ArticleAnnals of nuclear medicine2026
Quantitative SPECT imaging for predicting therapeutic response to lutetium-177 DOTATATE in neuroendocrine tumors.
Article in Annals of nuclear medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveAs the incidence of neuroendocrine tumors (NETs) increases, Lutetium-177 (Lu-177) DOTATATE targeted radionuclide therapy (TRT) has become a vital treatment strategy. However, its prolonged course makes early prediction of response challenging, and current predictive methods like dosimetry are complex. Therefore, a simpler, earlier prediction method is needed for timely treatment planning. This study aimed to investigate whether quantitative metrics from a single, initial post-therapy single-photon emission computed tomography / computed tomography (SPECT/CT) image could predict the final treatment response.
methodsThis retrospective, single-center study included 17 patients (60 tumor lesions) receiving Lu-177 DOTATATE TRT. Patients were classified into G1, G2, and G3/neuroendocrine carcinoma (NEC) groups according to the World Health Organization (WHO) 2019 classification. When multiple lesions with discrepant grades were present, the highest grade was assigned for patient-level classification. Tumor volume and maximum standardized uptake value (SUVmax) were calculated from initial and final post-therapy SPECT images using an adaptive thresholding method. Response was evaluated based on a ≥ 50% reduction in tumor volume. Statistical analyses included one-way analysis of variance (ANOVA) and Pearson's correlation.
resultsA higher initial post-therapy SUVmax tended to correlate with a better volumetric response. In an exploratory analysis, all lesions (n = 8) with an initial post-therapy SUVmax exceeding 55 achieved a volumetric response, yielding a positive predictive value of 100% for this subgroup. The overall response rates for tumor volume and SUVmax were 71.7% and 65.0%, respectively. Additionally, G3/NEC tumors showed a significantly greater initial volume reduction than G2 tumors (p = 0.042).
conclusionsOur findings suggest that the initial post-therapy SUVmax from a single SPECT/CT acquisition may serve as a promising exploratory predictor of early volumetric response to Lu-177 DOTATATE TRT. While this metric is clinically intriguing, it may reflect treatment-induced necrosis or edema rather than durable tumor control, particularly in high-grade tumors. Therefore, its relationship with long-term clinical endpoints such as progression-free survival remains to be established. This streamlined approach could contribute to personalized medicine, though further validation is required.
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