technetium-tc-99m-ethylenedicysteine and Neoplasms

Application of the nuclear approach for the detection of inherited diseases is an important goal for nuclear medicine and will likely result in an important breakthrough, which will, hopefully, lead to improved diagnoses of genetic defects and objective evaluations of the efficacy of therapeutic strategies. Although still largely in the research realm, molecular imaging is in the process of emerging as a vital component of the diagnosis of disease and monitoring of the therapy. The clinical research in nuclear medicine has made major advancements in the direction of molecular medicine and targeted therapy. In the past few years, exponential achievements have been accomplished in the development of molecular nuclear imaging agents, as described below.

Topics: Animals; Annexins; Antibodies, Monoclonal; Antigens; Apoptosis; Cysteine; Diagnostic Imaging; DNA; Fluorodeoxyglucose F18; Glycolysis; Humans; Indium Radioisotopes; Ligands; Lymphoma; Myocardial Infarction; Neoplasms; Octreotide; Organotechnetium Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Technetium; Tomography, Emission-Computed, Single-Photon; Yttrium Radioisotopes

A serious undesired effect of certain cytostatics is their nephrotoxicity. In this study, we investigated the toxic effects of ifosfamide and cisplatin by clinical and biochemical parameters in relation to (99m)Tc-dimercaptosuccinic acid ((99m)Tc-DMSA) and Tc(99m)N, N-ethylenedicysteine (EC) renal scintigraphy. The indicators were urinary beta2-microglobulin levels, tubular resorption of phosphate, urinary protein and glucose excretion, glomerular filtration rate, urinary pH and osmolarity. Thirteen paediatric patients (seven boys and six girls), aged 2-16 years, were investigated. Five patients received only cisplatin, six patients were treated with ifosfamide and cisplatin and two with ifosfamide and carboplatin for various malignancies. All except three patients had normal DMSA uptake (median, 19; range, 16-29%) prior to chemotherapy. The reduction in DMSA uptake was unilateral due to tumour invasion in those three patients. Following chemotherapy, DMSA uptake showed reduction in five patients with or without clinical nephrotoxicity. The observed pattern was decreased renal uptake and elevated bladder activity. Three patients with decreased DMSA uptake had normal tubular maximum phosphate reabsorption, which suggested subclinical injury. Decrease in DMSA uptake and tubular phosphate reabsorption (TPR) was detected simultaneously in two patients. No abnormalities were seen on Tc(99m)-EC scintigraphy to suggest nephrotoxicity in our investigation. However, Tc(99m)-EC clearly demonstrated a reduction in split renal function in children with tumour invasion. In summary, we found that ifosfamide induced tubular injury can be detected with (99m)Tc-DMSA scintigraphy before chemotherapy associated nephrotoxicity is observed by laboratory measurements. Our results also imply that, although a tubular agent, renal scintigraphy performed with Tc(99m)-EC is not able to detect subclinical injury or predict the outcome during treatment.

Topics: Adolescent; Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; beta 2-Microglobulin; Biological Transport; Child; Child, Preschool; Cisplatin; Creatinine; Cysteine; Female; Humans; Ifosfamide; Infant; Kidney; Male; Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Dimercaptosuccinic Acid; Tissue Distribution