In-111 Octreotide Research Articles

Carcinoid Tumors of the Lung and Multimodal Therapy

To report our experience with bronchial carcinoids. From January 1990 to March 2003 we treated 42 such patients, 30 females and 12 males. All patients underwent preoperative total body computed tomography (CT), total body In-111 octreotide scintigraphy, and SPECT of the thorax, with evaluation of serum levels of CEA, CgA, NSE, and urinary 5-HIAA. Diagnosis was obtained in 28 patients with fibre-optic bronchoscopy and in 14 patients with CT-guided trans-thoracic needle biopsy. There were 26 typical and 16 atypical carcinoids. 30 lobectomies, 5 bilobectomies, 6 wedge resections, and 1 pneumonectomy were carried out. The 3-year and the 5-year survival rates in the typical and atypical carcinoid groups were 100 % and 96 % vs. 81 % and 68 %, respectively (p < 0.001). Long-term survival is based on histological completeness of surgical treatment. Octreotide scintigraphy and SPECT document N (1) and N (2) precisely.

Changes in the Expression of Somatostatin Receptor Imaging Following Y-90 Lanreotide Therapy for Carcinoid Tumor: A Flare Response?

A 53-year-old man with In-111 octreotide-positive metastatic hepatic carcinoid was referred for Y-90 lanreotide therapy. A diagnostic In-111 lanreotide scan, performed to assess suitability for therapy, showed less uptake in lesions compared with In-111 octreotide. After 3 therapy doses of Y-90 lanreotide, a repeat In-111 lanreotide scan showed intense uptake in old lesions, appearance of new lesions, and uptake in the spleen. This was associated with improvement in flushing and regression of liver size. Computed tomography scan showed stable disease. Increased expression of somatostatin receptors has been observed with In-111 octreotide but not with In-111 lanreotide. If this is a flare response, then pretreatment with "cold" lanreotide may be beneficial before Y-90 lanreotide therapy.

2-Deoxy-2-[ 18F]Fluoro-D-Glucose Positron Emission Tomography Monitoring Disease Progress in a Patient with Islet Carcinoma of the Pancreas

A woman with islet cell carcinoma of the pancreas proven by biopsy at an exploratory laparotomy underwent six cycles of chemotherapy with paclitaxel and carboplatin. After the chemotherapy to monitor her primary tumor and hepatic metastases, she had three consecutive 2-deoxy-2-[ 18F]fluoro-D-glucose positron emission tomography (FDG-PET) determinations that correlated with an In-111 octreotide single photon emission computer tomography. FDG-PET might have utility in monitoring islet cell carcinoma of the pancreas in evaluating metabolic changes following chemotherapy.

Treating disseminated NETs with high activity In-111 Octreotide

s: Abstracts of an International Conference on Peptide Radiopharmaceuticals in Diagnosis and Therapy Rome, Italy, 25-28 May 2000: Oral Presentations

Carcinoid syndrome in the absence of hepatic metastases: correlation of CT and In-111 octreotide imaging

A 49-year-old man was hospitalized for investigation of a 2-year history of flushing and diarrhea. His urinary 5-hydroxyindoleacetic acid level was elevated. CT scanning showed no evidence of hepatic metastases and equivocal masses in the mesentery and right pelvis. In-111 octreotide imaging confirmed focal increased uptake in the midabdomen, right iliac fossa, and lower right pelvis at 24 and 48 hours. At laparotomy, soft tissue masses were resected from the mesentery, lower right pelvis, and small bowel in the right iliac fossa. One of the tumor masses was contained within a Meckel’s diverticulum in the terminal ileum. No liver abnormality was found. All resected masses showed classical carcinoid histologic signs. Symptoms resolved immediately after surgery. FIGURE 1Fig. 1: A CT image at the level of the umbilicus shows an equivocal soft tissue mass within the mesentery. This could easily be mistaken for an unopacified loop of the small bowel.FIGURE 2Fig. 2: A CT image of the pelvis shows a possible soft tissue mass (arrowhead) just medial to the opacified distal right ureter.FIGURE 3Fig. 3: An In-111 octreotide scan at 24 hours shows normal uptake in the liver and spleen. Abnormal uptake is present in the midabdomen, corresponding to the mesenteric soft tissue mass on seen on the CT.FIGURE 4Fig. 4: (A) An In-111 octreotide scan at 24 hours shows additional foci in the right iliac fossa and adjacent to the right superolateral wall of the bladder. (B) A CT scan shows no abnormality of the terminal ileum.

