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

Somatostatin Analogları ile Tedavi, 68Ga-DOTATATE PET/BT Görüntülemede Normal Hedef Organların ve Malign Lezyonların Radyoaktivite Alımını Etkiler mi?

Amaç: Somatostatin analogları (SSA), esas olarak antiproliferatif etkileri nedeniyle düşük dereceli nöroendokrin tümörlerin (NET) tedavisinde kullanılır. 68Ga-tetraazasiklododekantetraasetik asit- DPhe1-Tyr3-oktreotat (DOTATATE) PET/BT somatostatin reseptör görüntüleme 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 görüntülemesi yapılan 253 hastayı geriye dönük olarak inceledik. Bu hastalardan SSA kullanan düşük dereceli (grade 1 ve grade 2) olanlar çalışmaya dahil edildi. Normal hedef organların, primer tümörlerin ve her organda en yüksek SUVmax’ı (maksimum standart alım hacmi) olan metastazların değerleri SSA tedavisinden önce ve sonra karşılaştırıldı. Bulgular: SSA tedavisi ile düşük dereceli NET ve 68Ga-DOTATATE PET/BT görüntülemesi olan 28 hasta (16 kadın; 12 erkek, yaş [ortalama±SD], 54.82±14.27, aralık 18-78) çalışmaya dahil edilmiştir. Karaciğer ve dalakta SSA uygulaması sonrası ölçülen değerler, SUVmax azalmasına rağmen istatistiksel olarak anlamlı değildi (p>0.05). Primer tümördeki SUVmax değerleri ile karaciğer, kemik, akciğer veya lenf nodlarındaki metastatik lezyonlarda SSA uygulaması öncesi ve sonrası arasında anlamlı fark bulunmadı (P> 0.05). Sonuç: SSA kullanan nöroendokrin tümörlü hastalarda tedavi takibi için 68Ga-DOTATATE PET/ BT görüntülemeden önce kesilmeyebilir. Ayrıca SSA kullanımı karaciğer ve dalaktaki metastatik lezyonların görünürlüğünü artırarak raporun yorumlanmasına yardımcı olabilir.

Does Treatment with Somatostatin Analogs Affect the Radioactivite Uptake of Normal Target Organs and Malignant Lesions on 68Ga- DOTATATE PET/CT imaging?

Objective: Somatostatin analogs (SSA) are used in treating low-grade neuroendocrine tumors (NET), 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 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 SSAs. In addition, these drugs may help report interpretation by increasing the intensity of metastatic lesions in the liver and spleen.

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