Farise YILMAZ, Hasan ÖNNER, Gonca KARA GEDİK, Özlem ŞAHİN, Ahmet Volkan ÇELİK, Çağlagül EROL

68Ga-DOTATATE PET/BT görüntülemede somatostatin analogları ile tedavi normal hedef organların ve malign lezyonların alımında farklılık gösterir mi?

Amaç: Somatostatin analogları (SSA), antiproliferatif etkileri nedeniyle düşük grade’li nöroendokrin tümörlerin tedavisinde kullanılır. 68Ga tetraazasiklododekantetraasetik asit-DPhe1-Tyr3-oktreotat (DOTATATE) PET/CT somatostatin reseptör görüntülemesi olarak son yıllarda yaygın olarak kullanılmaktadır. Bununla birlikte, görüntülemeden önce SSA kullanımının kesilmesine yönelik kılavuzlar olmasına rağmen, literatürde çelişkili yayınlar bulunmaktadır. Bu çalışma, SSA'ların Somatostatin reseptör görüntülemesi üzerindeki etkisini araştırmayı amaçlamaktadır. Gereç ve Yöntem: 2018-2022 yılları arasında 68Ga-DOTATATE PET/BT görüntüleme yapılan 253 hastayı retrospektif olarak incelendi. Bu hastalardan SSA kullanan 28 düşük grade’li (Grade 1 ve Grade 2) hasta çalışmaya dahil edildi. Normal hedef organların, primer tümörlerin ve her organda en yüksek SUVmax‘ı (maksimum standart alım hacmi) olan metastazların SSA tedavisinden önce ve sonra SUVmax değerleri karşılaştırıldı. Bulgular: SSA tedavisi ile düşük grade’li (Grade 1 ve 2) NET ve 68Ga-DOTATATE PET/BT görüntülemesi olan 28 hasta (16 kadın; 12 erkek, yaş [ortalama±SD], 54.82±14.27, range:18-78) çalışmaya dahil edildi. Karaciğer ve dalakta SSA uygulaması sonrası ölçülen değerlerde SUVmax azalmasına rağmen istatistiksel olarak anlamlı değildi (p>0.05). Primer tümörlerdeki SUVmax değerleri ile karaciğer, kemik, akciğer veya lenf nodlarındaki metastatik lezyonlarda SSA uygulaması öncesi ve sonrası arasında anlamlı fark yoktu (P> 0.05). Sonuç: Somatostatin analogları kullanan nöroendokrin tümör hastalarında tedavi takibi için 68Ga-DOTATATE PET/BT görüntüleme öncesinde bu ilaçların mutlak kesilmesi gerekmez. Ayrıca, karaciğer ve dalaktaki metastatik lezyonların intensitesini (yoğunluğunu) dolaylı yoldan artırarak raporun yorumlanmasına katkı sağlar.

Anahtar Kelimeler:

Nöroendokrin Tümörler, 68Ga-DOTATATE PET/BT, Somatostatin analogları

Does treatment with somatostatin analogs differ in the uptake of normal target organs and malignant lesions on 68Ga-DOTATATE PET/CT imaging?

Abstract Objective: Somatostatin analogs (SSA) are used in treating low-grade neuroendocrine tumors, mainly because of their antiproliferative effect. 68Ga tetraazacyclododecantetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT as somatostatin receptor imaging has been widely used in recent years. However, there are conflicting publications in the literature, although there are guidelines for discontinuing the use of SSA before imaging. This study aims to investigate the effect of SSAs on Somatostatin receptor imaging. Material and Method: We retrospectively analyzed 253 patients who underwent 68Ga-DOTATATE PET/CT imaging between 2018 and 2022. Among these patients, those with low grades (Grade 1 and Grade 2) using SSA were included in the study. SUVmax (maximum standard uptake volume) of normal target organs, primary tumors, and metastases with the highest SUVmax in each organ were compared before and after SSA treatment. Results: 28 patients (16 females; 12 males, age [mean±SD], 54.82±14.27, range 18-78) with low-grade (Grade 1 and 2) NET and 68Ga-DOTATATE PET/CT imaging with SSA therapy were included in the study. Although SUVmax was decreased in the values measured after SSA application in the liver and spleen, it was not statistically significant (p>0.05). There was no significant difference between SUVmax values in primary tumors and metastatic lesions in the liver, bone, lung, or lymph nodes before and after SSA application (P> 0.05). Conclusion: In conclusion, these drugs do not need to be discontinued before 68Ga-DOTATATE PET/CT imaging for treatment follow-up in neuroendocrine tumor patients using somatostatin analogs. In addition, these drugs may help report interpretation by increasing the intensity of metastatic lesions in the liver and spleen.

Keywords:

68Ga-DOTATATE PET/CT, Somatostatin analogs, Neuroendocrine tumors.,

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