SCINTIGRAPHIC TECHNIQUES FOR HEPATIC IMAGING: Update for 2000

Nuclear medicine continues to evolve from a generic imaging approach to a collection of imaging techniques that are disease-specific. In-111 octreotide SPECT scan has quickly become the method of choice to image gastrinoma. A number of other agents have a role in other tumor models. FDG imaging of the liver is in its infancy, but has potential to outperform anatomic methods (CT scan, MR imaging), particularly in the detection of colorectal cancer metastases. The imaging of FDG in nuclear medicine involves rapidly evolving technology and has the potential to diffuse to the community level practice. To further face the controversial areas head on, another problem for nuclear medicine's role in hepatic imaging remains its somewhat separate existence from radiology. Frequently, the abdominal imager or the general radiologist is in the best position to recommend a scintigraphic liver study. A broad knowledge of these techniques by all radiologists is essential for their ultimate success.

Comparison of technetium-99m sestamibi and indium-111 octreotide imaging in a patient with ewing's sarcoma before and after stem cell transplantation

We report the use of two novel nuclide agents, Technetium-99m (99Tc)sestamibi (MIBI) and indium-111 (In-111) octreotide, in comparison with conventional computed tomography (CT) imaging in a patient with metastatic Ewing's sarcoma (ES) before and after high dose chemotherapy with autologous peripheral stem cell transplantation (PSCT). MIBI is taken up actively by metabolically active tumor cells. Octreotide, a somatostatin analog, binds specifically to somatostatin receptors.The patient was a 20-year-old male with recurrent metastatic ES to the lung. Before and sequentially after high dose chemotherapy and PSCT, the patient was imaged with MIBI. Whole body planar and single photon emission computed tomography (SPECT) images were obtained after the injection of 30 mCi of 99Tc MIBI. Prior to PSCT the patient was imaged with 6 mCi In-111 pentreotide.Conventional CT scans also were performed. Initial CT revealed pulmonary metastasis in the right lower lobe along with multiple left pleural-based lesions. These lesions were visualized clearly with MIBI. Octreotide detected only the left lung involvement. Sequential MIBI scans after PSCT correlated with tumor reduction in the right lung field and tumor progression in the left lung as well as the development of new pulmonary metastasis. These findings were confirmed on CT.MIBI imaging was highly concordant with CT scanning in the detection of metastatic ES. MIBI scanning holds promise for the direct detection of a variety of human malignancies, and may prove useful as a rapid whole body imaging modality.

Nuclear medicine imaging in lung cancer

The evaluation of the anatomical dissemination of lung cancer has a pivotal role in the choice of the most appropriate treatment modality. The techniques of nuclear medicine are founded on the use of different radiopharmaceuticals capable of exploiting the specific characteristics of malignant tissues. They may recognise diverse cell densities, growth rates, metabolic pathways, antigenic and surface receptor expressions. In the past, the use of Co-57-bleomycin and, then, of (67)Gallium has encountered a mixed acceptance among nuclear medicine specialists, with favourable reports claiming their utility, and others with more sceptical opinions. It is generally admitted that both Co-57-bleomycin and (67)Gallium scintigraphies are quite sensitive and rather accurate. Their use, however, is almost abandoned in favour of more innovative and encouraging approaches, including non-specific radio-tracers ((201)Thallium and Tc-99m-sestamibi), substances useful in particular clinical applications (the somatostatin analogues I-123-tyr(3) and the In-111 octreotide for neuronendocrine tumours), radio-labelled monoclonal antibodies, and the recently introduced positron emission tomography. Promising results with each of these techniques need to be further substantiated, before their entering into clinical practice. However, the abundance of choices offered by nuclear medicine might reasonably bring forward the ideal noninvasive test. We review the many scintigraphic methods investigated so far and their clinical significance.

