(dtpa-phe(1))-octreotide and Carcinoma

The medical approach to patients with secreting or clinically non-functioning pituitary adenoma as made considerable progress thanks to the use of new somatostatin analogs. They were first used to treat acromegaly in the mid 1980s and numerous studies have shown a reduction in GH concentration in over 90% of acromegalic patients. Good results were obtained using slow-release analog treatment also in TSH-secreting adenomas, whereas the therapeutic efficacy of these peptides in clinically non-functioning adenomas is still controversial. Treatment with somatostatin analogs improves symptoms, normalises hormone secretion and in some cases may induce a reduction in the volume of pituitary adenomas. Scintigraphy with octreotide may help to select patients who respond to this form of treatment.

Topics: Acromegaly; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adult; Aged; Antineoplastic Agents, Hormonal; Carcinoma; Humans; Indium Radioisotopes; Insulin-Like Growth Factor I; Kidney Neoplasms; Melanoma; Middle Aged; Octreotide; Pentetic Acid; Peptides, Cyclic; Pheochromocytoma; Pituitary Neoplasms; Predictive Value of Tests; Prolactinoma; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Somatostatin; Thymoma; Thymus Neoplasms; Thyroid Neoplasms; Thyrotropin; Treatment Outcome

The study of breast carcinogenesis is complicated by the heterogeneity of the disease. One way of simplifying is to subdivide these tumors into clinically relevant subgroups. There are indications that breast carcinomas, of which some express the somatostatin receptor (SS-R), can be divided this way. Expression of somatostatin receptors (SS-R's) in human primary breast cancer has a very high incidence. This can be demonstrated by in vitro autoradiography and in vivo by somatostatin receptor scintigraphy. However the clinical significance of somatostatin receptor expression in human breast cancer needs to be investigated. In this review article we summarize the current understanding of the functional role of somatostatin receptors in human breast cancer. Their relationship with neuroendocrine differentiation of the cancers and genetic and patient characteristics, the role of in vivo SS-R's visualization, and the possible medical and radiotherapeutic implications of these findings are discussed.

Topics: Autoradiography; Breast Neoplasms; Carcinoma; Cell Differentiation; Female; Gene Expression Regulation, Neoplastic; Humans; Indium Radioisotopes; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Terbium

The utility of In-111 DTPA octreotide scintigraphy (SRS) for disease detection in patients with metastatic thyroid carcinoma (TCA) remains controversial. The authors compared the sensitivity of In-111-based SRS, F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and extensive conventional radiographic imaging (CRI) in this type of cancer.. SRS, FDG PET, and CRI were performed concurrently in 21 patients (age, 56.4 +/- 12.9 years) who had aggressive TCA. Concordance rates % of lesion positivity among pairs of different techniques (A and B) were calculated as the ratio of the number of lesions positive with both techniques divided by the sum of the total number of lesions positive with technique A + total number of lesions positive with technique B, which was then multiplied by 200.. The combined use of CRI, FDG PET, and SRS resulted in the detection of 105 lesions, presumed to be due to metastatic deposits. Sensitivities for SRS and FDG-PET imaging were 49.5% and 67.6%, respectively. The lesion detection concordance rates were as follows: CRI versus FDG PET, 80.8%; CRI versus SRS, 74.2%; and FDG-PET versus SRS, 58.6%. Importantly, SRS detected five unexpected lesions, which were negative by both CRI and FDG-PET imaging. In two representative patients, a positive correlation (Spearman's rank = 0.71; = 0.0576) existed between the percentage of lesional In-111 DTPA octreotide uptake and the standard uptake value in eight concordant lesions.. Although SRS has only moderate sensitivity for disease detection in metastatic TCA, sometimes it can reveal lesions that otherwise would be undetectable by either CRI or FDG-PET imaging.

Topics: Bone Neoplasms; Carcinoma; Cohort Studies; Female; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Octreotide; Pentetic Acid; Pleural Neoplasms; Radiography; Radiopharmaceuticals; Sensitivity and Specificity; Skin Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed

Some breast tumors are classified as primary neuroendocrine carcinomas because of argyrophilia and positivity for neuroendocrine markers (chromogranins A and B and neuron-specific enolase), regardless of their cellular rest and cord structures. Tc-99m sestamibi has been widely used to identify epithelial breast carcinoma and lymph node metastases, whereas In-111 DTPA-octreotide has been used to identify primary and secondary neuroendocrine neoplasms specifically. The use of In-111 DTPA-octreotide and Tc-99m sestamibi scintigraphy in a woman with neuroendocrine differentiated cancer of the left breast is reported. Uptake of these radiopharmaceuticals only in the breast tumor permitted identification of a primary breast carcinoma, whereas absence of In-111 DTPA-octreotide uptake in other sites helped to exclude the presence of other neuroendocrine neoplasms in other organs.

