Purpose: We performed a systematic review and meta-analysis to investigate the efficacy of peptide receptor radionuclide therapy (PRRT) by using radiolabeled somatostatin analogues in high grade gastro-entero-pancreatic neoplasms (GEP-NEN).
Methods: All clinical studies published up to March 2025, including patients with grade 3 (G3) GEP-NEN treated with [177Lu] Lu-DOTA-TATE and/or [90Y] Y-SSA, were identified based on systematic searches in the PubMed and Embase databases. Eligible studies had to report at least one of the following outcomes: 1) response to therapy evaluated according to RECIST (version 1.1 as complete response, partial response, stable disease, progressive disease; 2) median progression free survival (PFS) with 95% confidence intervals (CI); 3) median overall survival (OS) with 95% CI. Objective response rate (ORR) and disease control rate (DCR) were considered as primary outcomes.
Results: The final analysis included 7 studies accounting for a total of 317 patients with G3 disease (ranging from 18 to 112). Six studies evaluated response to therapy according to RECIST in 288 patients, and in 4 of them patients were also stratified according to ki67 values. The pooled ORR and DCR were 34% (95% CI: 22-46) and 64% (95% CI: 52-76), respectively. The funnel plot indicated no publication bias among these studies. Five studies reported in 239 patients median PFS with 95% CI, with a pooled estimate of 13.88 (95% CI: 10.33-18.64) months. Three studies fully reported in 174 patients median OS with 95% CI, with a pooled estimate of 29.95 (95% CI: 19.80-45.30) months.
Conclusions: In patients with G3 GEP-NEN, PRRT may provide substantial disease control and response rates, and it seems able to delay the progression of the disease.
Background: Intra-abdominal desmoid tumours (IADT) can closely mimic gastrointestinal stromal tumours (GISTs), particularly in recurrence and metastases. However, differentiating these two diseases using radiological methods remains challenging. This study aimed to investigate the value of [18F]FAPI-42 PET/CT in differentiating IADT and GISTs compared to [18F]FDG PET/CT.
Methods: This study retrospectively included a total of 24 patients (12 patients with IADT and 12 patients with recurrent/metastatic GISTs) who underwent two separate PET/CT scans using [18F]FAPI-42 and [18F]FDG, respectively. The differences in tumour SUVmax on [18F]FAPI-42 PET/CT (SUVmax-FAPI) and [18F]FDG PET/CT (SUVmax-FDG) and the ratio of tumour SUVmax on FAPI PET/CT to SUVmax on FDG PET/CT [SUVmax ratio (FAPI/FDG)] were compared between IADT and GISTs. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performance of these parameters in differentiating IADTs from GISTs. Immunohistochemistry was used to verify FAP expression in all IADT lesions and GISTs lesions.
Results: The SUVmax of IADTs on [18F]FAPI-42 PET/CT was significantly higher than that of GISTs [8.8 (7.2, 10.6) vs. 3.9 (2.8, 7.6), P = 0.045], whereas the SUVmax of IADTs on [18F]FDG PET/CT was significantly lower than that of GISTs [2.5 (1.9, 3.5) vs. 6.1 (3.6, 8.3), P = 0.007]. The SUVmax ratio (FAPI/FDG) of IADTs was significantly higher than that of GISTs [3.3 (2.2, 4.1) vs. 0.8 (0.3, 1.4), P < 0.001]. SUVmax-FAPI, SUVmax-FDG, and the SUVmax ratio (FAPI/FDG) achieved AUCs of 0.743, 0.819, and 0.896, with corresponding accuracies of 75.0%, 83.3%, and 87.5%, respectively, for distinguishing IADT from GISTs. Immunohistochemistry revealed significantly higher FAP expression in IADTs compared to GISTs (P = 0.002), with most IADTs showing strong (3+) staining (8/12, 66.7%), while GISTs primarily demonstrated weak (1+) or no staining (7/12, 58.3%).
Conclusion: The distinct uptake characteristics of [18F]FAPI-42 and [18F]FDG observed in IADTs and GISTs provide preliminary evidence that these two tracers may offer complementary diagnostic information when evaluating desmoid tumours that mimic recurrent or metastatic GISTs.
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