# Multimodal Deep Learning for Prediction of Progression-Free Survival in Patients with Neuroendocrine Tumors Undergoing 177Lu-based Peptide Receptor Radionuclide Therapy

arXiv: https://arxiv.org/abs/2511.05169 · HTML: https://mlsanity.com/paper/2511.05169/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 4 of its 38 references that are in the map.
- First posted on arXiv 7 Nov 2025.

## Builds on (most cited first, 4 of 4)

- [UMAP: Uniform Manifold Approximation and Projection for Dimension Reduction](https://mlsanity.com/paper/1802.03426/) (2018)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [Random orthogonal additive filters: a solution to the vanishing/exploding gradient of deep neural networks](https://mlsanity.com/paper/2210.01245/) (2022)
- [On the effectiveness of multimodal privileged knowledge distillation in two vision transformer based diagnostic applications](https://mlsanity.com/paper/2508.06558/) (2025)

## Abstract (arXiv)

Peptide receptor radionuclide therapy (PRRT) is an established treatment for metastatic neuroendocrine tumors (NETs), yet long-term disease control occurs only in a subset of patients. Predicting progression-free survival (PFS) could support individualized treatment planning. This study evaluates laboratory, imaging, and multimodal deep learning models for PFS prediction in PRRT-treated patients. In this retrospective, single-center study 116 patients with metastatic NETs undergoing 177Lu-DOTATOC were included. Clinical characteristics, laboratory values, and pretherapeutic somatostatin receptor positron emission tomography/computed tomographies (SR-PET/CT) were collected. Seven models were trained to classify low- vs. high-PFS groups, including unimodal (laboratory, SR-PET, or CT) and multimodal fusion approaches. Explainability was evaluated by feature importance analysis and gradient maps. Forty-two patients (36%) had short PFS (< 1 year), 74 patients long PFS (>1 year). Groups were similar in most characteristics, except for higher baseline chromogranin A (p = 0.003), elevated gamma-GT (p = 0.002), and fewer PRRT cycles (p < 0.001) in short-PFS patients. The Random Forest model trained only on laboratory biomarkers reached an AUROC of 0.59 +- 0.02. Unimodal three-dimensional convolutional neural networks using SR-PET or CT performed worse (AUROC 0.42 +- 0.03 and 0.54 +- 0.01, respectively). A multimodal fusion model laboratory values, SR-PET, and CT -augmented with a pretrained CT branch - achieved the best results (AUROC 0.72 +- 0.01, AUPRC 0.80 +- 0.01). Multimodal deep learning combining SR-PET, CT, and laboratory biomarkers outperformed unimodal approaches for PFS prediction after PRRT. Upon external validation, such models may support risk-adapted follow-up strategies.