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Peptide receptor radionuclide therapy (PRRT) have been successfully used for the past 20 years to target metastatic or inoperable neuroendocrine tumors expressing the somatostatin receptors. Both prospective and retrospective studies indicate that patients receiving PRRT show significantly high objective responses, leading to longer survival and improved quality of life. PRRT is generally well tolerated, with acceptable hematological toxicity profiles. Nephrotoxicity is dose-limiting with Y-90 labelled peptides and not with Lu-177. The majority of centers use standard protocols based on fixed activities, at most modulating the activity or the number of administrations based on the patient clinical scenario and risk factors. This guidance covers the rationale, indications and contraindications for PRRNT, assessment of treatment response and patient follow-up. This practical guidance is aimed at guiding nuclear medicine specialists in delivering the treatment in a safe and effective manner.

Neuroendocrine tumors (NETs) are one of the rare cancers that have been increasing in recent years. The importance of Ga-68 DOTA-Conjugated Peptides Receptor imaging has been reported in many retrospective and prospective studies in the diagnosis and clinical management of NETs. Three different somatostatin analogues labeled Ga-68 are used in clinical practice. The most commonly used Ga-68 DOTA-Conjugated Peptides are DOTA-D-Phe-Tyr3-octreotide (DOTA-TOC), DOTA-1-NaI (3)- octreotide (DOTA-NOC) and DOTA-D-Phe-Tyr3-octreotate (DOTA-TATE) in rutin. Although all these radiopeptides bind to sst-r 2, each has different affinity profiles for other sst-r subtypes. Performed related studies have shown that the compound with the highest affinity for somatostatin receptor 2 (sst-r 2), which is most frequently expressed in NETs, is DOTA-TATE. Ga-68 DOTA-bound somatostatin receptor (sst-r) PET/CT is used in the preoperative staging of NETs, determination of treatment response, restaging, showing somatostatin receptor uptake before peptide receptor radionuclide treatment. This guideline, mainly for nuclear medicine physicians contains recommendations in terms of procedure, reporting and interpretation in order to standardize Ga-68 DOTA conjugated peptid PET/CT imaging in NETs.

Skeletal system is the most common metastasis site in patients with advanced cancer. Pain is an important health problem in patients with bone metastasis. Bone seeking radionuclides to treat bone pain due to bone metastasis in patients with advanced stage cancer can be used in selected group of cancer patients. In this review, evaluating patients who might be candidates for radionuclide treatment of bone metastases using beta-emitting radionuclides such as strontium-89, samarium-153 lexidronam, phosphor-32 sodium phosphate, Lutetium-177 ethylenediaminetetramethylene phosphonic acid and alfa-emmiting Radium-223, performing the treatments; and understanding and evaluating the treatment outcome and side effects.