Summary of Studies on Carcinoid Tumors Presented
at the Society of Nuclear Medicine
51st Annual Society of Nuclear Medicine Meeting
June 19-23, 2004, Philadelphia
Prepared by: Seza A. Gulec, MD
COMPARISON BETWEEN I-123 MIBG AND
IN-111 OCTREOTIDE IN THE
DETECTION OF NEUROENDOCRINE TUMORS.
W. Gayed et al. University of Texas M.D. Anderson Cancer Center,
Twenty patients were included in the study (4 carcinoid, 2 medullary
thyroid cancer, 2
pheochromocytoma, 2 islet cell tumors, 1 paraganglioma, 4
non-neuroendocine tumors, 5
no cancer). Six patients had positive MIBG scan and 5 had positive
sensitivity, specificity, positive and negative predictive values for
the MIBG scans were
50, 100, 100, and 63% and for Octreoscan were 45, 100, 100, and 62%.
There was no
statistically significant difference in the performance of the two
procedures with p=1.0.
MIBG scan was positive in one patient with pheochromocytoma, one
medullary thyroid cancer and one patient with carcinoid while
negative. Octreoscan was positive in one patient with carcinoid and
another with islet cell
tumor when MIBG scans were negative.
The performance of I-123 MIBG and In-111 Octreotide in the detection of
neuroendocrine tumors was comparable with very high specificity and
HIGH DOSE I131 METAIODOBENZYLGUANIDINE (MIBG) THERAPY FOR
METASTATIC NEUROENDOCRINE TUMORS.
M. Stachowiak et al. University of Texas M.D. Anderson Cancer
Center, Houston, TX
Response to therapy was monitored using urine and blood chemical
markers, quality of
life questionnaires, tumor size measurements by CT and tumor activity
Iodine-123- MIBG scans. Of the fourteen patients, four have stable
disease at this time
and the average time to progressive disease was 6.1 months. Three
subjects died during
the study follow-up period due to disease progression.
The result of this protocol suggests that Iodine-131- MIBG is an
alternative or additional
option for patients with neuroendocrine tumors that show uptake of
on diagnostic scans.
In-111 PENTETREOTIDE THERAPY IN REFRACTORY SST2+ WELLDIFFERENTIATED
NEUROENDOCRINE NEOPLASMS IN A COMMUNITY
Le, L. Linares et al. LSUHSC New Orleans, LA
85 patients (46 females) were treated with an average dose of 487.9 mCi
pentetreotide. The median age was 54.9 yrs. The majority (90%) of
patients had a welldifferentiated
neuroendocrine tumor (such as carcinoid or pancreatic islet cell
and Grade 1 to 4 uptake on the diagnostic In-111 pentetreotide scan.
142 treatments were
delivered with 41 patients receiving 2 or more treatments (28 patients
were treated twice;
10 patients received 3 doses and 3 patients received 4 doses). The
clearance was 93 ml/min. For the 41 patients receiving one more
creatinine clearances were 82.8, 95.2 and 81.9 ml/min following a
cumulative dose of
493, 986 and 1,483 mCi, respectively. Treatment-related
myelodysplasia was not observed. The median survival was 22.1 months
from the time of
the first In-111 pentetreotide treatment and 84.3 months from the time
In-111 pentetreotide therapy can be safely administered in a community
and results in a median survival of 22.1 months in patients with
metastatic well-differentiated neuroendocrine malignancies.
MINIMUM 1 YEAR PROGRESSION AND OVERALL SURVIVAL DATA IN
PATIENTS TREATED WITH Y-90 LANREOTIDE.
