AUTHOR=Liu Yuxuan , Sun Yingying , Zuo Di , Wang Han , Zheng Fei , Wang Jingfu , Sun Xiaorong 

TITLE=Role of 18F-AlF-NOTATATE PET/CT in selecting pediatric neuroblastoma candidates for 177Lu-DOTATATE peptide receptor radionuclide therapy

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1615136

DOI=10.3389/fmed.2025.1615136

ISSN=2296-858X

ABSTRACT=BackgroundNeuroblastoma 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 18F-AlF-NOTATATE PET/CT at baseline and post-treatment for predicting response in PRRT in pediatric neuroblastoma.MethodsPatients with high-risk neuroblastoma that was either recurrent or resistant to treatment were prospectively enrolled for one or two cycles of 177Lu-PRRT. 18F-AlF-NOTATATE PET/CT was performed 1 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.ResultsTwenty-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%).ConclusionQuantitative baseline and mid-treatment 18F-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.