Impact of CXCR4-Directed PET/CT on Staging and Proposed Oncologic Management in Patients with Digestive System Tumors

Alexander Weich, Sebastian E. Serfling, Wiebke Schlötelburg, Takahiro Higuchi, Philipp E. Hartrampf, Andreas Schirbel, Marieke Heinrich, Andreas K. Buck, Steven P. Rowe, Aleksander Kosmala, Rudolf A. Werner

Research output: Contribution to journalArticlepeer-review


Purpose To elucidate the influence of CXC motif chemokine receptor 4 (CXCR4)-directed imaging on staging and proposed oncologic management in patients with digestive system tumors compared with guideline-appropriate imaging (GAI). Methods From our PET/CT database, we retrospectively identified 37 patients with advanced digestive system tumors, which had been scheduled for CXCR4-targeted [68Ga]Ga-pentixafor PET/CT for potential theranostic considerations. In all subjects, concurrent GAI was also available. Patients were afflicted with gastroenteropancreatic neuroendocrine neoplasms (21/37 [56.8%]), pancreatic duct adenocarcinoma (6/37 [16.2%]), cholangiocarcinoma (5/37 [13.5%]), hepatocellular carcinoma (4/37 [10.8%]), and colorectal carcinoma (1/37 [2.7%]). Staging results and impact on proposed oncologic management by a board-certified gastroenterologist were compared between GAI and [68Ga]Ga-pentixafor PET/CT. Results Relative to GAI, CXCR4-directed PET/CT resulted in staging changes in 14 of 37 patients (37.8%). Upstaging was seen in 1 of 14 patients (7.1%), whereas downstaging was recorded in the remaining 13 of 14 patients (92.9%). Among those, staging changes would not have triggered any changes in oncological management in 4 of 14 (28.6%). For the remaining 10 of 14 patients (71.4%), however, findings on [68Ga]Ga-pentixafor PET/CT would have impacted subsequent clinical algorithm, including the necessity for further diagnostic steps or failure to initiate antitumor therapy. Conclusion [68Ga]Ga-pentixafor PET/CT missed tumor lesions in 13 patients with digestive system tumors, which would have led to inappropriate downstaging and clinical treatment of 10 patients. As such, our results do not support a more widespread use of [68Ga]Ga-pentixafor PET/CT for clinical staging in those tumor entities.

Original languageEnglish (US)
Pages (from-to)586-593
Number of pages8
JournalClinical nuclear medicine
Issue number7
StatePublished - Jul 1 2023


  • CXCR4
  • TNM
  • [Ga]Ga-pentixafor
  • chemokine receptor
  • staging
  • therapeutic management

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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