(dtpa-phe(1))-octreotide and Lung-Neoplasms

[(111)In-DTPA(0)]octreotide is a radiopharmaceutical with a great potential for the visualization of somatostatin receptor-positive tumors. The overall sensitivity of Somatostatin Receptor Imaging (SRI) to localize neuroendocrine tumors is high. In a number of neuroendocrine tumor types, as well as in Hodgkin's disease, inclusion of SRI in the localization or staging procedure may be very rewarding, either in terms of cost-effectiveness, patient management, or quality of life. The value of SRI in patients with other tumors, like breast cancer, or in patients with granulomatous diseases, has to be established. The development of Peptide Receptor Radionuclide Therapy (PRRT) is expected to stimulate peptide receptor imaging.

Topics: Brain Neoplasms; Breast Neoplasms; Carcinoma, Small Cell; Humans; Indium Radioisotopes; Lung Neoplasms; Lymphoma; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin; Sarcoidosis

Current therapeutic approaches in neuroendocrine tumours include surgery, radiotherapy and polychemotherapy. Different metabolic patterns of neuroendocrine tumours allow the use of a wide range of diagnostic options in nuclear medicine, due to the presence of a wide spectrum of radiotracers electively concentrating in these neoplasms. Nuclear medicine, and in particular 111In Octreotide (OCT) scintigraphy, 123I Methaiodobenzylguanidine (MIBG) and pentavalent 99mTc-DMSA (V-DMSA), together with biohumoral markers, are currently able to locate tumours also not detectable using traditional diagnostic techniques. Somatostatin analogs, such as octreotide have become increasingly important over the years in the treatment of patients with neuroendocrine tumours. At present the therapeutic use of somatostatin analogs can be schematised as 1) pharmacological treatment (with cold octreotide); 2) surgical treatment (radioguided surgery); 3) radiometabolic treatment (with marked octreotide). The development of new synthetic molecules and new radiocompounds will probably open up interesting scenarios in the near future.

Topics: Adrenal Gland Neoplasms; Adrenalectomy; Antineoplastic Agents, Hormonal; Carcinoma, Medullary; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Humans; Indium Radioisotopes; Lung Neoplasms; Neoplasm Proteins; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Pheochromocytoma; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Somatostatin; Surgery, Computer-Assisted; Thyroid Neoplasms; Thyroidectomy; Tomography, X-Ray Computed

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

To determine its usefulness, we evaluated 111In-DTPA-Octreotide (octreotide scintigraphy) in the initial staging of 19 patients with histologically proven small cell lung cancer (SCLC) and compared the results to those of conventional imaging. Images performed during initial staging demonstrated 21 known pulmonary lesions and two known supraclavicular nodes. We detected a previously unknown mediastinal lesion. The number of metastases was underestimated, with no liver (5), brain (1) or skin metastases detected. Bone lesions were identified in 4 out of 5 patients. There were fewer lesions detected with octreotide scintigraphy than with bone scintigraphy (except for one case). We therefore conclude that octreotide scintigraphy is a highly effective method for detecting SCLC primary tumour and supraclavicular nodes; the procedure is of limited value for distant metastasis. Further studies are needed to establish its ability for detecting residual intrathoracic disease, and confirm the value of octreotide scintigraphy in differentiating residual disease from other benign lesions.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Small Cell; Female; Humans; Indium Radioisotopes; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Octreotide; Pentetic Acid; Radionuclide Imaging

Topics: Carcinoma, Small Cell; Cell Survival; Humans; Indium Radioisotopes; Lung Neoplasms; Octreotide; Pentetic Acid; Radiopharmaceuticals; Radiotherapy Dosage; Receptors, Somatostatin; Somatostatin; Tissue Distribution; Tumor Cells, Cultured

