Multicentre evaluation of the role of Gallium DOTA-PET (GaPET) imaging in well differentiated bronchial carcinoids (BC): Impact on patients' (pts) management

Date

10 Oct 2016

Session

Endocrine and neuroendocrine tumours

Presenters

Angela Lamarca

Citation

Annals of Oncology (2016) 27 (6): 136-148. 10.1093/annonc/mdw369

Authors

A. Lamarca1, D..M. Pritchard2, T. Westwood3, G. Papaxoinis1, S. Vinjamuri4, J.W. Valle5, P. Manoharan3, W. Mansoor1

Author affiliations

  • 1 Department Of Medical Oncology, Enets Centre Of Excellence, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 2 Liverpool Enets Centre Of Excellence; Institute Of Translational Medicine, University Of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, L7 8XP - Liverpool/GB
  • 3 Department Of Radiology And Nuclear Medicine, Enets Centre Of Excellence,, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 4 Liverpool Enets Centre Of Excellence, Royal Liverpool and Broadgreen University Hospitals NHS Trust, L7 8XP - Liverpool/GB
  • 5 Department Of Medical Oncology, Enets Centre Of Excellence; Manchester Academic Health Sciences Centre, Institute Of Cancer Sciences, University Of Manchester, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
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Background

New nuclear medicine imaging techniques have improved diagnosis, staging and treatment planning for BC. GaPET is preferable to standard somatostatin receptor scintigraphy where available (ENETS guidelines); however, its role in the management of BC remains unclear.

Methods

All consecutive pts diagnosed with BC from two ENETS Centres of Excellence were identified retrospectively; pts with high grade tumours or lacking biopsy confirmation were excluded. Primary objective: to assess the impact of GaPET on clinical management in pts with BC.

Results

Of 166 pts screened, 46 were eligible: 52% female, median age 57 years (range 21-86); type of BC: DIPNECH (4%), typical (44%), atypical (35%), not reported (17%); median Ki67 and mitotic count were 3 and 1, respectively. Stage: localised (63%), locally advanced (13%) and metastatic (17%); 27 pts (59%) had curative resection; 18 (39%) received palliative treatment (somatostatin analogue (12; 67%) chemotherapy (4; 23%), PRRT (1; 5%), debulking surgery (1; 5%)). A total of 47 GaPETs were performed with the following rationale: BC confirmation (4; 9%), primary tumour identification (2; 4%), post-surgical assessment (19; 40%), staging (patients with known BC present at time of GaPET) (19; 40%) and consideration of Peptide Receptor Radionuclide Therapy (PRRT) (3; 7%). Twenty-seven (57%) scans showed evidence of non-physiological uptake: median SUVmax 7.2 (range 1.42-53). Uptake rate in primary tumour, liver, lung, bone and lymph node metastases was high (80-100%). GaPET provided additional information in 37% (95%CI 22-51) of pts and impacted on management in 26% (95%-CI 12-41); 9 pts (21%) were identified to have occult sites of metastases. Out of the 19 pts with post-surgical GaPET, 3 (16%) were identified distant metastases. There were no differences in the rate of practice changing GaPET results by type of BC (p-value 0.5). No factors predictive of changes in management were identified (logistic regression).

Conclusions

Our results support the use of GaPET in patients with BC for planning treatment, including post-surgical assessment due to potential for identifying occult metastases.

Clinical trial identification

Legal entity responsible for the study

The Christie NHS Foundation Trust and Royal Liverpool and Broadgreen University Hospitals NHS Trust

Funding

Dr Angela Lamarca was part-funded by the Pancreatic Cancer Research Fund and Spanish Society of Medical Oncology Fellowship Programme

Disclosure

All authors have declared no conflicts of interest.

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