Integrated Detection and Treatment: A New Hope in Tumor Therapy—Positron Emission Tomography and Peptide Receptor Radionuclide Therapy (PRRT) for Neuroendocrine Tumors
Update Date：2025/02/07，
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Dr. Li Yue from the Department of Nuclear Medicine
Apple co-founder Steve Jobs passed away due to a neuroendocrine tumor (NET) that developed in his pancreas, which has since been referred to as "Jobs' disease." Dr. Li Yue pointed out that neuroendocrine tumors are a type of malignant tumor originating from neuroendocrine cells. These cells are widely distributed throughout the body and have functions in signal transmission and hormone secretion, especially concentrated in the pancreas, gastrointestinal tract, and lungs. Tumors originating from different locations can secrete various hormones, leading to diverse and often subtle symptoms that are not easily recognized, such as skin flushing, diarrhea, hypoglycemia, abnormal blood pressure, or palpitations. These symptoms are often misdiagnosed as other conditions like gastroenteritis or cardiovascular problems.
With the advancement of medical technology, the new technique in modern nuclear medicine—Peptide Receptor Radionuclide Therapy (PRRT)—is set to become a crucial weapon in changing the course of fate.
Due to the complex and variable nature of neuroendocrine tumors, diagnosing them can be difficult, and there are also radiation safety considerations when undergoing Peptide Receptor Radionuclide Therapy (PRRT). The treatment process requires evaluation by a multidisciplinary medical team and must be carried out in a specialized radiation isolation ward to ensure the safety of both patients and medical staff. A complete course of treatment involves four injections, with approximately 8 weeks between each session. After treatment, regular follow-up visits are necessary, including blood tests and imaging assessments, to monitor the effectiveness of the therapy and detect any potential side effects.
A 42-year-old male patient presented to our hospital due to frequent episodes of hypoglycemia, cold sweats, and tremors. Examination revealed the presence of an insulin-secreting pancreatic neuroendocrine tumor (insulinoma). As the pancreatic tumor had already metastasized to the liver, surgical removal was not possible. The patient initially underwent somatostatin injections and targeted therapy as part of the treatment plan.
However, after three months of treatment, the patient's hypoglycemia remained frequent, and he had to rely on high-concentration glucose solution for emergency treatment daily, making it impossible for him to get out of bed. After evaluation, PRRT treatment was decided. Seven weeks post-treatment, the patient's blood sugar stabilized, and his quality of life significantly improved. Upon completion of the treatment course, the tumor lesions had notably reduced in size, and the patient was successfully discharged. In addition, our hospital has accumulated successful experience using PRRT to treat neuroendocrine tumors in other areas, such as the rectum and lungs.
Dr. Li Yue shared that PRRT is highly effective because neuroendocrine tumors are different from other normal cells; they exhibit a high concentration of somatostatin receptors on the surface of tumor cells. When combined with a molecule called DOTATATE (a somatostatin analogue) that specifically binds to these receptors, and attached to the radioactive isotope Gallium-68 (Ga-68) for positron emission tomography (PET) scanning, it becomes a precise diagnostic tool specifically designed to locate tumors. Much like a reconnaissance aircraft, it allows for clear visualization of the tumor's location, size, and distribution range during PET scans, providing an accurate basis for treatment planning.
Once the tumor's location is confirmed, we administer another medication that replaces the radioactive isotope attached to DOTATATE with Lutetium-177 (Lu-177), which emits beta radiation (β rays). This transforms the treatment into a precise therapeutic agent targeting the tumor, much like a cruise missile. It specifically attacks tumor cells that express the unique receptors, while minimizing the impact on normal cells. This targeted approach allows for effective tumor destruction with reduced side effects.
The synergy between Ga-68 and Lu-177 DOTATATE exemplifies the core concept of nuclear medicine theranostics—seamlessly integrating diagnosis and treatment. It precisely targets the tumor, providing a direct path from "locating the lesion" to "destroying the lesion" in one step, ensuring a highly effective and personalized approach to cancer care.
According to a study published in the authoritative medical journal The New England Journal of Medicine, when comparing progression-free survival (PFS) over a 20-month period, the PRRT treatment group achieved a 65.2% survival rate, compared to just 10.8% in the control group. In terms of overall survival (OS), the PRRT treatment group had a 3-year survival rate of approximately 80%, while the control group’s rate was below 50%, demonstrating highly significant treatment effectiveness. Additionally, the side effects were mostly mild, with no significant difference compared to the control group, indicating excellent overall tolerability.
The advent of Ga-68 PET scanning and PRRT has brought new hope to patients with neuroendocrine tumors. Through the precise detection and targeting capabilities of nuclear medicine, the control of neuroendocrine tumors is no longer merely a matter of "doing our best and leaving the rest to fate," but has truly become a realization of "precision medicine." Our hospital will continue to uphold the spirit of professionalism, innovation, and patient-centered care, striving to provide the highest quality medical services for each and every patient.