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A head-to-head comparison of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in patients with nasopharyngeal carcinoma: a single-center, prospective study

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Abstract

Purpose

We aimed to compare the staging efficiency of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in nasopharyngeal carcinoma (NPC) patients.

Methods

Thirty-nine patients with pathologically confirmed NPC were enrolled in this prospective study. Each patient underwent paired [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT on 2 successive days. The accuracy of two PET/CT for assessing T, N, and M stages was compared by using head-and-neck MRI, histopathologic diagnosis and follow-up results as reference standards. The radiotracer uptake derived from two PETs was also compared.

Results

For treatment-naïve patients, [68Ga]Ga-DOTATATE PET/CT showed identical sensitivity for the primary tumours but clearer tumor delineation induced by higher tumour-to-background (TBR) ratio (19.1 ± 8.7 vs. 12.4 ± 7.7, P = 0.003), compared with [68Ga]Ga-FAPI PET/CT. Regarding cervical lymph node (CLN) metastases, [68Ga]Ga-DOTATATE PET had significantly better sensitivity and accuracy based on neck sides (98% vs. 82%, P < 0.001; 99% vs. 88% P = 0.008), neck levels (98% vs. 78%, 99% vs. 97%; both P < 0.001) and individual nodes (89% vs. 56%, 91% vs. 76%; both P < 0.001), and higher TBR (8.1 ± 4.1 vs. 6.3 ± 3.7, P < 0.001). Additionally, [68Ga]Ga-DOTATATE PET/CT revealed higher sensitivity and accuracy for distant metastases (96% vs. 53%, 95% vs. 52%; both P < 0.001), particularly in bone metastases (99% vs. 49%, 97% vs. 49%; both P < 0.001). For post-treatment patients, [68Ga]Ga-DOTATATE PET/CT identified one more true-negative case than [68Ga]Ga-FAPI PET/CT.

Conclusion

[68Ga]Ga-DOTATATE PET/CT performed better than [68Ga]Ga-FAPI PET/CT in visualizing the primary tumours, detecting the metastatic lesions and identifying the local recurrence, suggesting [68Ga]Ga-DOTATATE PET/CT may be superior to [68Ga]Ga-FAPI PET/CT for NPC staging.

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References

  1. Chen YP, Chan ATC, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet. 2019;394:394. https://doi.org/10.1016/S0140-6736(19)30956-0.

    Article  Google Scholar 

  2. Hudgins PA, Baugnon KL. Head and Neck: Skull Base Imaging. Neurosurgery. 2018;82:255–67. https://doi.org/10.1093/neuros/nyx492.

    Article  PubMed  Google Scholar 

  3. Tang LL, Chen WQ, Xue WQ, He YQ, Zheng RS, Zeng YX, et al. Global trends in incidence and mortality of nasopharyngeal carcinoma. Cancer Lett. 2016;374:22–30. https://doi.org/10.1016/j.canlet.2016.01.040.

    Article  CAS  PubMed  Google Scholar 

  4. Young LS, Dawson CW. Epstein-Barr virus and nasopharyngeal carcinoma. Chin J Cancer. 2014; 33: 581 − 90. https://doi:10.5732/cjc.014.10197.

  5. Lee AWM, Ng WT, Chan JYW, Corry J, Mäkitie A, Mendenhall WM et al. Management of locally recurrent nasopharyngeal carcinoma. Cancer Treat Rev. 2019;79:101890. https://doi.org/10. 1016/j. ctrv. 2019. 101890.

  6. Lai V, Khong PL. Updates on MR imaging and 18F-FDG PET/CT imaging in nasopharyngeal carcinoma. Oral Oncol. 2014;50(6):539–48. https://doi.org/10.1016/j.oraloncology.2013.05.005.

    Article  PubMed  Google Scholar 

  7. Lee SH, Huh SH, Jin SM, Rho YS, Yoon DY, Park CH. Diagnostic value of only 18F-fluorodeocyglucose positron emission tomography/computed tomography-positive lymph nodes in head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 2012;147:692–8. https://doi.org/10.1177/0194599812443040.

