Clinical Diagnostic Application of ¹¹¹In-DTPA-Octreotide Scintigraphy in Small Cell Lung Cancer

Abstract

Some years ago it was proved that a good percentage of small cell lung cancers, classified among cancers of the APUD system, produces somatostatin receptors that can be detected in vivo by scintigraphy with 111In-DTPA-octreotide. With the method in the whole body it is possible to identify the principal neoformation and the probable metastases. The authors present a study of 21 patients afflicted with small cell lung cancer diagnosed histologically. The study, carried out between January 1995 and December 1997, compared the radiologic iconography of the CT scan with the scintigraphic map obtained by a planar scintigraphy and in SPECT 1, 4 and 24-hr after iv injection of 110 MBq of 111In-DTPA-octreotide. The comparison was made with reference to the principal neoplasm and probable metastases. A scintigraphic study, a CT of restaging and a follow-up, done after 3 and 6 months of chemotherapy, on 15 patients with cancer that produces somatostatin receptors proved that the neoplasm sometimes regresses and sometimes progresses. In the latter case, it is possible to identify cerebral, mediastinal and hepatic metastases with the administration of 200 microg of octreotide 3 times a day for 7 days before the scintigraphy. In fact, the administration lowers background activity. The authors concluded that scintigraphy with 111In-DTPA-octreotide plays an important part in the study of patients afflicted with small cell lung cancer. Scintigraphy identifies the subgroups of patients who can be cured with somatostatin analogues together with chemotherapy. Scintigraphy presents a good sensibility in the re-staging and in the follow-up of patients who are treated, even though it is difficult to identify subdiaphragmatic metastases where liver, spleen and kidney show an increase in 111In-DTPA-octreotide.

Expression of somatostatin receptor types 2, 3 and 5 in biopsies and surgical specimens of human lung tumours

“…Clinical study Reisinger [26] SCLC (96/100) a Octreoscan n.a. Clinical study Vaccarili [47] SCLC (15/21) Octreoscan n.a. Clinical study Fujita [6] SCLC and NSCLC RT PCR 1-2 Tumor cell lines Taylor [45] SCLC AR 2…”

“…several data have appeared regarding sst expression in endocrine neoplasms in lung tumors. In the same tumors, sst binding sites were reported by means of in vivo studies based on octreotide scintigraphy [1,2,22,26,47]. The tissue localization of sst in lung tumors was analyzed by means of autoradiography [29,32], in situ hybridization [10,25,31] and immunohistochemistry [9,11,25,32,34].…”

Prognostic value of [ 18 F]FDG-PET imaging in small cell lung cancer

“…However, these methods have not been very successful [14,15,16]. Increased glucose metabolic activity in SCLC has been shown using FDG-PET imaging [17], and recent studies have shown its role in the staging of SCLC patients [18,19,20].…”

Diagnosis and treatment of lung cancer using nuclear medicine techniques — current state of the art

“…[ 111 In]In-DTPA shows a high affinity for SSTR2 and is used in staging and assessing the extent of disease in SCLC and lung NETs. Moreover, in some cases, performing an [ 111 In]In-DTPA measurement is helpful for stratifying patients who can be treated with somatostatin analogs and chemotherapy [40]. The development of a new generation of CT scanners has allowed solitary pulmonary nodules (SPNs) to be diagnosed in approximately 50% of smokers aged above 50 years [41].…”