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Neoplasie della tiroide Carcinoma scarsamente differenziato Terapia radiorecettoriale

Annibale Versari Medicina Nucleare – Centro PET AO Arcispedale S.Maria Nuova - IRCCS Reggio Emilia versari.annibale@asmn.re.it. Neoplasie della tiroide Carcinoma scarsamente differenziato Terapia radiorecettoriale. 15 giugno 2011. Background.

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Neoplasie della tiroide Carcinoma scarsamente differenziato Terapia radiorecettoriale

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  1. AnnibaleVersariMedicinaNucleare – Centro PETAO Arcispedale S.Maria Nuova - IRCCSReggio Emiliaversari.annibale@asmn.re.it 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 Target site: Somatostatin receptors Somatostatin analogs • Scintigraphy, SPECT, SPECT/CT • 111In-Octreoscan • PET/CT • 68Ga-DOTATOC • 68Ga-DOTANOC • 68Ga-DOTATATE

  5. Physics properties (LET) mean range in body tissue 177Lu 0.5-2mm 90Y 3-11 mm

  6. Results

  7. JJJ Teunissen et al J Nucl Med 2005

  8. JJJ Teunissen et al J Nucl Med 2005

  9. 68Ga DOTATOC PET/CT 68Ge/68Ga Generator

  10. 68Ge/68Ga Generator 68Ge (t1/2 : 270.8 d) 68Ga (t1/2 : 68 m) EC • 68Ga emissions b+ E(max) = 1.9 MeV 89% electron capture 11%

  11. Ant Lat

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

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

  14. Patients 45 pts with non-radioiodine-avid DTC, metastatic or suspicious metastatic underwent 68Ga-DOTATOC PET/CT m/f 21/24 age 23-82 yrs, mean 59 Results Negative PET: 23 pts (51%) Positive PET: 22 pts (49%)

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

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

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

  18. 90Y-DOTATOC 90Ittrium

  19. Radiolabelled Somatostatin Analogs Therapy

  20. 90Y/177Lu-DOTATOC Treatment

  21. Patientevaluation PET VCAR • RECIST evaluation • 68Ga-PET/CT evaluation • functional volume • SUV • tumor/muscle SUV

  22. Response to the treatmentFollow up: 6-15 months PR - partial response SD - stable disease PD - progression disease According to EORTC criteria modified by our Ethics Committee

  23. Severe dyspnea No dyspnea O2-therapy: 6-7 hours/day No O2-therapy Beforetherapy After 4 cycles 90Y-DOTATOC (cumulative dose 268 mCi) Mar 2009 Sept 2007 B.M. male, 75 year old

  24. B.M. male, 75 year old

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

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

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

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

  29. Tireoglobulin in comparison with treatment response PR - partial response SD - stable disease PD - progression disease

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

  31. 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

  32. Side effectsImpact on renal function

  33. Side effectsImpact on blood platelets

  34. Side effectsImpact on WBC

  35. Conclusions • Labelled somatostatin analogs are very interesting for pts with progressive radioiodine-negative Differentiated Tyroid Cancer • About 50% of these pts are positive at 68Ga-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.

  36. Grazie per l’attenzione Ponte di Calatrava Reggio Emilia

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