    Article  PubMed  Google Scholar 

  8. Tsai MC, Shu YC, Hsu CC, Lin CK, Lee JC, Chu YH, et al. False positive finding of retropharyngeal lymph node recurrence in both fluorine (18)FDG PET and MRI in a patient with nasopharyngeal carcinoma. Head Neck. 2016;38:E84–6. https://doi.org/10.1002/hed.24205.

    Article  PubMed  Google Scholar 

  9. Tang LL, Chen YP, Chen CB, Chen MY, Chen NY, Chen XZ, The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma.Cancer Commun (Lond), 2021;41:1195 − 227. https://doi:10.1002/cac2.12218.

  10. OuYang PY, Liu ZQ, Lin QG, He Y, Guo ZX, Yao WY, et al. Benefit of [18F] FDG PET/CT in the diagnosis and salvage treatment of recurrent nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2023;50:881 − 91. https://doi:10.1007/s00259-022-06020-3.

  11. Comoretto M, Balestreri L, Borsatti E, Cimitan M, Franchin G, Lise M. Detection and restaging of residual and/or recurrent nasopharyngeal carcinoma after chemotherapy and radiation therapy: comparison of MR imaging and FDG PET/CT. Radiology. 2008;249:203 − 11. https://doi:10.1148/radiol.2491071753.

  12. Qin C, Liu F, Huang J, Ruan W, Liu Q, Gai Y, et al. A head-to-head comparison of 68Ga-DOTA-FAPI-04 and 18F-FDG PET/MR in patients with nasopharyngeal carcinoma: a prospective study. Eur J Nucl Med Mol Imaging. 2021;48:3228-37. https://doi:10.1007/s00259-021-05255-w.

  13. Zhao L, Pang Y, Zheng H, Han C, Gu J, Sun L, et al. Clinical utility of [68Ga]Ga-labeled fbroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography for primary staging and recurrence detection in nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2021;48:3606-17. https://doi:10.1007/s00259-021-05336-w.

  14. Zheng J, Liu F, Lin K, Zhang L, Huang N, Zheng W, et al. [68Ga]GaFAPI PET/CT improves the T staging of patients with newly diagnosed nasopharyngeal carcinoma: a comparison with [18F]FFDG. Mol Imaging Biol. 2022;24:973–85. https://doi.org/10.1007/s11307-022-01748-8.

    Article  CAS  PubMed  Google Scholar 

  15. Loh KS, Waser B, Tan LK, Ruan RS, Stauffer E, Reubi JC. Somatostatin receptors in nasopharyngeal carcinoma. Virchows Arch. 2002;441:444–8. https://doi.org/10.1007/s00428-002-0693-y.

    Article  CAS  PubMed  Google Scholar 

  16. Schartinger VH, Dudás J, Url C, Reinold S, Virgolini IJ, Kroiss A, et al. (68)Ga-DOTA (0)-Tyr (3)-octreotide positron emission tomography in nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2015;42:20–4. https://doi.org/10.1007/s00259-014-2905-5.

    Article  CAS  PubMed  Google Scholar 

  17. Khor LK, Loi HY, Sinha AK, Tong KT, Goh BC, Loh KS, et al. (68)Ga-DOTA-peptide: a novel molecular biomarker for nasopharyngeal carcinoma. Head Neck. 2016;38:E76–80. https://doi.org/10.1002/hed.24164.

    Article  PubMed  Google Scholar 

  18. Bennink RJ, van der Meulen FW, Freling NJ, Booij J. Somatostatin receptor scintigraphy in nasopharyngeal carcinoma. Clin Nucl Med. 2008;33:558–61. https://doi.org/10.1097/RLU.0b013e31817dec00.

    Article  PubMed  Google Scholar 

  19. Zhao L, Pang Y, Wang Y, Chen J, Zhuang Y, Zhang J, et al. Somatostatin receptor imaging with [68Ga]GaDOTATATE Positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2022;49:1360–73. https://doi.org/10.1007/s00259-021-05587-7.

    Article  CAS  PubMed  Google Scholar 

  20. Lin Z, Zhu W, Zhang J, Miao W, Yao S, Huo L. Head-to-Head comparison of 68Ga-NODAGA-JR11 and 68Ga-DOTATATE PET/CT in patients with metastatic, well-differentiated neuroendocrine tumors: interim analysis of a prospective Bicenter Study. J Nucl Med. 2023;64:1406–11. https://doi.org/10.2967/jnumed.122.264890.

    Article  CAS  PubMed  Google Scholar 

  21. Puré E, Blomberg R. Pro-tumorigenic roles of fbroblast activation protein in cancer: back to the basics. Oncogene. 2018;37:4343–57. https://doi.org/10.1038/s41388-018-0275-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Wu HB, Wang QS, Wang MF, Zhen X, Zhou WL, Li HS. Preliminary study of 11 C-choline PET/CT for T staging of locally advanced nasopharyngeal carcinoma: comparison with 18F-FDG PET/CT. J Nucl Med. 2011;52:341–6. https://doi.org/10.2967/jnumed.110.081190.

    Article  CAS  PubMed  Google Scholar 

  23. van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990;177:379–84. https://doi.org/10.1148/radiology.177.2.2217772.

    Article  PubMed  Google Scholar 

  24. Zhang GY, Liu LZ, Wei WH, Deng YM, Li YZ, Liu XW. Radiologic criteria of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma treated with radiation therapy. Radiology. 2010;255:605–12. https://doi.org/10.1148/radiol.10090289.

    Article  PubMed  Google Scholar 

  25. Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, et al. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2014;110:172–81. https://doi.org/10.1016/j.radonc.2013.10.010.

    Article  PubMed  Google Scholar 

  26. Henry LR, Lee HO, Lee JS, Klein-Szanto A, Watts P, Ross EA, et al. Clinical implications of fibroblast activation protein in patients with colon cancer. Clin Cancer Res. 2007;13:1736–41. https://doi.org/10.1158/1078-0432.CCR-06-1746.

    Article  CAS  PubMed  Google Scholar 

  27. Leibel SA, Fuks Z, Zelefsky MJ, Wolden SL, Rosenzweig KE, Alektiar KM, et al. Intensity-modulated radiotherapy. Cancer J. 2002;8:164–76. https://doi.org/10.1097/00130404-200203000-00010.

    Article  PubMed  Google Scholar 

  28. Lee AW, Ng WT, Pan JJ, Poh SS, Ahn YC, AlHussain H, et al. International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma. Radiother Oncol. 2018;126:25–36. https://doi:10.1016/j.radonc.2017.10.032.

  29. Li C, Yang Y, Hu F, Xu Y, Wu B, Huang J, et al. Evaluation of 11C-Choline PET/CT for T Staging and Tumor Volume Delineation in Nasopharyngeal Cancer Patients in Comparison to 18F-FDG PET/CT. Clin Nucl Med. 2023;48:563 − 73. https://doi:10.1097/RLU.0000000000004645.

  30. Zaidi H, El Naqa I. PET-guided delineation of radiation therapy treatmentvolumes: a survey of image segmentation techniques. Eur J Nucl Med Mol Imaging. 2010;37:2165-87. https://doi:10.1007/s00259-010-1423-3.

  31. Yang SS, Wu YS, Chen WC, Zhang J, Xiao SM, Zhang BY, et al. Benefit of [18F]-FDG PET/CT for treatment-naïve nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2022;49:980 − 91. https://doi:10.1007/s00259-021-05540-8.

  32. Qin C, Song Y, Liu X, Gai Y, Liu Q, Ruan W, et al. Increased uptake of 68Ga-DOTA-FAPI-04 in bones and joints: metastases and beyond. Eur J Nucl Med Mol Imaging. 2022;49:709 − 20. https://doi:10.1007/s00259-021-05472-3.

  33. Tang W, Wang Q, Yang S, Chen Y. Elevated 68Ga-FAPI activity in the Plasmacytoma of the ribs. Clin Nucl Med. 2021;46:523–4. https://doi.org/10.1097/RLU.0000000000003632.

    Article  PubMed  Google Scholar 

  34. Tang W, Wang Q, Yang S, Chen Y. 68Ga-FAPI outperforms 18F-FDG PET/CT in identifying bone metastasis and peritoneal carcinomatosis in a patient with metastatic breast cancer. Clin Nucl Med. 2020;45:913–5. https://doi.org/10.1097/RLU.0000000000003263.

    Article  Google Scholar 

  35. Sun XS, Liu LT, Liu SL, Guo SS, Wen YF, Xie HJ, et al. Identifying optimal candidates for local treatment of the primary tumor among patients with de novo metastatic nasopharyngeal carcinoma: a retrospective cohort study based on EpsteinBarr virus DNA level and tumor response to palliative chemotherapy. BMC Cancer. 2019;19:92. https://doi.org/10.1186/s12885-019-5281-5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zou X, You R, Liu H, He YX, Xie GF, Xie ZH, et al. Establishment and validation of M1 stage subdivisions for de novo metastatic nasopharyngeal carcinoma to better predict prognosis and guide treatment. Eur J Cancer. 2017;77:117–26. https://doi.org/10.1016/j.ejca.2017.02.029.

    Article  PubMed  Google Scholar 

  37. Meng K, Tey J, Ho FCH, Asim H, Cheo T. Utility of magnetic resonance imaging in determining treatment response and local recurrence in nasopharyngeal carcinoma treated curatively. BMC Cancer. 2020;20:193. https://doi.org/10.1186/s12885-020-6664-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol. 2015;141:1985–94. https://doi.org/10.1007/s00432-015-1974-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Zhu W, Zhang J, Singh A, Kulkarni HR, Baum RP. Metastatic nasopharyngeal carcinoma treated with intraarterial combined with intravenous peptide receptor radionuclide therapy. Clin Nucl Med. 2019;44:989–90. https://doi.org/10.1097/RLU.0000000000002788.

    Article  PubMed  Google Scholar 

  40. Fu K, Pang Y, Zhao L, Lin L, Wu H, Sun L, et al. FAP-targeted radionuclide therapy with [177Lu]Lu-FAPI-46 in metastatic nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2022;49:1767–9. https://doi.org/10.1007/s00259-021-05634-3.

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported in part by the Joint Funds for the Innovation of Science and Technology Fujian Province (No.2021Y9134), Natural Science Foundation of Fujian Province (No.2023J01564) and the Fujian Provincial Health Technology Project (No.2022QNA032).

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Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China

    Jieling Zheng, Guochang Wang, Yun Yang & Weibing Miao

  2. Department of Nuclear Medicine, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China

    Jieling Zheng, Guochang Wang, Yun Yang & Weibing Miao

  3. Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China

    Qian Ru & Li Zhang

  4. Department of Radiotherapy, the First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China

    Li Su, Wenlong Lv, Chunlin Ke, Peirong Wang, Xiaohui Liu & Feng Liu

  5. Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China

    Weibing Miao

  6. Department of Nuclear Medicine, Provincial Clinical Key Specialty of Fujian, Fuzhou, 350005, Fujian Province, China

    Weibing Miao

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  1. Jieling Zheng
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  2. Guochang Wang
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  3. Qian Ru
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  10. Li Zhang
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  11. Feng Liu
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  12. Weibing Miao
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Contributions

Experimental design: Jieling Zheng and Weibing Miao; Patients recruiting: Jieling Zheng, Li Su, Wenlong Lv, Chunlin Ke, Peirong Wang, Xiaohui Liu, Feng Liu; Radiopharmaceutical preparation: Yun Yang; PET imaging analyses: Jieling Zheng and Weibing Miao; Immunohistochemistry analysis: Qian Ru and Li Zhang; Statistical analyses: Jieling Zheng and Guochang Wang; Manuscript writing: Jieling Zheng; Manuscript revision: Guochang Wang and Weibing Miao. All authors have seen and approved the manuscript.

Corresponding author

Correspondence to Weibing Miao.

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All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any experiments with animals.

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Zheng, J., Wang, G., Ru, Q. et al. A head-to-head comparison of [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI PET/CT in patients with nasopharyngeal carcinoma: a single-center, prospective study. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06744-4

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