Dr Patrick Fielding
Dr Christopher Marshall
Dr John Rees
Dr Adam Dabkowski
IBA Radiopharma Solutions
Cardiff and Vale University Health Board
Neuroendocrine tumours are rare tumours derived from cells at the interface between the nervous and endocrine systems. There are many histological sub-types but many tumours secrete biologically active amines and most express receptors for peptide hormones (Somatostatin receptors). Treatment may include surgery, medical therapy with somatostatin analogues or targeted radiotherapy using agents which specifically bind to the somatostatin receptors (this is called Peptide Receptor Radionuclide Therapy (PRRT)).
Selection of appropriate therapy depends crucially on understanding the extent of the disease and the degree to which the tumour expresses somatostatin receptors. Previously CT and MRI scans have been used to image the anatomical spread and size of any tumours, but functional imaging has been shown to increase the diagnostic accuracy and to give molecular characterisation regarding the nature and behaviour of the tumours.
Functional imaging can be performed with Octreotide scans but the most accurate form of imaging is a positron emission scan (PET scan) using Gallium DOTA derivates. Currently this is not available in Wales and patients have to travel to London for the scans. The project is to support the development of Gallium PET imaging at the PETIC centre in Cardiff. The project involves developing all of the steps for the safe and efficient production of the radiopharmaceutical and training to provide clinical expertise for the provision of the service.
Specifically the exemplar budget has been used for staff training in production of the radiopharmaceutical and in the medical supervision and reporting of the scans. The Bevan Commission has supported training costs to Coimbra University in Portugal and the Memorial Sloane Kettering Cancer Centre in New York.
This Project Supports Prudent Healthcare
Accurate imaging and functional assessment allows patients to receive the right treatment every time, for example in selecting patients for surgery this allows the identification of patients that would truly benefit from a major surgical procedure.
The appropriate choice of treatment allows for the best use of resources and ensures resources are used most efficiently. Patients only receive treatments that will genuinely benefit them.
The development of a local service in Wales allows greater access to all patients, and access to patients who are too unwell to make the long journey to London.
The widespread availability of this imaging service allows treating doctors to give only the treatments that are most effective, to avoid treatments that will not be of benefit and to reduce harm associated with unhelpful or unnecessary treatments.
The development of a local service allows this state of the art imaging to be available to many patients who would otherwise be unable to access it by travelling long distances to other centres in the UK. Gallium DOTA-PET has a proven increased sensitivity compared to standard Octreotide scans currently available in many hospitals in Wales. The development of this service allows patients in Wales with neuroendocrine tumours to access the best and most accurate imaging available.
Ga-68 DOTA imaging will give the best information at staging and the most accurate restaging information following therapy to allow doctors to best understand whether or not therapeutic interventions are successful. The developments here are supported by the Welsh Health Specialist Services Committee (WHSCC) and by patient representative groups for neuroendocrine tumours.
The availability of this imaging will allow Wales to remain amongst the forefront of developing imaging technology and to produce cutting edge research in the field of neuroendocrine tumours.
Part of Cohort Bevan Exemplars 2015-16