ORIGINAL RESEARCH article
Front. Med.
Sec. Nuclear Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1615136
This article is part of the Research TopicDevelopment and Validation of New Molecular Probes of Nuclear Medicine and New Targets of Nuclear Drugs in CancersView all 7 articles
Role of 18 F-AlF-NOTATATE PET/CT in selecting pediatric neuroblastoma candidates for 177 Lu-DOTATATE peptide receptor radionuclide therapy
Provisionally accepted
- 1Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- 2Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Background: Neuroblastoma is the most common extracranial solid tumor in children. Peptide receptor radionuclide therapy (PRRT) is a treatment modality with great potential, however, the predictive indicators for its efficacy remain unclear. The aim of the study is to evaluate the prognostic utility of quantitative metrics obtained from 18 F-AlF-NOTATATE PET/CT at baseline and posttreatment for predicting response in PRRT in pediatric neuroblastoma.Methods: Patients with high-risk neuroblastoma that was either recurrent or resistant to treatment were prospectively enrolled for one or two cycles of 177 Lu-PRRT. 18 F-AlF-NOTATATE PET/CT was performed one month before and after PRRT; some patients underwent mid-treatment scans (7 weeks post-cycle). Treatment response was evaluated using a modified approach combining principles from European Organization for Research and Treatment of Cancer (EORTC) criteria and Response Evaluation Criteria In Solid Tumors (RECIST version 1.1) criteria. Lesions were delineated semiautomatically to obtain maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), ratio of tumor SUVmax to liver SUVmax (SUVT/L), ratio of tumor SUVmax to spleen SUVmax (SUVT/S), tumor volume, total lesion activity, and heterogeneity values. Data were analyzed using independent t-tests or Mann-Whitney U tests. Receiver operating characteristic curves were used to determine the optimal cut-offs for PET parameters. Results: Twenty-two patients (13 boys, 9 girls) were included. Baseline PET revealed significantly lower SUVT/S, tumor volume, and total lesion activity in non-progressive lesions (p < 0.05); SUVT/S predicted efficacy (area under the curve [AUC], 0.588). Interim PET showed significantly lower SUVmax, SUVmean, SUVT/L, and SUVT/S in non-progressive lesions (p < 0.05); SUVT/L predicted efficacy (AUC, 0.740). The SUVmax ratio (interim/baseline) had the highest predictive accuracy, with a cut-off of 1.25 (AUC, 0.796; sensitivity, 73.03%; specificity, 76.92%).Quantitative baseline and mid-treatment 18 F-AlF-NOTATATE PET/CT-derived parameters possess value in predicting PRRT response. An interim-to-baseline PET-derived lesion SUVmax ratio of ≤1.25 can effectively predict neuroblastoma response to PRRT.
Keywords: Neuroblastoma, radionuclide therapy, peptide receptor radionuclide therapy, quantitative, Therapy response
Received: 20 Apr 2025; Accepted: 15 Aug 2025.
Copyright: © 2025 Liu, Sun, Zuo, Wang, Zheng, Wang and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jingfu Wang, Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Xiaorong Sun, Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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