title: Initial Experience With Gallium-68 DOTA-Octreotate PET/CT and Peptide Receptor Radionuclide Therapy for Pediatric Patients With Refractory Metastatic Neuroblastoma.
abstract: BACKGROUND
  Pediatric patients with refractory neuroblastoma have limited therapeutic options. Neuroblastoma may express somatostatin receptors (SSTRs) allowing imaging with 68Ga-DOTA-Octreotate (GaTATE) positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT). We reviewed our experience with this theranostic combination.
  
  
  METHODS
  GaTATE studies (8 patients; 2 to 9 years old) were reviewed and compared with 123I-MIBG or posttreatment 131I-MIBG studies. Immunohistochemistry (IHC) for SSTR subtype 2 was performed in 5 patients. Four patients received PRRT.
  
  
  RESULTS
  GaTATE PET showed additional disease in 38% (3/8 patients), and upstaged 1 patient by detecting marrow involvement. IHC detected SSTR 2 in all patients assessed. Six patients were deemed suitable for PRRT on imaging. Four patients received 17 cycles of palliative PRRT (10 111In-DOTATATE; 5 177Lu-DOTATATE; 1 combined 111In and 177Lu-DOTATATE; 1 combined 177Lu and 90Y-DOTATATE) with no significant toxicity attributed to PRRT. All had objective responses. Two survivors are now 40 and 56 months from PRRT commencement.
  
  
  CONCLUSIONS
  GaTATE PET was positive in a high proportion of patients with refractory neuroblastoma, correlating with SSTR 2 on IHC, with additional disease identified compared with MIBG imaging. PRRT seems safe, feasible, with responses observed in patients with progression despite multimodality treatment. These data support ongoing clinical trials in such patients.
authors: *Centre for Cancer Imaging ‡Department of Pathology ∥Translational Research Laboratory, Peter MacCallum Cancer Centre §Children's Cancer Centre, Monash Health, Victoria ¶Department of Paediatrics, Monash University #Children's Cancer Centre, Royal Children's Hospital Melbourne, Melbourne †Department of Medicine **The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Parkville, Vic., Australia.
authors: Grace
authors: G
authors: Kong
authors: Michael S
authors: MS
authors: Hofman
authors: William K
authors: WK
authors: Murray
authors: Sharyn
authors: S
authors: Wilson
authors: Paul
authors: P
authors: Wood
authors: Peter
authors: P
authors: Downie
authors: Leanne
authors: L
authors: Super
authors: Annette
authors: A
authors: Hogg
authors: Peter
authors: P
authors: Eu
authors: Rodney J
authors: RJ
authors: Hicks
mesh_terms: D019797:3-Iodobenzylguanidine; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D064847:Multimodal Imaging; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D017481:Receptors, Somatostatin / Q000032:analysis / Q000096:biosynthesis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: C499964:111In-octreotate, DOTA(0)-Tyr(3)-Thr(8)-; C539274:90Y-octreotate, DOTA(0)-Tyr(3)-Thr(8)-; D000970:Antineoplastic Agents; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C574734:SSTR2 protein, human; D019797:3-Iodobenzylguanidine; C513399:gallium Ga 68 dotatate; C447941:lutetium Lu 177 dotatate; D015282:Octreotide