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Why are the Ga-68 scan and PRRNT so important for carcinoid/NET patients? They are in the forefront of imaging, diagnostic, treatment and follow-up tools for NET cancer. The Ga-68 scan is extraordinarily clear and sensitive, explains Dr. Baum, and can detect neuroendocrine tumors as small as 4 millimeters. It is also an excellent tool for measuring the density of a patient's receptors. This is especially important as the only way PRRNT can work is for patients to have somatostatin receptors in their tumors.

PRRNT is effective, says Dr. Baum, even for very advanced cases. The treatment leads to a significant improvement of clinical symptoms such as decreases in flushing, pain and diarrhea; weight gain in underweight patients; the ability to give up octreotide therapy; and improvement of overall health.

Most importantly, the median overall survival of patients from the start of treatment is 59 months.

Who should consider PRRNT? Patients with progressive tumors and uncontrollable symptoms despite the maximum conventional therapies may be good candidates for the treatment. It is also critical to take into account the size and number of tumors as well as their location. Other factors such as age and physical condition must also be considered. Baum's Bad Berka Score (BBBS) to determine whether or not the patient is a good candidate for PRRNT includes the time since diagnosis, previous therapies, liver involvement, extrahepatic tumor burden, blood counts, the Ki-67 proliferation rate which measures, how fast tumors grow, and kidney function. And the greater the number of receptors a patient has, as determined by the Ga-68 SMS scan, the greater the success of the PRRNT treatment. All of these factors are used to determine whether or not to proceed with PRRNT and if so, whether to treat with less frequent and higher radioisotope activity (high volume disease) or more frequently with lower doses of the radiolabeled peptides (small volume disease).

A systemic form of treatment that will affect NET tumors wherever they are in the body, PRRNT is used primarily for patients with nonresectable tumors at multiple sites. Some patients who have tumors predominantly in their liver are treated with PRRNT in order to reduce the size and number of metastases present in the liver or elsewhere in the body, or in preparation for surgery (neoadjuvant PRRNT).

PRRNT should only be performed at specialized centers, says Dr. Baum, as NET patients need highly individualized and interdisciplinary treatment and long-term care. Typically, patients receive 3 to 6 cycles of PRRNT, with some receiving up to 10. PRRNT with Lu-177 is more suitable for patients with reduced kidney function and is for patients with smaller metastases, but works also in large tumors. PRRNT with Y-90 is better for patients with huge metastases.

Dr. Baum has performed Ga-68 scans and PRRNT treatments on patients as young as 2 and as old as 86, with a median age of 59 years. He has treated nearly 1,000 patients with these therapies. Dr. Baum is presently creating a database of patients based on the more than 3,000 PRRNT treatment cycles he has performed so that other physicians can benefit from the data, which include over 250 variables per patient in the database.

To learn more about PRRNT (peptide receptor radionuclide therapy) at Bad Berka, visit the following websites: and

To view an excellent video presentation by Dr. Richard Baum on PRRNT in Germany, presented at the 2009 National Carcinoid/NET Patient Conference, CLICK HERE, and scroll down to Nuclear Medicine, PRRNT and other Radiotherapies Presentation Recordings from Day 2 Afternoon.

You may also visit YouTube at

which shows a video presentation on diagnosis & targeted therapy of neuroendocrine neoplasms recorded in Singapore in March 2009, containing approx. 90 minutes of information on PRRNT presented by Dr. Baum at a patient conference.