Purpose or Case Report: Though pediatric use of both ⁶⁸Gallium Dotatate and ¹⁷⁷Lutetium is off label, the advantages they offer over FDA approved agents has led to their preliminary use in a variety of pediatric clinical scenarios. The purpose of this poster is to present the range of potential diagnostic and therapeutic applications of ⁶⁸Gallium Dotatate in children.
Methods & Materials: Case examples were gathered by retrospective chart review focusing on ⁶⁸Gallium Dotatate use in the pediatric population. Project approval from the XXX Institutional Review Board was obtained prior to data collection. Individual patient charts were reviewed to obtain relevant data including demographics, type of neuroendocrine tumor, age of diagnosis, presence/absence of predisposing hereditary syndromes, and treatment course and imaging studies were reviewed.
Results: Though its use is considered off label in children, there are several advantages of ⁶⁸Gallium Dotatate PET/CT over traditional Octreoscan and MIBG scanning of neuroendocrine tumors, NET, in children. Dotatate has a far greater affinity for the somatostatin receptors these tumors often express than Octreotide which results in a greater target to background ratio and better lesion conspicuity. The various potential diagnostic uses of ⁶⁸Gallium Dotatate PET/CT in children include initial staging and follow-up of NET, including neuroblastoma, esthesioneuroblastoma, paragangliom/pheochromocytoma, pulmonary and gastrointestinal carcinoid tumors and well as screening in patient groups susceptible to the development of NET, such as SDH and MEN syndromes, are discussed and examples of each are provided. Additionally, examples of its role in proton beam treatment planning are presented. Lastly, examples of radiotherapy for MIBG-negative neuroblastomas or other dotatate-positive malignacies with 177-lutetium labelled dotatate will be presented.
Conclusions: Dotatate-based imaging and therpeutic agents show great promise in the evaluation and treatment of pediatric patients with NET. Though their use is off label, the advantages they have over current standard imaging agents and the potential complimentary role to Iodine-131 MIBG therapy they offer show great promise.