Topics: Aged; Breast Neoplasms; Carcinoma; Carcinoma, Neuroendocrine; Diagnosis, Differential; Female; Humans; Indium Radioisotopes; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Terbium

Many tumors with neuroendocrine characteristics express high amounts of somatostatin receptors that enable in vivo imaging with [(111)In-DTPA-D-Phe1]-octreotide. In this study, we have analyzed the feasibility in detecting and characterizing thymic masses by somatostatin receptor scintigraphy (SRS).. Eighteen patients (13 women, 5 men, ages 18-78 yr; mean +/- s.d. = 42.1 +/- 17.6 yr) were enrolled in this study. Eleven patients were studied during diagnosis and seven during routine follow-up. In seven patients, myasthenia gravis was the presenting symptom. SRS was performed within 4 wk after CT and/or MRI. Planar and tomographic images were acquired within 24 hr after the injection of approximately 111 MBq of [(111)In-DTPA-D-Phe1]-octreotide. The scintigraphic results were categorized according to the histologic findings.. Histology diagnosed 10 mixed epithelial/lymphoid thymomas (8 with prevalent epithelial component), 2 thymic carcinomas, 1 thymic carcinoid, 1 lymphangioma and 4 thymic hyperplasias. Two thymoma were Stage I, 3 were Stage II, 2 were Stage III and 5 were Stage IV, as was the thymic carcinoid. Indium-111-DTPA-D-Phe1-octreotide concentrated in primary and/or metastatic sites of thymic tumors, thereby enabling successful external gamma imaging of sites greater than 1.5 cm in size. Tumor-to-lung (T/L) ratios were as high as 7.6-fold (range 1.7-7.6). Untreated thymomas showed higher T/L (4.34 +/- 1.57) than treated ones (2.68 +/- 1.18). No uptake was detectable in the four patients with benign thymic hyperplasia and the patient with the lymphangioma.. Indium-111-DTPA-D-Phe1-octreotide is avidly concentrated within thymic tumors, but it is not concentrated by thymic hyperplasia, which allows differential diagnosis. Thus, in patients with myasthenia gravis, SRS may have a role in characterizing thymic masses, thereby overcoming the limits of cross-sectional imaging modalities.

Topics: Adolescent; Adult; Aged; Carcinoid Tumor; Carcinoma; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Magnetic Resonance Imaging; Male; Middle Aged; Octreotide; Pentetic Acid; Radiopharmaceuticals; Thymoma; Thymus Hyperplasia; Thymus Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Personal experience on the use of 111In-DTPA-octreotide scintigraphy (Octreoscan) in the staging of neuroendocrine and non-neuroendocrine tumors of the lung is reported. From July 1995 to May 1996 26 scintigraphic studies were performed in patients affected by lung cancer at the Department of Thoracic Surgery and at the Service of Nuclear Medicine of the University of Turin. The scintigraphy allowed to detect the lesion in all the neuroendocrine tumors and in 63.2% of the non neuroendocrine ones. Their preliminary results are discussed and stress is laid on the importance of this scintigraphic procedure in the staging and the follow-up of neoplastic patients.

Topics: Carcinoma; Humans; Indium Radioisotopes; Lung Neoplasms; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Radionuclide Imaging

In a prospective study, 18 patients with recurrent medullary thyroid carcinoma (MTC) underwent magnetic resonance imaging (MRI) of the neck and mediastinum and somatostatin receptor scintigraphy (SRS) with 111In-labeled pentetreotide. In nine patients with macroscopic MTC, 17 corresponding lesions were found on MRI and SRS; in addition, 13 suspicious lesions were seen on SRS only. Histological confirmation was available for 19 metastatic lesions, showing MRI to be true positive in 13 metastases, SRS in 18. In minimal residual disease (n = 10), MRI and SRS were compared with the histological findings in three patients and with selective venous catheterization (SVC) in seven patients. Corresponding findings on MRI and SVC were seen in one of seven, whereas SRS and SVC showed concordant localization of tumor recurrence in five of seven. Histological examination demonstrated MTC tissue in one of three cases; MRI and SRS were false positive in one of three cases, while in the others the interpretation remained uncertain. In conclusion, SRS is a promising imaging modality for localization of MTC recurrence. MRI provides better spatial resolution and thus facilitates the planning of surgery for macroscopic metastases. In minimal residual disease, SRS turned out to be superior in detecting occult MTC recurrence, confirming SVC findings.

Topics: Adolescent; Adult; Aged; Biomarkers, Tumor; Carcinoma; Female; Humans; Indium Radioisotopes; Magnetic Resonance Imaging; Male; Middle Aged; Octreotide; Pentetic Acid; Receptors, Somatostatin; Thyroid Neoplasms; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon