SSTR positive

P1, N=4, Completed, University of Wisconsin, Madison | Recruiting --> Completed | N=10 --> 4

This case demonstrates that emergency surgery can be performed safely during the early phase after PRRT when appropriate radiation safety precautions are implemented. Radiation exposure to surgical staff remained minimal at typical working distances, and even near-field exposure was within acceptable limits. Urgent surgical intervention should not be unnecessarily delayed following PRRT when clinically indicated, provided that appropriate monitoring and precautions are in place.

This case highlights that parathyroid disorders can coexist with TIO, and they may delay its diagnosis. In this circumstance, a high index of clinical suspicion is represented by the persistence of hypophosphatemia post-parathyroidectomy.

[68Ga]DOTATOC PET yields higher Krenning scores and increases PRRT eligibility compared with [111In]octreotide scintigraphy. PET may be unnecessary for clearly positive planar studies but identifies additional candidates with borderline or negative planar results.

Radionuclide therapy in GEP-NETs is transitioning from a late-line option toward a flexible, biology-driven treatment strategy with important implications for clinical practice.

Current data suggest that PRRT, traditionally approved as a later-line therapy, may play a promising role in neoadjuvant and first-line settings for selected GEP-NET patients, enhancing resectability, improving surgical outcomes, and potentially prolonging survival. Further prospective, randomized studies are needed to define selection criteria, determine optimal timing, and assess the long-term impact on disease trajectory.

Using sunitinib as an internal control, our results show clinically significant antitumour efficacy of [177Lu]Lu-dota-tate in pretreated, progressive, somatostatin receptor-positive, metastatic pancreatic neuroendocrine tumours, and a better quality of life during the treatment phase. Late adverse events were reported in the [177Lu]Lu-dota-tate group that might affect the tolerance of subsequent lines of treatment.

Theranostic radiopharmaceutical therapy has moved from niche practice to mainstream oncology, anchored by approvals of lutetium Lu 177 dotatate for somatostatin receptor-positive neuroendocrine tumors and lutetium Lu 177 vipivotide tetraxetan for PSMA-positive prostate cancer. Yet the field's future depends on rigorous clinical trial design, realistic operational planning, and workforce readiness. This review summarizes how theranostics evolved, outlines current regulatory and trial-design yardsticks (including dose optimization and expectations for assessment of late-toxicity), and provides a practical framework for nuclear medicine physicians to assess protocols and prepare their practices for expanding indications and combinations.

P1, N=10, Active, not recruiting, Memorial Sloan Kettering Cancer Center | Trial completion date: Sep 2026 --> Sep 2027 | Trial primary completion date: Sep 2026 --> Sep 2027

P=N/A, N=164, Completed, Novartis Pharmaceuticals | Active, not recruiting --> Completed

In SSTR-directed PET/CT, a distinction between PMT and bone fracture may be possible with a SUVmax threshold of 7.6. The integration of PET derived TLU, along with TmP/GFR may improve diagnosis and treatment planning for TIO.

Baseline NSE elevation and early post-treatment declines may serve as potential prognostic indicators. These results are hypothesis-generating and warrant validation in larger, multicenter studies.