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 Table of Contents     
CASE REPORT
Year : 2014  |  Volume : 29  |  Issue : 3  |  Page : 175-176  

Ga-68 DOTATATE positron emission tomography/computer tomography in initial staging and therapy response evaluation in a rare case of primary neuroblastoma in neck


1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication11-Jul-2014

Correspondence Address:
Bhagwant Rai Mittal
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.136580

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   Abstract 

Gallium-68 (Ga-68) DOTA-peptide positron emission tomography/computer tomography (PET/CT) has higher sensitivity and improved spatial resolution for the detection of somatostatin receptor expressing tumors than conventional somatostatin receptor scintigraphy. We present the findings of Ga-68 DOTATATE PET/CT in a rare case of primary neuroblastoma of the neck in a 12-year-old female child and its role in the evaluation of the treatment response.

Keywords: Extra-abdominal neuroblastoma, gallium-68 DOTATATE, positron emission tomography/computer tomography, response evaluation


How to cite this article:
Agrawal K, Kumar R, Shukla J, Bhattacharya A, Mittal BR. Ga-68 DOTATATE positron emission tomography/computer tomography in initial staging and therapy response evaluation in a rare case of primary neuroblastoma in neck. Indian J Nucl Med 2014;29:175-6

How to cite this URL:
Agrawal K, Kumar R, Shukla J, Bhattacharya A, Mittal BR. Ga-68 DOTATATE positron emission tomography/computer tomography in initial staging and therapy response evaluation in a rare case of primary neuroblastoma in neck. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 10];29:175-6. Available from: http://www.ijnm.in/text.asp?2014/29/3/175/136580


   Introduction Top


Gallium-68 (Ga-68) DOTA-peptide positron emission tomography/computer tomography (PET/CT) has a higher sensitivity and improved spatial resolution for the detection of somatostatin receptor expressing tumors than conventional somatostatin receptor scintigraphy (SRS). Anatomical evaluation of therapy response does not correlate well with progression-free survival, clinical outcome, or quality of life in neuroendocrine tumors (NET). We present Ga-68 DOTATATE PET/CT findings in a rare case of primary neuroblastoma of the neck and its role in the evaluation of the treatment response.


   Case report Top


The case we present here is about a 12-year-old female child presented with gradual onset painless neck swelling. Contrast enhanced CT study demonstrated large soft-tissue lesions on the left side of the neck, which was later on histopathologically confirmed as neuroblastoma. Ga-68 DOTATATE PET/CT performed for initial staging showed [Figure 1]a-c abnormal tracer uptake in an enhancing large soft-tissue mass on the left side of neck (SUVmax 11.7), the left cervical and axillary lymph nodes, and bones suggestive of primary neuroblastma in the neck with nodal and skeletal metastases. The patient was treated with three cycles of chemotherapy and Ga-68 DOTATATE PET/CT study was repeated for treatment response evaluation. Post-chemotherapy Ga-68 DOTATATE PET/CT showed [Figure 2]a-c decrease in tracer uptake in the soft-tissue mass in the neck (SUVmax 5.1 in comparison to SUVmax 11.7 in the pre-therapy scan), in the cervical and axillary lymph nodes, in the paravertebral mass (SUVmax 5.5 in comparison to SUVmax 11.0 in the pre-therapy scan) and in the bones (SUVmax 3.8 in comparison to SUVmax 10.0 in the pre-therapy scan) without significant change in the size of the lesions suggesting favorable response to chemotherapy. F-18 fluoro-2-deoxy-D-glucose (FDG) PET/CT was also performed before and after chemotherapy, which confirmed favorable metabolic response, although the decrease in uptake of F-18 FDG was of lesser magnitude than decrease in Ga-68 DOTATATE uptake.
Figure 1: Pre-therapy Gallium-68 (Ga-68) DOTATATE positron emission tomography/computer tomography (PET/CT) coronal image (a) showing abnormal tracer uptake in an enhancing large soft tissue mass in the left neck (SUVmax 11.7), left cervical and axillary lymph nodes, and multiple bones. Transaxial CT (b) and fused positron emission tomography/computer tomography (PET/CT) (c) images show abnormal tracer uptake in a large enhancing softtissue mass on the left side of the neck (SUVmax 11.7)

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Figure 2: Post-chemotherapy Ga-68 DOTATATE PET/CT coronal image (b) shows decrease in tracer uptake in the soft-tissue mass in the neck (SUVmax 5.1), cervical and axillary lymph nodes and in the skeleton without significant change in the size of the lesions. Transaxial CT, (b) and fused PET/CT (c) images show a significant decrease in tracer avidity (SUVmax 5.1) compared with pre-therapy scan