J. R. Buscombe et al. Royal Free Hospital, London, United Kingdom
Using formal criteria of response only 3 patients (10%) had a partial
response. A further
15 (50%) had disease stability, though many of these had a minor
At 12 months 21 patients had radiological evidence of progression with
progression free survival of 7 months. However of those patients
showing stability or
response, at 3 months, 7 had no further evidence of progression during
the follow up
phase with a median progression free survival was 13 months. A total of
13 patients died
during the follow-up period so the median overall survival has not been
7 deaths (58% mortality)occurred in the 12 patients with disease
progression at 3 months
compared with only 6 (33% mortality) in those with stability or
toxicity occurred in 6 patients, 2 requiring supportive therapy. Both
of these had
disseminated progressive disease
It would appear that 60% of patients receiving Y-90 lanreotide received
from the treatment with evidence of stability or response at 3 months
suggesting both an
improved progression free and overall survival.
18F]6-FLUORO-L-m-TYROSINE IN THE ASSESSMENT OF PATIENTS WITH
C. J. Marriott et al. Hamilton Health Sciences, Hamilton, ON, Canada
In 3 of 4 patients tumour was identified with [18F]-FmT imaging; the
fourth patient was
not demonstrated to have disease by any assessment and remains well. Of
the 3 patients
with demonstrable tumor, CT imaging did not distinguish between
scarring and tumor in 2 and was negative in the third. Octreotide
imaging was negative in
2 of 3 patients. 131I-MIBG did not visualize tumor which was positive
imaging. No bowel activity was noted on [18F]-FmT images as compared to
imaging where substantial gut activity was seen. Renal excretion of
[18F]-FmT imaging appears to be more sensitive than octreotide imaging
in the detection
of metastatic disease from carcinoid tumors. Absence of bowel activity
improved imaging. Renal excretion of [18F]-FmT results in interference
from activity in
the bladder and ureters that could be reduced with diuretic
specificity is noted over anatomical imaging with CT.
EFFICACY OF INDIUM-111-LABELED OCTREOTIDE SCINTIGRAPHY IN
DETECTING SOMATOSTATIN RECEPTOR-RICH MALIGNANCY.
G. El-Haddad et al., Hospital of the University of Pennsylvania,
Among the 232 octreoscans, 112 were true positive, 88 were true
negative, 27 were false
negative and 5 were false positive scans. Therefore the sensitivity was
81% (112 of 139
scans), the specificity was 95% (88 of 93 scans), the accuracy was 86%
positive predictive value (PPV) was 96% (112 of 117), and the negative
(NPV) was 76% (88 of 115). data demonstrates that
(Octreotide) scintigraphy has a very high specificity and positive
predictive value in
detecting somatostatin receptor-rich malignancy. Its routine use as an
modality is well justified.
CLINICAL APPLICATION OF SMS RECEPTOR PET/CT USING Ga-68-
DOTATOC IN CARCINOIDS.
M. Hofmann et al. Medical School Hannover, Hannover, Germany,
Essen, Essen, Germany, Radiological Chemistry, Kantosspital Basel,
Switzerland, Rayal Surrey County Hospital, London / Surrey, United
CT showed 35 lesions, all seen on the PET. PET demonstrated 45
additional lesions. All
extra-hepatic soft tissue lesions on PET smaller than 10 mm could not
be identified with
CT, but were retrospectively seen only on fused PET/CT images. Most
bone lesions (<15
mm diameter) without soft tissue invasion were not detected by CT. PET
anatomical alignment in 65% of the lesions. Especially the localization
of bone lesions or
lesions near organ boundaries was frequently mis-judged on PET alone.
PET using Ga-68-DOTATOC is superior to CT in the detection of
lesions, but PET/CT fusion is required for correct anatomical alignment
of all lesions.
The application of PET/CT is most desirable in all SMS-receptor
positive tumors and
may soon become the gold standard for staging and therapy control in
FIRST CLINICAL APPLICATION OF THE NEW SMS RECEPTOR PET
RADIO-LIGAND GA-68-DOTANOC - A LIGAND WITH BROAD SUBTYPE
M. Hofmann et al. Medical School Hannover, Hannover, Germany;
Chemistry, Kantonsspital Basel, Basel, Switzerland.
