Neuroendocrine tumors – Nuclear medicine diagnostics and therapy (PRRT)

Neuroendocrine tumors are rare diseases whose diagnosis and treatment require a highly specialized team with extensive experience. As a certified center of excellence, we offer all modern diagnostic and treatment procedures for these special diseases and also know what to do in difficult situations. Our aim is to provide all those affected with the best possible diagnosis and treatment.

Overview

Among many possible therapies, the University Hospital Zurich offers radiopeptide therapy with Lutetium-177 DOTATATE. This therapy behaves similarly to octreotide or lanreotide and binds to the somatostatin receptor 2 in order to irradiate the tumor cells locally. This therapy is usually administered over four cycles every eight weeks. Referrals are made via the oncology department and all patients are presented and discussed at our interdisciplinary tumor board.

Risk

The risk of experiencing side effects with this radiation is low. Most patients do not experience any adverse effects. The radioactive particle lutetium-177 only emits radiation in a radius of max. 4 mm. It therefore only radiates in the tumor for the most part.

Procedure of the therapy

Like amino acids, lutetium-177 DOTATATE is also partly absorbed by the kidneys. To prevent kidney damage, the kidney must be blocked for the “DOTATATE”. This is done by intravenous administration of an amino acid solution. The infusion is usually tolerated without any adverse effects and is safe for your kidneys. Nevertheless, Lutetium-177 DOTATATE therapy is associated with a low risk of kidney damage. In very rare cases, this can even lead to the need for dialysis. In studies, however, this occurred in less than half a percent. In most cases, these were patients with pre-existing kidney disease.

Indications for Lutetium-177-DOTATATE therapy

General indication:

  • According to ENETS guidelines (e.g. second line MIDGUT tumors after Sandostatin), inoperable, metastatic, well-differentiated NET (grade I and II), ECOG 0-2
  • Sufficient uptake in the tumors in the diagnostic PET

Contraindication:

  • Pregnancy or breastfeeding
  • Severe renal insufficiency (clearance <30ml/min)
  • Hb < 5 g/dl, Tc < 75’000 /ul, Leuk < 2’000 ug/l
  • Severe liver dysfunction (bilirubin > 100 mg/dl)
  • Severe cardiac dysfunction NYHA III or IV
  • Severe internal diseases in general (e.g. COPD Gold IV)

Side effects of the therapy

The injection of DOTATATE may also cause short-term (5 min) nausea with vomiting (in approx. five percent of patients). Apart from a few exceptions, the further course of therapy is tolerated without any adverse effects. During treatment, 30 percent of patients experience a slight drop in white blood cells, which however regenerate within a few weeks.

Responsible professionals

Ivette Engel-Bicik, Dr. med.

Attending Physician with extended responsibilites, Department of Nuclear Medicine

Tel. +41 44 255 35 55
Specialties: Thyroid diseases incl. Therapy, Radionuclide therapies (SIRT, PRRT, Xofigo)

Stephan Beintner-Skawran, Dr. med.

Attending Physician, Department of Nuclear Medicine

Tel. +41 43 253 87 10

For patients

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For referrering physicians

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Tel. +41 44 255 35 55
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