Novel approaches to increasing the therapeutic efficacy of targeted radiotherapy of cancer are required. One strategy to achieve this goal is to induce high-level expression of a receptor on the surface of tumor cells that can be targeted with a radiolabeled peptide. The objectives of this study were to 1) induce somatostatin receptor (SSTr2) expression in tumor cells using an adenovirus encoding the SSTr2 gene (AdSSTr2), 2) demonstrate tumor localization of [(111)In]-DTPA-D-Phe(1)-octreotide in AdSSTr2-injected tumors, and 3) show therapeutic efficacy with [(90)Y]-DOTA-D-Phe(1)-Tyr(3)-octreotide ([(90)Y]-SMT 487).. SSTr2 expression was validated in vitro by the binding and subsequent internalization of [(111)In]-DTPA-D-Phe(1)-octreotide (21.3% per mg of total protein) in A-427 cells infected with AdSSTr2. In vivo imaging confirmed 5- to 10-fold greater uptake 5.5 hours after intravenous administration of [(111)In]-DTPA-D-Phe(1)-octreotide in AdSSTr2-injected tumors relative to control tumors. For therapy studies, mice bearing established subcutaneous A-427 tumors were given two intratumoral injections of AdSSTr2 1 week apart, followed by an intravenous injection of 400 microCi or 500 microCi [(90)Y]-SMT 487 at 2 and 4 days after each adenoviral administration. Control animals either were not treated or were administered 500 microCi [(90)Y]-SMT 487 with no AdSSTr2 injection.. These studies showed that untreated animals and animals treated with no virus and 500 microCi [(90)Y]-SMT 487 had median tumor quadrupling times of 16 and 25 days, respectively. Mice administered AdSSTr2 and either 400 microCi or 500 microCi of [(90)Y]-SMT 487 demonstrated significantly longer median tumor quadrupling times of 40 and 44 days, respectively (P < 0.02).. These studies are the first to demonstrate in vivo therapeutic efficacy using a radiolabeled peptide targeted to a receptor expressed on the surface of tumor cells following gene transfer. Future studies will focus on the optimization of this approach.

Topics: Adenoviridae; Animals; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Disease Models, Animal; Drug Delivery Systems; Genetic Vectors; Humans; Lung Neoplasms; Mice; Mice, Inbred BALB C; Mice, Nude; Neoplasm Transplantation; Octreotide; Pentetic Acid; Radioimmunodetection; Radiotherapy; Receptors, Somatostatin; Somatostatin; Treatment Outcome; Tumor Cells, Cultured; Xenograft Model Antitumor Assays; Yttrium

This study aimed to evaluate the diagnostic utility of 111In-DTPA-D-Phe1-octreotide scintigraphy in the different situations that can be present when an examination is requested during the clinical course of the carcinoid tumor (CT).. We have performed 41 scintigraphies with 111In-octreotide (145-185 MBq) in 35 patients (19 females and 16 males) with clinically suspected or confirmed CT. The patients were classified into five groups: Group A: Indolent symptoms of CT (n=9); B: CT staging located in lung (n=4), stomach (n=2), cecum (n=1), thymus (n=1) and pancreas (n=1); C: Carcinoid syndrome (n=1); D: CT staging after surgery located in pancreas (n=1), ovary (n=1), cecum (n=1), stomach (n=1), appendix (n=1) and ileum (n=1); and E: Post-treatment follow-up (n=13), with CT located in bronchial tree (n=5), small intestine (n=3), appendix (n=2), thymus (n=1), ovary (n=1) and unknown primary tumor (n=1). Three patients of this group had one scintigraphic study before the treatment. Head and neck, thorax and abdomen images were obtained at 4 and 24 h in all of the patients and SPECT images of the abdomen (n=14), thorax (n=10), and brain (n=1) were obtained at 24 h in 25 patients.. Group A: In the 3 patients with a positive scintigraphy, the definitive diagnosis was meningioma, Hurtle cell's carcinoma and lung adenocarcinoma. The clinical follow-up in the six other patients, at least during one year, did not show any evidence of CT. Group B: Six of the 9 CT were detected with the scintigraphy. In 2 cases of bronchial CT, the scan showed sarcoidotic regional lymph node involvement and CT hepatic and bone metastases, respectively. Group C: The scintigraphy detected hepatic metastases from an unknown primary tumor. Group D: The scintigraphy was positive in 3 cases (hepatic or/and abdominal metastases) and was normal in the other 3. The scintigraphy was negative in one patient with peritoneal metastases. Group E: The scintigraphy was normal in 7 patients in concordance with the clinical follow-up. In 3 patients with a scintigraphy performed prior to treatment, the scintigraphy detected recurrence (thymic CT), progression of the metastatic disease (ovarian CT) and partial regression of the hepatic metastases (carcinoid syndrome). In the three other patients, the scintigraphy showed metastases located in liver in one patient and hepatic and extra-hepatic metastases in the two other patients. The sensitivity and specificity of 111In-Octreotide in the detection of the primary tumor and metastases were 72% and 84% respectively.. The 111In-Octreotide scintigraphy has a low diagnostic utility in patients with indolent symptoms of CT. However, it is the first line of diagnosis for the staging of the CT and to evaluate the follow up after therapy.

