WP RT + NCHT improves PFS compared with PO RT and NCHT or PO RT and AHT, and compared with WP RT + AHT in patients with a risk of LN involvement of 15%.

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We performed a systematic review and meta-analysis of the performance of Ga-DOTA-conjugated somatostatin receptor targeting peptides (Ga-DOTA-SST) PET in the detection of pheochromocytomas and paragangliomas (PPGLs). PubMed and Embase were searched until 08 May 2018. We included studies that reported the detection rate ofGa-DOTA-SST PET in patients with PPGLs. Detection rates were pooled using a random-effects model. Subgroup analyses and meta-regression were performed to explore the cause of heterogeneity. Thirteen studies were included for qualitative synthesis. Per-lesion detection rates ofGa-DOTA-SST PET were consistently higher (ranging from 92 to 100%) than other imaging modalities, including F-FDOPA PET,F-FDG PET, and 123/I-MIBG scintigraphy. However, in patients with polycythemia/paraganglioma syndrome, the detection rate of Ga-DOTA-DOTATATE PET was 35%. Nine studies (215 patients) with no specific inclusion criteria for subtype were quantitatively synthesised. The pooled detection rate was 93% (95% confidence interval [CI] 91-95%), which was significantly higher than that ofF-FDOPA PET (80% [95% CI 69-88%]), F-FDG PET (74% [95% CI 46-91%]), and 123/I-MIBG scan (38% [95% CI 20-59%], < 0.001 for all). A greater prevalence of head and neck paragangliomas was associated with higher detection rates of Ga-DOTA-SST PET ( = 0.0002). Ga-DOTA-SST PET exhibited superior performance for lesion detection, over other functional imaging modalities, in patients with PPGLs, with the exception of polycythemia/paraganglioma syndrome. This might suggestGa-DOTA-SST PET as a first-line imaging modality for the primary staging of PPGL or the re-staging of PPGL with unknown genetic status.

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