Peptide receptor radionuclide therapy (PRRT)

Peptide receptor radionuclide therapy (PRRT) - What it is

Peptide receptor radionuclide therapy is a type of radiopharmaceutical therapy which is given to patients through an intravenous infusion. This treatment is prescribed for patients who have advanced neuroendocrine tumours. Neuroendocrine tumours are sensitive to radiation and commonly overexpress certain types of somatostatin receptors. A radioactive material is bound to a drug which targets these receptors – this is called a radiolabelled peptide. The radiolabelled peptide is taken into the tumour cells, where radiation can exert its effects. The radionuclide used in this therapy is usually Lutetium 177 (Lu-177).

Peptide receptor radionuclide therapy (PRRT) - Symptoms

Neuroendocrine tumours are tumours that develop from neuroendocrine cells. These cells have the traits of hormone-producing cells and nerve cells. They are found all over the body.

Symptoms depend on the site and the type of neuroendocrine tumour. Some neuroendocrine tumours produce hormones while others do not.

Peptide receptor radionuclide therapy (PRRT) - How to prevent?

Peptide receptor radionuclide therapy (PRRT) - Causes and Risk Factors

Peptide receptor radionuclide therapy (PRRT) - Diagnosis

Neuroendocrine tumours are diagnosed by taking a tissue sample of the tumour and sending to the laboratory to be looked at by the pathologist. Following that, scans may be done to determine whether other parts of the body may be affected by the tumour. In some cases, blood tests are also needed to see if the tumour is producing hormones.

Peptide receptor radionuclide therapy (PRRT) - Treatments

Peptide receptor radionuclide therapy (PRRT) - Preparing for surgery

Blood tests looking at the blood counts, kidney function and liver function are needed before proceeding with PRRT. A Gallium-68 dotapeptide PET/CT scan is also done beforehand to determine if the tumour expresses somatostatin receptors and PRRT is a suitable treatment.

PRRT is administered intravenously. A short hospital stay in the radiation isolation room is required to monitor patients during and after the infusion of the radiopharmaceutical. Scans will be performed the day after to see the distribution of the radiopharmaceutical.

Peptide receptor radionuclide therapy (PRRT) - Post-surgery care

Upon discharge from hospital, you may be provided with medications for nausea and vomiting. You are encouraged to keep well hydrated. Regular blood tests will be ordered and you will be given appointments to return to see your doctor for review of these blood tests and follow-up.

PRRT is generally a well-tolerated procedure. The risks and complications from the treatment may include the following:

Transient nausea and vomiting.
General lethargy.
Local or regional compression due to transient tumour swelling.
Rarely, in patients with functional tumours that are producing hormones, PRRT may exacerbate the symptoms due to sudden massive release of hormones during and shortly after the treatment. You will be closely monitored and should you experience such symptoms, an injection of octreotide will be given to you as necessary.
In the short term following the treatment, patients may experience mild hair loss and a lowering of blood cells. In most patients, these are not permanent and recovery to normal state is expected. In a small number of patients, the lowered blood counts do not fully recover to normal due to radiation effects on the bone marrow.
Rarely, patients who receive repeated treatments of PRRT have been reported to develop impairment of kidney function or a second cancer (1-2%).
In patients who have large liver metastases or impaired liver function prior to PRRT, worsening of liver function may occur.

You are advised to avoid pregnancy or impregnating your partner for 6 months following PRRT as the radiation may have adverse effects on the embryo or foetus.

Peptide receptor radionuclide therapy (PRRT) - Other Information

Overview

Neuroendocrine Tumors

Article contributed by Nuclear Medicine and Molecular Imaging, Singapore General Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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