Topics: Adult; Aged; Bone Neoplasms; Brain Neoplasms; Carcinoid Tumor; Diagnosis, Differential; Digestive System Neoplasms; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Proteins; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Sarcoidosis; Thymus Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

The aims of this study were to determine the accuracy of somatostatin receptor scintigraphy in the detection of the primary tumor and its metastases in small-cell lung cancer (SCLC) in a large patient population, and to investigate the course of somatostatin uptake in primary tumors during therapy.. In a total of 100 patients, 134 examinations were performed. Twenty-seven of the patients were examined before and after chemotherapy. Planar whole-body images were acquired 4 hr and 24 hr after injection of approximately 200 MBq (111)In-pentetreotide. SPECT of the thorax was performed after 24 hr. Tumor-to-background (T/B) ratios for the primary tumor were averaged from anterior and posterior projections.. Compared to conventional investigations, somatostatin receptor scintigraphy (SRS) visualized the primary tumor with varying degrees of uptake in 96% of the examinations. Regional metastases and distant metastases were detected in 60% and 45% of the examinations, respectively. The uptake of the somatostatin analog by the primary tumor was significantly lower in the patients examined during chemotherapy as compared to those examined before treatment (T/B ratio = 1.94+/-0.79 versus 2.35+/-0.9, p < 0.005). A decrease in T/B ratio was noted in patients with remission at the time of SRS (from 2.40+/-1.56 to 1.63+/-0.72, p < 0.05). No difference in the pretreatment uptake of octreotide by the primary tumor was identified between patients with tumor progression and those with partial or complete remission.. Somatostatin receptor scintigraphy has a high sensitivity in the detection of the primary tumor in SCLC but fails in the detection of metastases. Thus, SRS does not provide useful information for staging of SCLC. Since somatostatin uptake by the primary tumor is affected by chemotherapy, it may be used to follow up on the course of SCLC.

Topics: Adult; Aged; Carcinoma, Small Cell; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

The differential diagnosis and management of Cushing's syndrome remain difficult, particularly for ectopic adrenocorticotropin (ACTH) syndromes resulting from small bronchial carcinoids. We report the case of a 41-year-old man with ectopic ACTH-dependent Cushing's syndrome. Two computed tomography scans of the thorax were normal and magnetic resonance imaging of the chest showed a 6-mm hyperintense T1-weighted area close to the left pulmonary hilus, interpreted as probably vascular by the radiologists. An [111In-DTPA-D-Phe1]octreotide scintigraphy scan demonstrated a positive image for somatostatin receptors in exactly the same location and surgery confirmed the presence of a small ACTH-secreting carcinoid tumour in the upper left lung lobe which was resected. Surgery cured the hypercorticism of the patient. The differential diagnosis of Cushing's syndrome and the procedure for localisation of an ACTH source are discussed.

