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Annibale Versari Medicina Nucleare – Centro PET AO Arcispedale S.Maria Nuova - IRCCS Reggio Emilia

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Presentation on theme: "Annibale Versari Medicina Nucleare – Centro PET AO Arcispedale S.Maria Nuova - IRCCS Reggio Emilia"— Presentation transcript:

1 Annibale Versari Medicina Nucleare – Centro PET AO Arcispedale S.Maria Nuova - IRCCS Reggio Emilia Neoplasie della tiroide Carcinoma scarsamente differenziato Terapia radiorecettoriale 15 giugno 2011

2 Background Metastases from differentiated thyroid carcinoma (DTC) can lose in time the capacity to concentrate radioiodine and the possibility to have a specific treatment.

3 Background DTC may express somatostatin receptors; this offers a further opportunity of diagnosis and treatment. Tenenbaum F et al J Nucl Med 1995 Görges R et al Nuklearmedizine 1999 Forssell-Aronsson EB et al J Nucl Med 2000

4 Nuclear Medicine Imaging Somatostatin analogs Target site: Somatostatin receptors Scintigraphy, SPECT, SPECT/CT 111 In-Octreoscan PET/CT 68 Ga-DOTATOC 68 Ga-DOTANOC 68 Ga-DOTATATE

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7 Physics properties (LET) mean range in body tissue 177 Lu 0.5-2mm 90 Y 3-11 mm β- (Mev) γ ( Kev ) T1/2 (days) 177 Lu Y

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9 Results

10 JJJ Teunissen et al J Nucl Med 2005

11 JJJ Teunissen et al J Nucl Med 2005

12 68 Ga DOTATOC PET/CT 68Ge/68Ga Generator

13 68 Ge (t 1/2 : d) 68 Ga (t 1/2 : 68 m) EC 68 Ga emissions   E(max) = 1.9 MeV 89% electron capture 11%

14 Ant Lat

15 B.M. male, 75 year old 68 Ga-DOTATOC PET/CT: Diffuse lung metastases (+ bone and lymph node mts) Metastatic differentiated thyroid cancer negative at radioiodine scan

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17 P.M. female, 61 year old 68 Ga-DOTATOC PET/CT: multiple bone metastases Metastatic differentiated thyroid cancer negative at radioiodine scan

18 Patients 45 pts with non-radioiodine-avid DTC, metastatic or suspicious metastatic underwent 68 Ga-DOTATOC PET/CT m/f 21/24 age yrs, mean 59 Results Negative PET: 23 pts (51%) Positive PET: 22 pts (49%)

19 Results Multivariate analysis does not show any significant association with a positive 68 Ga-DOTATOC PET/CT

20 From Diagnosis to Treatment Diagnosis 68 Ga Treatment 90 Y / 177 Lu DOTATOC

21 Results 13/45 (28%) patients satisfied the criteria ( high uptake in the lesions) to access PRRT with 90 Y/ 177 Lu-DOTATOC 11 pts underwent treatment ( 90 Y: 9 pts Lu: 2 pts)

22 90 Y-DOTATOC 90Ittrium

23 Radiolabelled Somatostatin Analogs Therapy

24 90Y/177Lu-DOTATOC Treatment ptsCumulative Dose (GBq) CyclesInterval (weeks) Dosimetry 90 Y In- DOTATOC 177Lu Lu

25 PET VCAR Patient evaluation RECIST evaluation 68 Ga-PET/CT evaluation functional volume SUV tumor/muscle SUV

26 Response to the treatment Follow up: 6-15 months RECIST ResponseSUV max Response PRSDPDPRSDPD Patients (11)244 (1 NA)245 Lesions Lymph node (23)18%78%4%34%52%14% Bone (130)NA 27%33%40% Lung (20)5%90%5%39%36%25% PR - partial response SD - stable disease PD - progression disease According to EORTC criteria modified by our Ethics Committee

27 Before therapy Sept 2007 Mar 2009 After 4 cycles 90 Y-DOTATOC (cumulative dose 268 mCi) Severe dyspnea No dyspnea O 2 -therapy: 6-7 hours/day No O 2 -therapy B.M. male, 75 year old

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29 Pre-therapy Post-therapy P.M. female, 61 year old

30 Pre-therapy Post-therapy P.M. female, 61 year old

31 Treatment steps pain no pain no pain pain P.M. female, 61 year old

32 Tumor/muscle SUV Treatment steps pain no pain no pain pain P.M. female, 61 year old

33 PatientTg pre- treatment Tg post- treatment 68Ga-PET SUV RECIST 1>1000stablePR 2300stablePD 30.5stablePR 4<0.3stableSD 5>6000stablePD 6380increasedPD 77500stableSD 8385increasedPD 90.4increasedSD 10227stableSD increasedPD Tireoglobulin in comparison with treatment response PR - partial response SD - stable disease PD - progression disease

34 Results The clinical response is superior to the PET/CT findings.

35 Side effects Nausea (grade 1): 4/11 Astenia (grade 1): 2/11 Hematologic Toxicity: 4/11 (transient decreasing of platelets, WBC, eritrocytes) Renal failure: 1/11

36 Side effects Impact on renal function

37 Side effects Impact on blood platelets

38 Side effects Impact on WBC

39 Conclusions Labelled somatostatin analogs are very interesting for pts with progressive radioiodine- negative Differentiated Tyroid Cancer About 50% of these pts are positive at 68 Ga- DOTATOC PET/CT The possibility to use the same peptide for therapy in PET positive pts is promising but needs further confirmation in larger number of pts.

40 Grazie per l’attenzione Ponte di Calatrava Reggio Emilia


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