Radioguided surgery in neuroendocrine tumors. A review of the literature

García-Talavera, P.; Ruano, Ricardo; Rioja, María Eugenia; Ferrera, José Manuel Cordero; Razola, P.; Vidal-Sicart, Sergi

doi:10.1016/j.remnie.2014.09.001

Cited by 7 publications

(6 citation statements)

References 47 publications

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“…Some authors support systematic lymphadenectomy in all cases of bronchial carcinoid tumors due to a 20% incidence of lymph node metastases in one pediatric series . A few institutions have reported preliminary experience using radioguided surgery employing 111 In‐labeled pentetreotide with intraoperative localization, demonstrating improved identification of residual tumor or metastatic disease . The use of chemotherapy, somatostatin analogs, and interferon‐α biotherapy, while advocated by some authors for metastatic bronchial carcinoid tumor in adults, have not been rigorously evaluated in the pediatric population .…”

Section: Discussionmentioning

confidence: 99%

Pediatric neuroendocrine carcinoid tumors: Management, pathology, and imaging findings in a pediatric referral center

Degnan

Tocchio

Kurtom

et al. 2017

Pediatric Blood & Cancer

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Contrary to recent epidemiological investigations in adults, appendiceal carcinoid tumors remain the most common site for pediatric carcinoid tumors. Appendiceal carcinoid tumors exhibited benign clinical courses without recurrence during short-term follow-up. Extra-appendiceal gastrointestinal carcinoid tumors exhibited much more aggressive behavior with greater metastases and recurrence. Bronchial carcinoid tumors demonstrated good clinical response to resection even in cases with mediastinal lymph node involvement. While increased use of urine 5-HIAA levels and somatostatin receptor-specific imaging might improve detection and guide management of extra-appendiceal carcinoid tumors, longer-term follow-up is needed.

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Section: Discussionmentioning

confidence: 99%

Pediatric neuroendocrine carcinoid tumors: Management, pathology, and imaging findings in a pediatric referral center

Degnan

Tocchio

Kurtom

et al. 2017

Pediatric Blood & Cancer

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“…The introduction of portable g-probes enabled real-time radioguidance during surgery (7)(8)(9). Nevertheless, radioguidance can neither determine tumor margins nor identify small metastases accurately (4,10).…”

mentioning

confidence: 99%

Evaluation of a Fluorescent and Radiolabeled Hybrid Somatostatin Analog In Vitro and in Mice Bearing H69 Neuroendocrine Xenografts

et al. 2016

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In the treatment of neuroendocrine tumors (NETs), complete surgical removal of malignancy is generally desirable, because it offers curative results. Preoperative guidance with radiolabeled somatostatin analogs, commonly used for NET diagnosis and preoperative planning, is limited by its low resolution, with the risk that tumor margins and small metastases will be incompletely resected with subsequent recurrence. A single hybrid probe combining radiotracer and optical dye would enable high-resolution optical guidance, also during surgery. In the current study, the hybrid labeled somatostatin analog Cy5-DTPA-Tyr 3 -octreotate (DTPA is diethylene triamine pentaacetic acid) was synthesized and evaluated for its ability to specifically trace NET cells in vitro and in an animal model. The performance of the hybrid tracer was compared with that of octreotate with only radiolabel or only optical label. Methods: The binding affinity and internalization capacity of Cy5-DTPA-Tyr 3 -octreotate were assessed in vitro. Biodistribution profiles and both nuclear and optical in vivo imaging of Cy5-111 In -DTPA-Tyr 3 -octreotate were performed in NET-bearing mice and compared with the performance of 111 In-DTPA-Tyr 3 -octreotate. Results: In vitro studies showed a low receptor affinity and internalization rate for Cy5-DTPA-Tyr 3 -octreotate. The dissociation constant value was 387.7 ± 97.9 nM for Cy5-DTPA-Tyr 3 -octreotate, whereas it was 120.5 ± 18.1 nM for DTPA-Tyr 3 -octreotate. Similarly, receptor-mediated internalization reduced from 33.76% ± 1.22% applied dose for DTPA-Tyr 3 -octreotate to 1.32% ± 0.02% applied dose for Cy5-DTPA-Tyr 3 -octreotate. In contrast, in vivo and ex vivo studies revealed similar tumor uptake values of Cy5-111 In-DTPA-Tyr 3 -octreotate and 111 In -DTPA-Tyr 3 -octreotate (6.93 ± 2.08 and 5.16 ± 1.27, respectively). All organs except the kidneys showed low background radioactivity, with especially low activities in the liver, and high tumor-to-tissue ratios were achieved-both favorable for the tracer's toxicity profile. Hybrid imaging in mice confirmed that the nuclear and fluorescence signals colocalized. Conclusion: The correlation between findings with the optical and the nuclear probes underlines the potential of combining SPECT imaging with fluorescence guidance and shows the promise of this novel hybrid peptide for preoperative and intraoperative imaging of NET.

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“…Wängberg advised the surgeons to aim the probe away from organs with high levels of normal tracer uptake 20 . Review papers by García-Tavalera and Gulec take this further, both suggesting the placement of 20 OCT Statistical 2 standard deviations Hall et al wide malleable retractors below the liver and spleen in order to provide some shielding whilst searching the tumour bed and move the organs with high-physiological uptake away from the tumour bed 37,38 . Hodolič mentions the use of small lead shields, but does not elaborate on their construction or size 23 .…”

Section: Surgical and Pre-surgical Protocolsmentioning

confidence: 99%

Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review

Cockburn

Toumi

Mackie

et al. 2021

Journal of Gastrointestinal Surgery

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Background Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit. Methods A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed. Results Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0–24 h with technetium-99m, and 19–193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination—four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery. Conclusions RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.

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Radioguided surgery in neuroendocrine tumors. A review of the literature

Cited by 7 publications

References 47 publications

Pediatric neuroendocrine carcinoid tumors: Management, pathology, and imaging findings in a pediatric referral center

Pediatric neuroendocrine carcinoid tumors: Management, pathology, and imaging findings in a pediatric referral center

Evaluation of a Fluorescent and Radiolabeled Hybrid Somatostatin Analog In Vitro and in Mice Bearing H69 Neuroendocrine Xenografts

Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review

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