Objective <p>Foregut and hindgut neuroendocrine tumors (NETs) contribute significantly to the global NET burden especially in Asian population; however, these cohorts are sparse and underrepresented in current trials assessing peptide receptor radionuclide therapy (PRRT) in gastroenteropancreatic (GEP) NETs. This single-centre study evaluates the efficacy and safety of PRRT in advanced foregut and hindgut NETs.</p> Methods <p>Retrospective data evaluation of consecutive patients with biopsy-proven metastatic foregut (gastric, lung and thymic NETs) and hindgut NETs (colorectal, anal and sacral NETs) who underwent PRRT from 2014 to 2024 at a tertiary care hospital was done. Up to four cycles of ¹⁷⁷Lu-DOTATATE (7.4 GBq/cycle) were administered intravenously every 6–8 weeks along with nephroprotection. Interim and end-of-treatment ⁶⁸Ga-DOTANOC PET/CT scans were acquired for response evaluation, based on RECIST v1.1. Objective response rate (ORR), disease control rate (DCR), best biochemical response, toxicity profile, quality-of-life scores, progression-free survival (PFS) and overall survival (OS) were assessed.</p> Results <p>Thirty-four patients (median age-56 yrs) with foregut (<i>n</i> = 16) and hindgut (<i>n</i> = 18) NETs received a total of 111 cycles (range 1–4) of ¹⁷⁷Lu-DOTATATE (median cumulative activity 26.5 GBq). The best ORR and DCR were 45% and 80%, median PFS was 29.7 months (95% CI, 20.3–39.1), and the 1- and 5-year OS rates were 93.8% (95% CI, 85.4–100) &amp; 53.6% (95% CI, 28.6–78.6), respectively, after a median follow-up of 45.3 months. Grade 3 adverse events were observed in only five patients.</p> Conclusion <p>PRRT appears to be safe and effective treatment modality in advanced foregut and hindgut NETs. More prospective trials are required to validate these findings in larger cohorts.</p>