Results and adverse events of personalised peptide receptor radionuclide therapy in 1048 patients with neuroendocrine neoplasms
The largest single-centre report of a radioactive treatment for neuroendocrine tumours, from over a thousand patients treated across a decade at one German hospital, showing typical survival times and how often serious side effects such as blood cancers occurred.
Overview
This retrospective single-centre analysis from Zentralklinik Bad Berka, Germany, reports outcomes for 1048 patients with neuroendocrine neoplasms treated with personalised peptide receptor radionuclide therapy (PRRT) using 90Y- and/or 177Lu-labelled somatostatin analogues between 2004 and 2014, drawn from 2294 patients screened by 68Ga-SSTR PET/CT. Radionuclide, dose and cycle number were individualised to tumour and organ dosimetry rather than fixed, reflecting the Bad Berka group's long-standing personalised-dosimetry approach to PRRT, predating the fixed four-cycle regimen later used in NETTER-1.
Median overall survival across all patients was 51 months (95% CI 47.0-54.9), varying significantly by radionuclide used, tumour grade, prior therapies and tumour origin (for example, gastrinoma and glucagonoma patients had median survival of 66 and 127 months respectively; insulinoma patients 32 months). Median progression-free survival (by 68Ga-SSTR PET/CT with EORTC criteria) was 19 months. Myelodysplastic syndrome or leukaemia developed in 22 patients (2.1%), and five patients required haemodialysis after treatment; other serious adverse events were rare.
As one of the largest published PRRT cohorts, and predating the randomised NETTER-1 trial, this paper was widely cited as real-world evidence for PRRT's long-term safety and effectiveness, and its dosimetry-personalised approach is a touchstone for the ongoing debate about fixed-activity versus dosimetry-guided PRRT dosing.
- Median overall survival across all 1048 patients: 51 months (95% CI 47.0-54.9), varying by radionuclide, tumour grade, prior therapies and site of origin.
- Median progression-free survival by 68Ga-SSTR PET/CT: 19 months overall.
- Myelodysplastic syndrome or leukaemia developed in 22 of 1048 patients (2.1%); 5 patients required haemodialysis after treatment.
- Survival varied widely by tumour subtype: gastrinoma 66 months and glucagonoma 127 months median OS, versus insulinoma 32 months.
In the largest reported group of neuroendocrine tumour patients treated with individually dosed radioactive peptide therapy, most people lived several years after treatment, and serious long-term harms such as blood cancers were uncommon but real, occurring in about 1 in 50 patients.
- Retrospective, single-centre, uncontrolled cohort - there is no comparator arm, so the survival figures cannot be attributed to PRRT alone.
- Radionuclide choice, dose and cycle number were personalised per patient rather than fixed, so results may not generalise directly to fixed-activity regimens such as the one used in NETTER-1 or Lutathera's approved label.
- Long recruitment period (2004-2014) spans changes in imaging, patient selection and supportive care that could affect outcomes over time.
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