This section is for doctors who are considering the selection of PRRT to treat one of their patients.

Considering PRRT for a Patient: What a physician should look for

Progressive, somatostatin receptor positive neuroendocrine tumor patients (non-resectable disease) with the following characteristics:

* A fundamental prerequisite is that high somatostatin receptor expression has been proven before PRRT by OctreoScan or (preferable) by Ga-68 DOTATOC PET/CT.

* Renal function and blood counts should be in the normal range.

* Small bowel tumors (midgut), progressive under octreotide (Sandostatin, Somatuline) therapy - 1st line before chemotherapy

* Small bowel tumors (midgut) with persistent, severe clinical symptoms (diarrhea, flushing), despite maximum medical therapy - 1st line before chemotherapy

* Pancreatic neuroendocrine tumors (pNET), progressive on CT/MRI after Sunitinib/chemotherapy - 2nd line

* Functional pNET (e.g. insulinoma, gastrinoma, VIPoma) with persistent, severe clinical symptoms despite a low proliferation rate (Ki-67<5%) - 1st or 2nd line

- Lung NET (typical carcinoids with low proliferation rate), metastatic, progressive

- Neural crest tumors (paraganglioma/pheochromocytoma), metastatic, progressive

- Other tumors with high somatostatin receptor expression (e.g. metastatic medullary thyroid cancer, radioiodine negative, differentiated thyroid cancer)

For reference physicians should consult the guidelines by the European Neuroendocrine Tumour Society (ENETS)

Patient Medical Information Required: Dr. Baum typically asks referring physicians to provide the following information about their patient:

* All medical (histological and surgical) reports

* Recent reports of CT, MRI, sonography, endoscopy exams

* OctreoScan study (original images or study on CD) – This is Must Have information --- or --- Alternatively Ga-68 DOTATOC PET/CT study on CD in DICOM format.

* PET, PET/CT, CT or MRI studies on CD (in DICOM format) if possible

* Recent blood tests and laboratory values (blood counts (RBC, WBC, platelets), creatinine, urea, liver transaminases)

* Measurements of GFR (glomerular filtration rate, e.g. using Tc-99m DTPA) - this can also be done at the Zentralklinik Bad Berka.

* Measurement of TER (tubular extraction rate, measured by Tc-99m MAG 3 scintigraphy with clearance measurement), this can also be done at the Zentralklinik Bad Berka.

At the Zentralklink Bad Berka the following studies are conducted:

* Pretherapeutic somatostatin receptor PET/CT (with Ga-68 DOTATOC) for dosimetry purposes. This PET/CT study will also serve as a control for follow-up (evaluation of therapy response) and is most important.

* GFR measurement using Tc-99m DTPA (if not done within 8 weeks of admission)

* Renal scintigraphy using Tc-99m MAG3 for measuring of the tubular function (if not done within 6 weeks of admission)

* Ultrasound

* Full laboratory tests, including all relevant tumor markers in blood (e.g. chromogranin A, serotonin, gastrin, etc.)