Topics: ACTH Syndrome, Ectopic; Adult; Carcinoid Tumor; Humans; Indium Radioisotopes; Lung Neoplasms; Male; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals

This report describes a technique that increases the specificity of 111In-pentetreotide as evaluated in a patient with ectopic Cushing syndrome.. Two separate SPECT studies were performed with different pharmacologic protocols, both including treatment with cold octreotide. The imaging protocol provides acquisitions at 4 and 24 hr after injection. The quantitative approach was based on the ROI activity (manually designed) of an area of pathological lung uptake (ROI-T) versus background (ROI-NT). Histological, histochemical and specific mRNA measurements confirmed the presence of an SSR2 receptor carcinoid in the lung.. The time course of ROI-T/ROI-NT is a linear increase between 4 and 24 hr. Washout with cold octreotide diminished the ROI-T activity content and the saturation protocol increased ROI-T/ROI-NT, confirming the specific nature of the uptake.. Displacement and saturation protocols in 111In-pentetreotide imaging demonstrated the specificity of tumor binding.

Topics: ACTH Syndrome, Ectopic; Adult; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Lung Neoplasms; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Sensitivity and Specificity; Time Factors; Tomography, Emission-Computed, Single-Photon

The authors report their preliminary experience and results of the use of 111In-DTPA-octreotide scintigraphy (octreoscan) in the staging of neuroendocrine and non-neuroendocrine tumors of the lung.. From July 1995 to May 1996 twenty-six 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.. Scintigraphy made it possible to detect the lesion in all the patients affected by neuroendocrine tumors and in 63.2% of the patients affected by non-neuroendocrine neoplasm of the lung. Scintigraphy also revealed mediastinal lymphnodal metastases in patients in which thoracic CT scan was negative: this result was confirmed by postoperative TNM.. The authors stress the importance of 111In-DTPA-octreotide scintigraphy in a correct procedure of staging of neuroendocrine and non-neuroendocrine tumors of the lung and in the follow-up of neoplastic patients.

Topics: Adenocarcinoma; Carcinoma, Large Cell; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Neoplasm Staging; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

Small cell lung cancer (SCLC) tumors have neuroendocrine features. In vitro and in vivo studies have demonstrated that 50%-75% of SCLC tumors express receptors for somatostatin. This might enable in vivo localization of the primary tumor and its metastases by using scintigraphy with a radiolabeled somatostatin analogue, such as octreotide.. The efficacy of scanning with In-111 labeled octreotide (octreotide scan) was studied in the staging of SCLC patients and compared with the results of conventional staging (liver ECHO, bone scintigraphy, MRI of the brain, spine, and pelvis). Imaging was performed in 29 patients with histologically confirmed SCLC at 4, 24, and 48 hours after intravenous injection of 185 MBq In-111 octreotide.. In 24 of 29 patients, the primary tumor was visualized. In these 24 patients, 26 metastases were demonstrated with conventional staging, of which only nine were visualized with octreotide scan. Octreotide scans showed two metastases in the brain that were not visualized by MRI. In the other five patients, five metastases were demonstrated with conventional staging. Only two of these were detected with octreotide scan. However, octreotide scan did show a further metastasis in the brain that was not visualized by MR imaging.. Octreotide imaging has a limited use in the detection of SCLC metastases compared to conventional staging. It might have some specific value in the detection of brain involvement in patients with limited disease.

Topics: Carcinoma, Small Cell; Female; Humans; Indium Radioisotopes; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Octreotide; Pentetic Acid; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon

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

We analyzed the results of conventional imaging and somatostatin receptor scintigraphy in 150 patients with neuroendocrine tumors.. The outcomes of combinations of imaging modalities were compared in terms of tumor localization, effect on patient management and financial costs.. In patients with carcinoids, a combination of somatostatin receptor scintigraphy, chest radiograph and ultrasound of the upper abdomen had a high sensitivity for tumor localization, and detected lesions in patients in whom no tumor was found with conventional imaging, justifying the greater cost. In patients with medullary thyroid carcinoma, somatostatin receptor scintigraphy adds little to the information obtained with conventional imaging and therefore should not be used as a screening method. In patients with paraganglioma, CT scanning of the region where a paraganglioma is suspected, followed by somatostatin receptor scintigraphy to detect multicentricity has the best cost effectiveness ratio. In patients with gastrinomas, the combination of somatostatin receptor scintigraphy and CT scanning of the upper abdomen had the highest sensitivity. The relatively high cost of this process is outweighed by its demonstrating a resectable tumor. In patients with insulinomas, the highest yield against the lowest cost is obtained if somatostatin receptor scintigraphy is only performed if CT scanning fails to demonstrate the tumor.. Somatostatin receptor scintigraphy should be performed in patients with small-cell lung carcinoma because it can lead to a change of stage and may demonstrate otherwise undetected brain metastases. The cost increase is outweighed by the omission of unnecessary treatment for some of the patients and by the possibility of irradiating brain metastases at an early stage, which may lead to a better quality of life.

Topics: Carcinoid Tumor; Carcinoma, Medullary; Carcinoma, Small Cell; Cost-Benefit Analysis; Costs and Cost Analysis; Humans; Indium Radioisotopes; Lung Neoplasms; Netherlands; Neuroendocrine Tumors; Octreotide; Pancreatic Neoplasms; Paraganglioma; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin; Sensitivity and Specificity; Thyroid Neoplasms; Tomography, X-Ray Computed

The authors report their experience on the use of 111In-DTPA-octreotide scintigraphy in the diagnosis of neuroendocrine carcinomas of the lung. The studies were performed both preoperatively, to obtain a correct staging of the tumor, or postoperatively, because of the suspicion of a recurrence or distant metastases. The main findings were: high sensitivity in localizing the tumor and its recurrences or metastases and high predictive value for responsiveness to "cold" octreotide therapy.

Topics: Adult; Aged; Carcinoma, Neuroendocrine; Female; Humans; Indium Radioisotopes; Lung Neoplasms; Male; Middle Aged; Octreotide; Pentetic Acid; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity

Somatostatin receptors have been described on the membrane of neoplastic cells derived from the APUD system and their expression has also been demonstrated on small cell lung cancer (SCLC) in vitro and in vivo. 21 patients with SCLC were studied using 111In-octreotide (111In-OCT) scintigraphy. Scintigraphic examinations were performed following intravenous (i.v.) injection of 111 MBq 111In-OCT with whole-body scintigraphy and planar scintigraphy of the thorax as well as the SPET technique. No short-term side effects were described following 111In-OCT administration. We studied the 111In-OCT biodistribution in 3 patients with serial scintigraphies at 1, 5 and 24 h. We used the 5 h as standard scanning time for the following 18 patients. The scintigraphic results were compared with those of other conventional diagnostic procedures. 111In-OCT detected 86% (48/56) of the lesions already known at the time of scintigraphy. It was positive in all 20 SCLC patients and negative in one lung adenocarcinoma. 111In-OCT showed high sensitivity for mediastinal metastases (94%) and good sensitivity for bone metastases (75%) and abdominal lymph node metastases (71%). 111In-OCT did not detect two liver metastases. 111In-OCT detected five unknown lesions which were confirmed by other diagnostic examinations. 111In-OCT was also effective in cancer patients with low levels of NSE. Our study shows that 111In-OCT scintigraphy is a reliable, non-invasive technique to detect primary SLCL and its locoregional or distant metastases. The clinical utility of receptor status characterisation obtained with 111In-OCT scintigraphy should be evaluated by means of an appropriate prospective study.

