Clinical Report: Changes in Intratumoral Spatial Heterogeneity Monitored by [68Ga]Ga-DOTA-NOC PET/CT

Overview

This case study reports on a 4-year-old male with high-risk neuroblastoma who underwent monitoring with [68Ga]Ga-DOTA-NOC PET/CT during dinutuximab beta treatment. The primary tumor showed structural regression, while a focal area exhibited increased radiotracer uptake, indicating the presence of a viable, poorly differentiated neuroblastoma subclone.

Background

Neuroblastoma is a prevalent extracranial solid tumor in children, characterized by significant biological heterogeneity that can lead to treatment resistance. The use of [68Ga]Ga-DOTA-NOC PET/CT for assessing somatostatin receptor expression is being explored, particularly in the context of immunotherapy.

Data Highlights

Key Findings

• A 4-year-old male with high-risk neuroblastoma was monitored using [68Ga]Ga-DOTA-NOC PET/CT.
• Post-treatment imaging showed structural regression of the primary tumor but increased uptake in a focal area.
• The focal area with increased uptake was confirmed to contain viable, poorly differentiated neuroblastoma.
• Histopathological evaluation revealed 20% poorly differentiated neuroblastoma and 20% differentiating nodular ganglioneuroblastoma components.
• Increased SSTR accumulation post-immunotherapy necessitates careful multidisciplinary evaluation.

Clinical Implications

The findings emphasize the use of [68Ga]Ga-DOTA-NOC PET/CT for monitoring treatment response in neuroblastoma. Elevated SSTR uptake in residual tumors may indicate viable disease, warranting further investigation.

Conclusion

This case highlights the interpretation of imaging results in the context of immunotherapy for neuroblastoma. Enhanced SSTR expression following treatment may signify viable tumor subclones.

Related Resources & Content

1. European Radiology, 2024 -- Evaluating the Diagnostic Efficacy of [68Ga]DOTATATE PET/CT
2. European Radiology, 2023 -- Advancements Over Two Decades in Pediatric Imaging Using a Reduced Dose of [18F]Fluorodeoxyglucose PET/CT
3. The ASCO Post, 2016 -- Approval of Dinutuximab for High-Risk Neuroblastoma: Lessons Learned
4. Neuroblastoma Treatment (PDQ®) - NCI
5. European Radiology — Key Insights on the Use of PET/CT for Neuroendocrine Tumors: Guidelines from the European Society for Hybrid, Molecular, and Translational Imaging
6. Neuroblastoma Treatment (PDQ®) - NCI
7. Qarziba, INN-Dinutuximab beta
8. Imaging of High‐Risk Neuroblastoma: Recommendations From SIOPEN Radiology and Nuclear Medicine Specialty Committees - Littooij - 2026 - Pediatric Blood & Cancer - Wiley Online Library
9. Guidelines on nuclear medicine imaging in neuroblastoma | European Journal of Nuclear Medicine and Molecular Imaging | Springer Nature Link
10. Recommendations for the use of nuclear medicine imaging in patients with neuroblastoma | Clinical and Translational Oncology | Springer Nature Link
11. Joint EANM, IAEA, and SNMMI practical guidance on somatostatin receptor-targeted radionuclide therapy of neuroendocrine tumours - ScienceDirect
12. Association between SSTR2 expression and [68Ga]Ga-DOTATOC PET/CT uptake in neuroblastoma: A retrospective analysis - ScienceDirect
13. Frontiers | Role of 18F-AlF-NOTATATE PET/CT in selecting pediatric neuroblastoma candidates for 177Lu-DOTATATE peptide receptor radionuclide therapy
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