PRRT for neuroendocrine tumours

Could this treatment help me?

Many neuroendocrine tumours have somatostatin receptors, which act like docking sites on their cells. A treatment medicine, commonly lutetium-177 DOTATATE, attaches to these sites and delivers radiation.

PRRT is established for selected NETs arising in the digestive system or pancreas that have enough somatostatin receptors. Use in other NETs needs specialist consideration. Your team will discuss the right time for treatment, taking the tumour’s features and your earlier care into account.

Your team considers the receptor scan, previous treatment, symptoms, kidney and liver function, and the bone marrow's ability to make blood cells. Bone marrow is the blood-making tissue inside bones. Sometimes positron emission tomography (PET) using fluorodeoxyglucose (FDG), a tracer similar to glucose, a sugar used for energy, adds information about areas behaving more aggressively.

Preparing for treatment

• Confirm the planned medicine, number of treatment sessions or cycles and how benefit will be assessed.
• Have the requested blood tests and report any new illness.
• Ask for exact instructions for octreotide or lanreotide injections, medicines that help control hormone symptoms and may slow tumour growth. They can interact with receptor-targeted treatment, but changing them yourself can also allow symptoms to return.
• Tell the team about severe diarrhoea, flushing, wheeze or other hormone-related symptoms; a protection plan may be needed.
• Discuss kidney disease, heart problems and any fluid restriction.
• Tell the team about pregnancy, possible pregnancy and breastfeeding. Discuss fertility (the ability to have children) and contraception (preventing pregnancy).
• Arrange transport and discuss your sleeping, childcare and caregiving arrangements before treatment.
• Ask your treatment centre about any fasting requirements, as these can vary between centres.

On treatment day

After checks and preparation, a drip to help protect your kidneys is started. The radioactive medicine is then given into a vein while this drip continues. You stay in the unit for monitoring and completion of the drips. Plan for several hours; some people need a hospital stay.

One commonly used lutetium-177 DOTATATE course is four treatments about eight weeks apart, but your team may delay, adjust or stop treatment if necessary. Imaging after a dose may check distribution or help measure radiation delivery. The team assesses how well treatment is working over time.

A drip to help protect your kidneys

A drip, also called an infusion, containing amino acids is a standard part of lutetium-177 DOTATATE treatment to help protect the kidneys. Amino acids are the building blocks of proteins. The infusion contains lysine and arginine, which reduce how much of the radioactive medicine is taken up by kidney tissue.

The infusion starts before the radioactive medicine and continues for several hours. The solution and schedule can vary between centres; your team will explain your plan and account for any heart or kidney problems. Anti-sickness medicine is usually given first because the infusion can cause nausea. Tell the nurse if you feel sick so they can help.

Side effects and when to call

Nausea, tiredness, reduced appetite and changes in blood counts can occur. Regular blood tests help the team monitor your blood cells and kidneys, even when you feel well. Kidney damage and lasting problems with blood cell production are less common; rarely, another blood cancer can develop. Your team will explain your individual risk and how earlier treatments may affect it.

Rarely, treatment can trigger a rapid release of hormones from a functioning NET, a tumour that releases excess hormones. Sudden severe flushing, diarrhoea, wheezing, dizziness or faintness needs urgent assessment, especially around treatment. The team can plan extra monitoring and medicines for people at risk.

Contact the treatment team immediately for fever, shivering or suddenly feeling very unwell. Also report unusual bruising or bleeding, persistent vomiting, reduced urine, severe diarrhoea or worsening weakness without waiting for your next appointment. If you cannot reach the team and need urgent help, seek urgent medical care. Severe breathing difficulty or collapse requires emergency care.

Going home and follow-up

Your team will explain how to reduce other people's exposure while radioactivity decays and unused medicine leaves the body. Follow your written plan for distance, sleeping, personal care, toilet hygiene, sex, contraception, work and travel.

Brief contact, prolonged close contact and sharing a bed are different situations. Children and pregnant people may need longer restrictions. Ask for an end date and time for each activity in your own discharge plan.

Drink within your medical limits, pass urine regularly and wash your hands well. During the advised precaution period, sitting to pass urine helps reduce splashes. Follow the centre's flushing, cleaning and laundry instructions. Ask about gloves and disposal if someone helps with toileting.

Tell the team if you use a urinary catheter (a tube that drains urine), a stoma (a surgically created opening for urine or stool), or pads for urinary leakage. Do not flush pads, wipes or medical supplies. If you cannot manage the suggested sleeping or contact arrangements, tell the service before treatment so a safe plan can be made.

Between treatments

The team follows blood counts, kidney and liver function, symptoms and scans. Changes in hormone-related symptoms are useful information but do not replace imaging. Tumour shrinkage is not the only possible benefit: stability may be a worthwhile result when the aim is to slow growth.

Continue other medicines according to your written plan, including the agreed timing of octreotide or lanreotide injections. Keep a record of symptoms, eating and drinking difficulties, and any urgent contacts.

Questions you may have