Topics: Aged; Bone Neoplasms; Brain Neoplasms; Carcinoma, Small Cell; Female; Humans; Indium Radioisotopes; Lung Neoplasms; Male; Middle Aged; Octreotide; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin

The aim of this study was to use compartmental analysis as a theoretical tool to provide quantitative and unitary data for a more precise determination of 111In-OCT concentrations in a tumour site and various body organs. Five subjects (3 male and 2 female) with neoplasias were studied. Structural and parametric identification of the model was based on the plasma, urine, total body and ROI (soft tissue, spleen, kidney and tumour) activity values. The model was of the mammillary type with 5 compartments (blood, soft tissue, spleen, kidneys and urine) for the 4 patients with a negative scintiscan and 6 (blood, soft tissue, spleen, kidneys, urine and tumour) for the adenocarcinoma patient. Numerical constants were determined by running a best-fit procedure with the MINUIT minimisation program (CERN library) using a microVAX 3800 computer. The reliability of the models was also tested. 111In-OCT accumulates in the kidneys and spleen, from which it is slowly released into the blood. Elimination is via the urine at first rapidly, then more slowly. The maximum concentration in the tumour compartment is reached at 12-14 hours and remains almost constant.

Topics: Adenocarcinoma; Carcinoma, Small Cell; Computer Simulation; Female; Humans; Indium Radioisotopes; Kidney; Lung Neoplasms; Male; Metabolic Clearance Rate; Models, Biological; Models, Chemical; Neuroblastoma; Neuroectodermal Tumors; Octreotide; Pentetic Acid; Radiopharmaceuticals; Reproducibility of Results; Spleen; Tissue Distribution

Twenty-one patients with small cell lung cancer (SCLC) were investigated with 111in-octreotide (111-In-OCT) scintigraphs, 5 hours after the i.v. injection of 111 MBq of the radiotracer. Whole-body and planar scintigraphy as well as SPECT of the thorax were required. The scintigraphic results were compared to those of other conventional diagnostic procedures used for the staging and follow-up of SCLC patients. 111In-OCT detected 86% (48/56) of the lesions already known at the time of scintigraphy, being positive for all 20 SCLC lesions and negative for one lung adenocarcinoma. 111In-OCT showed a high sensitivity for mediastinal metastases (94%) and good sensitivity for bone (75%) and abdominal lymph node metastases (71%). It did not detect 2 liver metastases but revealed 5 unknown lesions which were then confirmed by other diagnostic examinations. 111In-OCT was also effective in patients with low levels of NSE. Three patients received cold octreotide for seven days to investigate whether this treatment might affect SCLC imaging. Scans were performed before and after treatment. The 111In-OCT uptake increased in the cancer lesions while the fixation in normal tissues decreased, demonstrating enhancement of SCLC imaging following cold octreotide administration.

Topics: Adenocarcinoma; Aged; Antineoplastic Agents, Hormonal; Bone Neoplasms; Carcinoma, Small Cell; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Injections, Intravenous; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Octreotide; Pentetic Acid; Phosphopyruvate Hydratase; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

Somatostatin receptors have been identified on the cellular surface of a subset of patients with small cell lung cancer (SCLC) and may be associated with a less aggressive evolution of the tumor. Moreover, medical therapy with somatostatin analogues holds promise for neoplastic growth control. We performed planar imaging in 22 patients with histologically proven SCLC at 2-4 and 24 hours after the injection of 111-185 MBq of 111In-DTPA-octreotide (Octreoscan, Byk-Gulden). Tumor uptake was observed in 19 patients in both early and late scans, while 2 patients previously treated with chemotherapy showed negative early and late scans. One patient had a positive early scan and a negative late scan. All the scintigraphic studies showed more extensive disease than expected by CT. No significant modification in tumor uptake of radiooctreotide was observed in three patients studied before and after chemotherapy. In conclusion, 111In-octreotide is a suitable radiopharmaceutical for the in vivo evaluation of the somatostatin receptors of small lung cancer. The prognostic and therapeutical implications of this nuclear technique must be further investigated, however.

