technetium-tc-99m-depreotide and Carcinoma

The aim of our study was to determine whether treatment with a long-acting somatostatin-receptor analogue is effective in patients with (131)I-negative but somatostatin-receptor-positive metastases from dedifferentiated and anaplastic thyroid cancer.. Twelve patients were screened for the study. All of them showed progressive disease confirmed by radiologic evaluation, increasing serum thyroglobulin (Tg), and negative diagnostic or posttherapeutic (131)I whole-body scans (WBS). Eight of 12 patients (4 males and 4 females; age range, 57-89 years; 1 papillary thyroid cancer; 4 poorly differentiated follicular thyroid cancer; 1 follicular and anaplastic thyroid cancer; 2 anaplastic thyroid cancer) showed positive somatosatin-receptor expression in Tc-99m depreotide WBS/SPECT (Tc-99m Dep.WBS). Initially, in all patients fluorine-18 2-fluoro-2- D-glucose-positron emission tomography-computed tomography ((18)F-FDG-PET-CT), Tc-99m Dep.WBS, and Tg measurements were performed. In the case of positive receptor scintigraphy, patients were treated with 20mg Sandostatin LAR (Novartis Pharmaceuticals, Basel, Switzerland) once per month intramuscularly over a period of 6 months followed by repeated (18)F-FDG-PET-CT, Tc-99m Dep.WBS, and Tg measurement to determine metabolic activity and tumor size. In case of tumor progression, the dose was increased to 30mg of Sandostatin LAR once per month.. Only 3 patients were able to undergo long-term treatment. Two patients were treated with octreotide long-acting release (LAR) for 1 year and 1 patient for 1(1/2) years. All patients showed progressive disease during the treatment: an increase of serum Tg on one hand and an increase in the number of lesions and extent in tumor size visible on FDG-PET-CT and Tc-99m Dep.WBS on the other. During the treatment there was no change in receptor expression, nevertheless, clear tumor progression under therapy with a somatostatin analogue was visible in FDG-PET-CT and in Tc-99m Dep.WBS.. Our data demonstrate that all of our patients treated with a somatostatin analogue showed clinical progression and that our attempt to achieve a stabilization of the disease failed.

Topics: Adenocarcinoma, Follicular; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Carcinoma; Carcinoma, Papillary; Female; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Male; Middle Aged; Octreotide; Organotechnetium Compounds; Radiopharmaceuticals; Receptors, Somatostatin; Somatostatin; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Treatment Failure

Scintigraphy with 99mTc-depreotide, a somatostatin analogue-technetium ligand, has been used for evaluation of various malignant neoplasms, including lung cancer. The diagnosis of bone metastases in patients with lung cancer is not always definitive with current imaging methods. Visualisation of somatostatin receptors (SSTRs) in bone lesions, when the primary tumour exhibits such receptors, could be helpful in characterising them as metastatic. The aim of this study was to assess the value of 99mTc-depreotide in differentiating between benign and malignant bone lesions in patients with lung cancer.. The study population comprised 20 patients (17 males and three females, mean age 63 years) with proven lung cancer in whom bone lesions had been detected by conventional imaging methods. All patients underwent 99mTc-hydroxydiethylene diphosphonate and 99mTc-depreotide scintigraphy within 2 weeks. Bone lesions were classified as benign or malignant on the basis of clinical, imaging and/or histological criteria.. 99mTc-depreotide uptake in the primary tumour was seen in 19 of the 20 patients. Conventional imaging methods detected 55 bone lesions, 31 of which were classified as malignant. Twenty-eight (90%) of these lesions showed 99mTc-depreotide uptake, suggesting bone metastases, while three did not. Twenty-four bone lesions were classified as benign by conventional imaging methods, and none of them showed 99mTc-depreotide uptake. In addition, 99mTc-depreotide demonstrated extra-osseous lesions in six patients.. In patients with lung cancer and bone lesions, 99mTc-depreotide scintigraphy uptake in the bone lesions supports the diagnosis of malignancy, in particular if the primary lung tumour also exhibits SSTRs. Furthermore, whole-body 99mTc-depreotide scintigraphy may disclose extra-osseous disease.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Somatostatin

Tc-99m depreotide is a synthetic somatostatin analog with a low molecular weight of 1358 and binding domains for somatostatin receptors (SSTRs) subtypes 2, 3, and 5. This agent has been used for imaging pulmonary nodules in an effort to differentiate malignancies from infectious processes. To investigate whether there is significant ratio variability predicting a specific lung cancer type, we undertook this study. We analyzed the semiquantitative tumor-to-normal lung ratios among 23 patients with histopathologically proven lung carcinoma. Eleven patients with squamous cell carcinoma had 14 nodular lesions (n = 14); the ratios ranged from 6.0 to 1.4; the mean was 3.500. Nine patients with adenocarcinoma had 9 nodular lesions (n = 9); the ratios ranged from 3.2 to 1.0; mean was 1.89. Three patients with large cell carcinoma had 3 nodular lesions (n = 3); mean was 1.2. There were significantly different ratio values between squamous cell carcinoma and nonsquamous cell carcinoma. On a statistical analysis by t test, this difference proved to have a statistically significant value of P < 0.038. For patients with lung cancer, we could predict the tumor most likely to be squamous cell carcinoma if the uptake ratio was greater than 3.5. Otherwise, the lower ratio appeared to be either the result of large cell carcinoma or adenocarcinoma. High tumor uptake of Tc-99m depreotide reflecting abundant SSTRs of a tumor and/or peritumoral neovasculature such as squamous cell carcinoma could be potentially useful in diagnostic and therapeutic guidance.

Topics: Aged; Carcinoma; Humans; Image Interpretation, Computer-Assisted; Lung; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Solitary Pulmonary Nodule; Somatostatin; Statistics as Topic; Tomography, Emission-Computed, Single-Photon