Peptide Receptor Radionuclide Therapy (PRRT)

Neuroendocrine tumours do not behave in a uniform way. In some patients, they remain stable for long periods, while in others, they progress slowly but steadily. Even when growth is not rapid, symptoms can develop over time and begin to affect daily life. Patients may notice abdominal discomfort, weight changes, loose stools, and other symptoms. Some patients mainly report feeling tired. 

Management depends on how the disease presents. Surgery is considered only when the tumour is localised and can be removed safely. Many patients are diagnosed at a stage where the disease has already spread, or it may progress later despite treatment.

In such situations, additional options are considered, such as Peptide Receptor Radionuclide Therapy (PRRT). This treatment approach is considered when certain features are present, particularly somatostatin receptor expression on tumour cells. At Gleneagles Hospitals, an expert multidisciplinary team carefully reviews scans, prior treatment, and the patient’s condition before proceeding with PRRT.

PRRT is a targeted form of radionuclide therapy. It is used mainly in neuroendocrine tumours that express somatostatin receptors.

The treatment combines:

• A peptide that binds to these receptors
• A radioactive component attached to that peptide

After administration, the compound circulates in the bloodstream. It attaches to the sites where these receptors are present. Radiation is then delivered at those points. 

The effect is gradual. It does not produce immediate changes. In many cases, the aim is to slow progression and reduce disease activity. It is still considered a systemic treatment. Even though it is targeted, it can reach tumour deposits in different parts of the body.

PRRT is not a first-line treatment in most situations. It is considered in selected patients, usually after other options have been reviewed or when the disease shows a certain pattern over time.

It may be advised when:

• The tumour cannot be completely removed
• Disease is present at multiple sites
• Symptoms continue despite treatment
• Imaging shows progression

Patients may present differently. Some have hormone-related symptoms. Others have symptoms due to tumour size or involvement of nearby structures. In a few cases, symptoms may be mild, but imaging shows clear progression.

The decision usually depends on:

• Imaging findings
• Clinical condition
• Previous treatments

No single factor is used in isolation. At Gleneagles Hospitals, the choice will generally be made after consultation among specialists, based on clinical observations and test results.

Prior to administering PRRT, a comprehensive evaluation will first be performed. This step helps ensure that the treatment is both appropriate and safe for the patient.

This usually includes:

• Imaging to confirm receptor uptake
• CT or MRI to assess disease extent
• Blood tests, including kidney and liver function

Kidney function is important. The treatment is cleared through the kidneys, so steps are taken during therapy to reduce exposure. In some patients, additional precautions may be required depending on baseline function.

This stage helps determine whether the treatment is suitable and whether it can be given safely. Gleneagles Hospitals' team minutely analyses the test results and evaluates the patient prior to prescribing treatment.

PRRT is not suitable for every patient.

It may not be considered in:

• Significant kidney impairment
• Low blood counts
• Pregnancy
• Tumours without receptor uptake

There are also situations where overall health plays a role. In some patients, the expected benefit may be limited, especially if the disease is very advanced or the general condition is poor.

These decisions are made individually. Clinical judgment becomes particularly important in such instances, as the risk-benefit ratio must be considered.

Preparation

Before each cycle, the patient is assessed, and blood test results are reviewed. This helps decide if treatment can go ahead.

Patients are usually told to stay hydrated. They should also inform the team about any medicines they are taking. In some cases, patients are given a few additional instructions beforehand as required. At times, treatment may be adjusted or delayed if blood test results or recent symptoms require it.

During the Procedure

PRRT is given through a drip. The session usually begins with an infusion given to protect the kidneys. Once that is underway, the treatment is started slowly. Monitoring continues throughout the process. The whole session takes a few hours. Patients remain in the unit during this time, and basic checks may be done from time to time.
Immediately After

Once the infusion is over, patients are observed for a short while before they are allowed to leave. They are given instructions regarding:

• Fluid intake
• General precautions

Patients are usually advised to maintain good hydration for the next day or two. Most patients can go home after a short period, although instructions may vary based on individual circumstances.

Recovery varies depending on the patient. Many tolerate the treatment reasonably well, and some patients experience fatigue afterwards. Nausea can occur in a few cases, and appetite may be reduced for a short time. These effects are usually mild and settle over the next few days without much intervention.

Most patients gradually return to their usual routine. Follow-up visits are planned, and blood tests are done periodically to monitor progress. Any change in symptoms tends to take time. It is not always immediate; in many cases, it becomes noticeable only after a few weeks.

PRRT is a targeted therapy. However, some risks remain.

Short-term effects:

• Nausea
• Fatigue

These are usually mild. They settle within a few days in most cases. Supportive care is often sufficient, and most patients can continue their routine between cycles.

Long-term considerations:

• Changes in blood counts
• Effects on kidney function

Because of this, regular blood tests are done during and after treatment. Kidney function is monitored regularly. Measures are taken during each cycle to help reduce exposure. Rare complications can occur. Monitoring is part of the treatment plan, and follow-up is structured to identify any changes early.

PRRT is being used more often in selected patients, particularly in those with advanced neuroendocrine tumours where other treatments may have limited effect.

Some reasons include:

• Targeted delivery of treatment
• Ability to treat disease in different locations
• Symptom control in certain cases

Another reason is that it allows treatment to reach tumour deposits that may not be accessible surgically. In some patients, it also helps stabilise the disease over time. It is usually used along with other treatments and forms part of an overall management plan. It does not completely replace other therapies.

• Multidisciplinary Coordination
  PRRT involves more than one speciality. Oncology, nuclear medicine, and supportive care teams are all involved at different stages of treatment.
• Pre-treatment Evaluation
  Imaging and lab reports are reviewed first. The patient is assessed in light of these findings before a decision is made.
• Monitored Treatment Setting
  The therapy is given in a controlled environment. Kidney protection is part of the process, and the infusion is carried out step by step. Observation continues during each cycle.
• Planned Follow-ups
  Patients are reviewed at intervals. Follow-up tests may be conducted along the way to assess progress and inform subsequent decisions.
• Structured Care Approach
  Care is typically planned in stages so that the effect of the treatment can be assessed at regular intervals. This is to ensure safety at all times.

PRRT may be considered for people with neuroendocrine tumours when the disease continues to progress or has spread to other parts of the body. The treatment is designed to bind to specific receptors on tumour cells, allowing radiation to be delivered more selectively. Because neuroendocrine tumours can behave differently from one patient to another, the effect of treatment can vary. In some cases, tumour growth slows, while in others, there may also be relief from symptoms related to hormone production or tumour burden. Suitability for PRRT is assessed individually. 

At Gleneagles, doctors thoroughly consider scan results, laboratory findings, prior treatment reports, and the patient’s overall condition before deciding whether this approach is appropriate. The review process takes place periodically to determine whether there are any new developments in the symptoms, the tumour activity, or the treatment side effects. Our specialists ensure the patient receives personalised care for optimal results.