Tumor uptake reached a plateau in most tumors at 60min p.i..
delineated malignant lesions in: 6/6 carcinoid patients, 4/5 papillary
thyroid cancers (no
accumulation in 1 papillary thyroid cancer metastasis after sequential
therapy with 17 GBq I-131-NaI), 1/4 medullary thyroid cancers (1
patient showed only a
slight uptake (SUVmean = 2.5)), 3/3 insulinomas were highly positive.
visceral SUVs were 7,5 (range 4-12) for liver, 20 (13-27) for spleen,
12 (range 8-17) for
the adrenal glands and 3,6 (range 3-8) for the pineal gland.
In this preliminary study , Ga-68-DOTANOC PET seemed to be feasible in
of endocrine tumors such as carcinoids, papillary thyroid cancers and
yielding high tumor to non-tumor ratios. However, it cannot be
medullary thyroid cancers.
In-111-DTPA-DGlu1-MINIGASTRIN IN COMPARISON TO In-111-DTPADPhe1-
Octreotide IN 87 PATIENTS WITH NEUROENDOCRINE TUMORS.
M. Gotthardt et al. Philipps-University of Marburg, Marburg,
87 patients were eligible for the study. 51 patients had carcinoid
tumors, 3 gastrinomas, 2
glucagonomas, 1 insulinoma, 3 phaeochromocytomas/paragangliomas, 1
small cell lung
cancer (SCLC), and 26 medullary thyroid carcinomas (MTC). Somatostatin
scintigraphy (SRS) revealed positive findings in 63.2% while Gastrin
scintigraphy (GRS) was positive in 79.3%. SRS was superior to GRS in
27.6%, GRS was
superior to SRS in 40.2%. If patients with MTC are not considered, SRS
is better than
GRS (82% versus 78.7%). In these patients, GRS performed better than
SRS in 23%
while SRS was superior in 41%. In half of the SRS-negative patients,
GRS was positive.
In patients with MTC, GRS performed clearly better reaching a
sensitivity of 80.8%
versus 19.2% in SRS. In one patient with SCLC, GRS was strongly
positive while SRS
In patients with MTC, GRS is clearly superior to SRS. In patients with
Neuroendocrine tumors (NET), SRS remains the standard other
have to be compared to. However, GRS is able to give additional
in 23% of these patients. Thus, GRS is a very promising new method for
detection of NET. Especially in SRS negative patients, GRS should be
NUCLEAR MEDICINE TECHNIQUES IN DIAGNOSIS AND
SUMMARY OF CARCINOID-RELATED PAPERS PRESENTED AT
THE SOCIETY OF NUCLEAR MEDICINE 50th ANNUAL MEETING
June 21-25, 2003, New Orleans, LA
Seza Gulec, MD
DETECTION OF PRIMARY AND RECURRENT CARCINOID TUMORS WITH F-18 FDG
COMPARISON WITH In-111 PENTETREOTIDE.
Y. Menda et al, University of Iowa College of Medicine, Iowa City,
FDG PET has a good sensitivity in carcinoid tumors and can be
helpful for detection of the
primary carcinoid tumor and metastatic spread in patients with a
In-111 pentetreotide scan.
Further studies are needed to evaluate whether FDG positive/ In-111
tumors have a different clinical course compared with FDG negative
IMAGING OF NEUROENDOCRINE TUMORS WITH 18F-FLUORODOPA AND PET.
A. Becherer et al University of Vienna, Vienna, Austria.
Although SRS is a suitable first line staging method, FDOPA should be
as an additional
modality as it performs markedly better in NET visualization than SRS.
bone lesions are
detected by FDOPA while for liver metastases, contrast augmented CT is
ACCURACY OF FDG-PET IN THE EVALUATION OF METASTATIC OR RECURIT~NT
TUMORS WHICH ARE CANDIDATES FOR OCTREOSCAN.
H. M. Zhuan et al. University of Pennsylvania, Philadelphia, PA.
FDG-PET and octreoscan provide comparable results in patients who are
optimal candidates for
octreoscan although FDG-PET is slightly more sensitive while octreoscan
to be slightly more
specific. Considering similarity of costs between these two types of
but substantially superior
image quality (whole body vs regional tomographic images), convenience
the patient (2 hours vs 24 hour
for completion of the test), PDG-PET may prove to be more efficient in
HYBRID IMAGING USING lllIn OCTREOTIDE SPECT/CT IN EVALUATION OF
SOMATOSTATIN RECEPTOR POSITIVE TUMORS.