In-111 Octreotide Scintigraphy in the Diagnostic Evaluation of En Plaque Meningioma

A 44-year-old woman had a 13-year history of a small bulge of the left frontal region which had increased in size during the last year. At admission, an orange-sized, hard, fixed left frontal mass was found. Magnetic resonance imaging showed hyperostosis in the left frontal region which was causing a skull deformity and marked focal meningeal enhancement. A hyperostotic plaque meningioma was hypothesized. In-111 octreotide scintigraphy confirmed the diagnosis before surgery. In-111 octreotide scintigraphy allows biologic characterization of neoplasms in vivo.

Endocrinological applications in nuclear medicine

Diagnosis and treatment of thyroid diseases have played a major role in Central European Nuclear Medicine. Since 1950, endocrinological nuclear medicine has been one of the strengths of this medical discipline. Not only diagnosis but also conservative treatment with thyroid depressants or hormones is performed by the nuclear medicine specialists. Nuclear medicine also takes part in the diagnosis of other endocrine diseases. The respective procedures include imaging of the adrenal gland (cortex and medulla) as well as of the parathyroid glands. Especially in the latter diseases, imaging was improved through Tc-99m sestamibi scintigraphy. Beyond that, the measurement of bone mineral content contributes to the full spectrum of endocrinological nuclear medicine. The development of In-111 octreotide now plays a limited role in the diagnosis of diseases of the pituitary gland.

Detection of a Carcinoid Tumor by the Radionuclide Method

The authors describe a patient with carcinoid tumor. Results of all the usual investigations, except scintigraphy were normal. Both I-123 MIBG and In-111 octreotide (OCT) scintiscans showed multiple abnormal hot spots in the right lower abdomen. With a sensitivity of 55% and 90%, respectively, I-123 MIBG or In-111 OCT scintigraphy are effective for detecting carcinoid tumors, especially when the results of the usual examinations are not contributive

The role of nuclear medicine in oncology.

Nuclear Medicine offers screening methods for oncology such as bone and bone marrow scintigraphy. During the last two decades, special procedures have gained widespread application. This paper is centered around the "tumor-specific" radiopharmaceuticals. In patients with thyroid cancer, I-131 still plays a significant role. Ga-67 still has its indications in lymphoma, while in other diseases Tl-201 chloride is now the agent of choice. Especially in thyroid cancer, Tl-201 has proved to be a reliable tumor imaging radiopharmaceutical. More recently, Tc-99m MIBI was introduced for tumor imaging. Tc-99m HMPAO may also be used for tumor scintigraphy, especially in brain lesions. In addition, I-123 IMP has successfully been used for imaging malignant melanoma. Another promising field of tumor diagnosis is receptor imaging. In neuroblastoma and malignant pheochromocytoma, I-131/123 mIBG is the radiopharmaceutical of choice and may be considered as a receptor imaging agent also. First clinical results with In-111 octreotide show potentials as somatostatin-receptor radiopharmaceutical in insulinoma, islet cell carcinoma, medullary and lung cancer, while I-123 estradiol needs some improvement until it may be recommended as diagnostic tool in breast cancer. Since 1978, radiolabeled poly- or monoclonal tumor antibodies and their fragments have gained widespread application. Especially the Tc-99m 225.28S melanoma antibody, I-131 or Tc-99m CEA and In-111/I-131 labeled OC-125 antibodies have proven to be of clinical significance in melanoma, colorectal and ovarian cancer.