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- Title
Metastatic Medullary Thyroid Cancer: The Role of 68Gallium-DOTA-Somatostatin Analogue PET/CT and Peptide Receptor Radionuclide Therapy.
- Authors
Hayes, Aimee R.; Crawford, Alexander; Al Riyami, Khulood; Tang, Christine; Bomanji, Jamshed; Baldeweg, Stephanie E.; Wild, Damian; Morganstein, Daniel; Harry, Alice; Grozinsky-Glasberg, Simona; Oleinikov, Kira; Khoo, Bernard; Caplin, Martyn E.; Nicolas, Guillaume P.; Grossman, Ashley B.
- Abstract
<bold>Context: </bold>Metastatic medullary thyroid cancer (MTC) is a rare malignancy with minimal treatment options. Many, but not all, MTCs express somatostatin receptors.<bold>Objective: </bold>Our aim was to explore the role of 68Ga-DOTA-somatostatin analogue (SSA) positron emission tomography (PET)/computed tomography (CT) in patients with metastatic MTC and to determine their eligibility for peptide receptor radionuclide therapy (PRRT).<bold>Methods: </bold>We retrospectively identified patients with metastatic MTC who had 68Ga-DOTA-SSA PET/CT at 5 centers. We collected characteristics on contrast-enhanced CT, 68Ga-DOTA-SSA and 18F-FDG PET/CT. The efficacy of PRRT was explored in a subgroup of patients. Kaplan-Meier analysis was used to estimate time to treatment failure (TTF) and overall survival (OS).<bold>Results: </bold>Seventy-one patients were included (10 local recurrence, 61 distant disease). Of the patients with distant disease, 16 (26%) had ≥50% of disease sites with tracer avidity greater than background liver, including 10 (10/61, 16%) with >90%. In 19 patients with contemporaneous contrast-enhanced CT, no disease regions were independently identified on 68Ga-DOTA-SSA PET/CT. Thirty-five patients had an 18F-FDG PET/CT, with 18F-FDG positive/68Ga-DOTA-SSA negative metastases identified in 15 (43%). Twenty-one patients had PRRT with a median TTF of 14 months (95% CI 8-25) and a median OS of 63 months (95% CI 21-not reached). Of the entire cohort, the median OS was 323 months (95% CI 152-not reached). Predictors of poorer OS included a short calcitonin doubling-time (≤24 months), strong 18F-FDG avidity, and age ≥60 years.<bold>Conclusions: </bold>The prevalence of high tumor avidity on 68Ga-DOTA-SSA PET/CT is low in the setting of metastatic MTC; nevertheless, PRRT may still be a viable treatment option in select patients.
- Subjects
THYROID cancer; SOMATOSTATIN; COMPUTED tomography; RESEARCH; THYROID gland tumors; RESEARCH methodology; CELL receptors; PROGNOSIS; RETROSPECTIVE studies; MEDICAL cooperation; EVALUATION research; ORGANOMETALLIC compounds; COMPARATIVE studies; NEUROENDOCRINE tumors; LONGITUDINAL method
- Publication
Journal of Clinical Endocrinology & Metabolism, 2021, Vol 106, Issue 12, pe4903
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgab588