Neuroendocrine Tumor Theranostics: An Update and Emerging Applications in Clinical Practice

AJR Am J Roentgenol. 2021 Aug;217(2):495-506. doi: 10.2214/AJR.20.23349. Epub 2021 Jun 2.


OBJECTIVE. Theranostics have shown great promise for delivering precision medicine, particularly in neuroendocrine tumors (NETs). The clinical applications of radiolabeled somatostatin analogues in imaging and radionuclide therapy have been rapidly increasing over the past 2 decades and are currently integrated into the management guidelines of NETs. This article summarizes the available literature on different somatostatin receptor-targeting radiopharmaceuticals with theranostic potential in NETs, pheochromocytomas, and paragangliomas. We discuss the clinical application, administration, and toxicity of recent FDA-approved radionuclide therapies, including 177Lu-DOTATATE in advanced gastroenteropancreatic NETs and 131I-MIBG in advanced paragangliomas and pheochromocytomas. CONCLUSION. Several studies support the safety and clinical efficacy of peptide receptor radionuclide therapies in disease control and quality-of-life improvement in patients with NETs and report potential benefits of combined radionuclide treatment approaches. The utility and pitfalls of functional imaging in therapy response assessment and surveillance of NETs remain to be established.

Keywords: neuroendocrine tumor; somatostatin analogue; theranostic.

Publication types

  • Review

MeSH terms

  • 3-Iodobenzylguanidine / therapeutic use*
  • Humans
  • Iodine Radioisotopes / therapeutic use*
  • Neuroendocrine Tumors / radiotherapy*
  • Octreotide / analogs & derivatives*
  • Octreotide / therapeutic use
  • Organometallic Compounds / therapeutic use*
  • Pheochromocytoma / radiotherapy*
  • Precision Medicine / methods*
  • Radiopharmaceuticals / therapeutic use*


  • Iodine Radioisotopes
  • Iodine-131
  • Organometallic Compounds
  • Radiopharmaceuticals
  • 3-Iodobenzylguanidine
  • lutetium Lu 177 dotatate
  • Octreotide