Topics: Aged; Carcinoma, Small Cell; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Injections, Intravenous; Lung Neoplasms; Male; Middle Aged; Octreotide; Pentetic Acid; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Somatostatin; Tomography, X-Ray Computed; Treatment Outcome

High numbers of high-affinity somatostatin binding sites have been found on carcinoid tumors, gastrinomas, small cell lung cancers and the majority of medullary thyroid cancers, enabling in vivo visualization of these tumors with octreotide scintigraphy. A comparison of the results obtained at our institution and another 15 centers in Europe show a few remarkable similarities and differences. The overall sensitivity of octreotide receptor scintigraphy to detect the primary GEP tumor and its metastases is high, e.g. 80-90%. The main difference was found in gastrinomas and to a lesser extent in insulinomas. These differences might be attributed to different scanning protocols. Furthermore, octreotide scintigraphy also has a high sensitivity to localize the primary tumor and its metastases causing Cushing's syndrome by ectopic production of ACTH or CRH. Octreotide scintigraphy is a new, sensitive and noninvasive technique to localize somatostatin receptor expressing endocrine tumors and their metastases.

Topics: Carcinoid Tumor; Cushing Syndrome; Gastrinoma; Gastrointestinal Neoplasms; Humans; Indium Radioisotopes; Lung Neoplasms; Octreotide; Pancreatic Neoplasms; Pentetic Acid; Receptors, Somatostatin; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

A case of a patient with small cell lung cancer and right submandibular node enlargement due to granulomatous lymphadenitis is presented. Diagnostic procedures included: biopsy of the cervical node, transmission computed tomography of the chest, bronchoscopic examination and biopsy of the pulmonary lesion. The patient underwent 111In-octreotide scintigraphy (whole body and single photon emission tomography) which revealed both lesions. We conclude that granulomatous lesions are to be considered as a possible cause of false positive results, when octreotide scintigraphy is used to evaluate distant metastases in patients with known cancer.

Topics: Carcinoma, Small Cell; Humans; Indium Radioisotopes; Lung; Lung Neoplasms; Lymphomatoid Granulomatosis; Male; Middle Aged; Octreotide; Pentetic Acid; Tomography, Emission-Computed, Single-Photon; Tuberculosis, Lymph Node

We evaluated octreotide scintigraphy in 81 untreated patients who were suspected of having bronchial carcinoma. Octreotide scintigraphy visualized the primary tumour in all of 40 patients with non-small-cell lung carcinoma (non-SCLC), and all of 26 patients with SCLC. In the remaining patients, other bronchial disease and metastases from extrapulmonary carcinomas were also visualized. Mediastinal lymph node involvement and distant metastases were recognized in 5 of 15 and 1 of 7 patients with non-SCLC, respectively. In vitro, none of the non-SCLCs were shown to bear somatostatin receptors. We postulate that the visualization of non-SCLC during octreotide scintigraphy is caused by binding of labelled octreotide to activated leucocytes or to proliferating neuroendocrine cells around the tumours. In patients with SCLC, radiologically suspected lymph node involvement was visualized for 21 of 25 sites. Distant metastases, especially to the liver and abdomen, were missed for 14 of 20 sites, most probably because no laxatives were administered and single photon emission tomography of the abdomen was not performed. The failure to recognize liver metastases is most probably due to a comparable uptake of radioactivity by the surrounding normal liver tissue. In 15 of 26 patients, previously unrecognized tumour sites were suggested during octreotide scintigraphy, leading to a downstaging of 5 of 14 patients with limited disease. Unexpected cerebral metastases were suggested in five patients with either limited or extensive disease. In all four of these for whom follow-up was available, cerebral metastases became manifest 5-8 months after octreotide scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Diagnosis, Differential; Female; Humans; Indium Radioisotopes; Lung Neoplasms; Lymphatic Metastasis; Male; Neoplasm Staging; Octreotide; Pentetic Acid; Receptors, Somatostatin; Tomography, Emission-Computed, Single-Photon