R. M. Mirtcheva et al, New York Presbyterian Hospital, WeilI Cornell
Center, New York, NY.
SPECT/CT fusion imaging significantly improves the diagnostic
in interpretation of 111 In
Octreotide SPECT. SPECT/CT has potential to change the diagnostic
and clinical management,
discriminating physiologic activity from disease and improving the
Localization of findings.
IN-VIVO CHARACTERISATION OF THE FUNCTIONAL ASPECTS OF CARCINOID
BY IMAGING SOMATOSTATIN RECEPTORS AND AMINE UPTAKE.
A. M. Quigley et al. Royal Free Hospital, London, United Kingdom;
Tumor Clinic, Royal
Free Hospital, London, United Kingdom.
Using functional imaging the majority of carcinoid tumors show
affinity for In-ll1 octreotide and
1-123 MIBG, even different lesions within the same patient can show
imaging with both agents is essential to fully characterize carcinoid
SURVIVAL IN PATIENTS WITH NEUROENDOCRINE TUMORS AFTER TREATMENT
[Y-90-DOTA,TYR3] OCTREOTIDE IN A PHASE-1 STUDY.
R. Valkem et al. Rotterdam, Netherlands; UCL St Luc, Brussels, Belgium,
Lee Mofitt Cancer Center,
Tampa, FL; Novartis Pharmaceuticals Corp, East Hanover, NJ.
Survival after PRRT is good, except in End-Stage patients. These
can be classified by clinical
criteria. Even in End-Stage patients a therapeutic effect (SD) may
TREATING ADVANCED LIVER METASTASES OF NEUROENDOCRINE TUMORS WITH
INTRA-HEAPTIC ARTERY INFUSIONS OF Y-90 LANREOTIDE.
J. R. Buscombe et al. Royal Free Hospital, London, United Kingdom
Objective evidence of tumor growth with stability or shrinkage of
growing tumor could be seen
in 75% of patients with symptom relief in the same proportion of
63% of patients survived at least
9 months after treatment, There was a low level of toxicity (15%) This
or a similar approach
should be considered in all such neuroendocrine tumor patients with
In-lll-DTPA-D-Glul-MINIGASTRIN USED FOR THERAPY OF METASTATIC
THYROID CARCINOMA AND OTHER NEUROENDOCRINE TUMORS: RESULTS OF AN
ONGOING DOSE-ESCALATION STUDY.
M. Gotthardt et al. Philipps-University of Marburg, Marburg, Germany.
To date, our patients did not show nephrotoxicity and only mild
Thus, the maximum
tolerated dose has not been reached as of yet. Some encouraging
could be observed.
EVALUATION OF RHENIUM-188 LIPIODOL IN THE TREATMENT OF LIVER
EXPERIENCE IN COLOMBIA.
P. Bernal et al. Fundacion Santa Fe Bogota, Bogota, Bogota, Colombia,
Sloan Kettering Cancer
Centre, New York, NY; InternationaI Atomic Energy Agency, Vienna,
Rhenium-188 Lipiodol appears to be a promising and safe
for the treatment of liver
cancer. Further studies to establish the efficacy of treatment are
carried out on a large number of
patients through a prospective Phase-II multi-center study.
EFFICACY OF OCTREOSCAN IN DETECTING SOMATOSTATIN RECEPTOR-RICH
J. Q. Yu et al. University of Pennsylvania, Philadelphia, PA.
scan is a very specific technique for
the evaluation of endocrine tumor with very high PPV. Therefore, a
octreoscan can be interpreted
with confidence. On the other hand, because of an only moderate NPV, a
octreoscan should not be
interpreted to represent a disease free state and further studies, such
FDG-PET should be considered.
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