decades to develop specific tracers including 11C-5HTP, 18F-DOPA and 11C-hydroxyefedrin. These radioactive tracers have been developed in centres with specific interest in NETs and are not available everywhere. 111In-DTPA-Octreotide is still the working horse in diagnosis and staging of metastatic NETs, but will in the future be replaced by 68Ga-DOTATOC/DOTATATE PET/CT scanning which provide higher sensitivity and specificity and is also more convenient for the patient because it is a one-stop-procedure. Both 90Yttrium-DOTATOC/DOTATATE as well as 177Lutetium-DOTATOC/DOTATATE are important new therapies for malignant metastatic NETs. However, the precise role in the treatment algorithm has to be determined in forthcoming randomized trials.

Keywords: PRRT, theranostics, 111In-DTPA-Octreotide, 68Ga-DOTATOC/TATE, 90Yttrium-DOTATOC, 177Lutetium-DOTATOC/DOTATATE