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   Discussion Top


Neuroblastoma arises from primitive neuroblasts of the embryonic neural crest. They can occur anywhere within the sympathetic nervous system. [1] The primary tumors most commonly occur within the abdomen (65%) and about half of these tumors arise from the adrenal medulla. Other common sites of neuroblastoma include the neck, chest, and pelvis. [2] In general, somatostatin receptors (particularly subtype 2) are expressed in these tumors. Therefore, SRS is a useful imaging modality in patients with neuroblastoma. [3],[4],[5] Ga-68-DOTA-peptide PET/CT has higher sensitivity and improved spatial resolution for the detection of somatostatin receptor positive tumors than conventional SRS and is superior to Indium-111 octreotide SPECT in detecting NET. [6] Ga-68 DOTA-peptide PET is superior to I-123 MIBG imaging and even to the CT or MRI technique in pre-therapy staging of neuroblastoma. [7] In this report, we showed Ga-68-DOTATATE PET/CT findings in a patient with primary extra-abdominal neuroblastoma. The peptide receptor radionuclide therapy (PRRNT) with 177 Lu-DOTATATE is safe and feasible in children with relapsed or primary refractory high-risk neuroblastoma. [8] Ga-68 DOTATATE PET/CT study may further help in the selection of patients for PRRNT in such patients with extensive disease. [9]

Anatomical evaluation of therapy response does not correlate well with progression-free survival, clinical outcome, or quality of life in NET. [10] Previous study has shown that the decreased Ga-68 DOTATATE uptake in NET after chemotherapy can predict clinical improvement. [11] In the current case, Ga-68 DOTATATE PET/CT showed favorable metabolic response to treatment despite significant residual tumor on CT. This interesting case illustrates the utility of Ga-68 DOTATATE PET/CT in the staging and treatment response evaluation in a rare case of primary neuroblastoma of the neck.

 
   References Top

1.Maris JM, Hogarty MD, Bagatell R, Cohn SL. Neuroblastoma. Lancet 2007;369:2106-20.  Back to cited text no. 1
    
2.De Bernardi B, Nicolas B, Boni L, Indolfi P, Carli M, Cordero Di Montezemolo L, et al. Disseminated neuroblastoma in children older than one year at diagnosis: Comparable results with three consecutive high-dose protocols adopted by the Italian Co-Operative Group for Neuroblastoma. J Clin Oncol 2003;21:1592-601.  Back to cited text no. 2
    
3.O'Dorisio MS, Chen F, O'Dorisio TM, Wray D, Qualman SJ. Characterization of somatostatin receptors on human neuroblastoma tumors. Cell Growth Differ 1994;5:1-8.  Back to cited text no. 3
    
4.Albers AR, O'Dorisio MS, Balster DA, Caprara M, Gosh P, Chen F, et al. Somatostatin receptor gene expression in neuroblastoma. Regul Pept 2000;88:61-73.  Back to cited text no. 4
    
5.Georgantzi K, Tsolakis AV, Stridsberg M, Jakobson A, Christofferson R, Janson ET. Differentiated expression of somatostatin receptor subtypes in experimental models and clinical neuroblastoma. Pediatr Blood Cancer 2011;56:584-9.  Back to cited text no. 5
    
6.Kowalski J, Henze M, Schuhmacher J, Mäcke HR, Hofmann M, Haberkorn U. Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D Phe (1)-Tyr (3)-Octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol 2003;5:42-8.  Back to cited text no. 6
    
7.Kroiss A, Putzer D, Uprimny C, Decristoforo C, Gabriel M, Santner W, et al. Functional imaging in phaeochromocytoma and neuroblastoma with 68Ga-DOTA-Tyr 3-octreotide positron emission tomography and 123I-metaiodobenzylguanidine. Eur J Nucl Med Mol Imaging 2011;38:865-73.  Back to cited text no. 7
    
8.Gains JE, Bomanji JB, Fersht NL, Sullivan T, D'Souza D, Sullivan KP, et al. 177Lu-DOTATATE molecular radiotherapy for childhood neuroblastoma. J Nucl Med 2011;52:1041-7.  Back to cited text no. 8
    
9.Reubi JC. Peptide receptors as molecular targets for cancer diagnosis and therapy. Endocr Rev 2003;24:389-427.  Back to cited text no. 9
    
10.Gopinath G, Ahmed A, Buscombe JR, Dickson JC, Caplin ME, Hilson AJ. Prediction of clinical outcome in treated neuroendocrine tumours of carcinoid type using functional volumes on 111In-pentetreotide SPECT imaging. Nucl Med Commun 2004;25:253-7.  Back to cited text no. 10
    
11.Haug AR, Auernhammer CJ, Wängler B, Schmidt GP, Uebleis C, Göke B, et al. 68Ga-DOTATATE PET/CT for the early prediction of response to somatostatin receptor-mediated radionuclide therapy in patients with well-differentiated neuroendocrine tumors. J Nucl Med 2010;51:1349-56.  Back to cited text no. 11
    


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  [Figure 1], [Figure 2]



 

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