Differentiated thyroid cancer

A new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients

Annibale Versari, Martina Sollini, Andrea Frasoldati, Alessandro Fraternali, Angelina Filice, Armando Froio, Mattia Asti, Federica Fioroni, Nadia Cremonini, Daniel Putzer, Paola Anna Erba

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The expression of somatostatin receptors (SSTR) in thyroid cells may offer the possibility to identify metastatic lesions and to select patients for peptide receptor radionuclide therapy (PRRT). We investigated 68Ga-DOTATOC positron emission tomography/computed tomography (PET/CT) to select patients with progressive differentiated thyroid cancer (DTC) for PRRT as well as treatment response and toxicity in treated patients. Methods: We enrolled 41 patients with progressive radioiodine-negative DTC (24 women and 17 men; mean age=54.3 years, median=59 years, range=19-78 years). In all patients, [18F]FDG-PET/CT was performed to determine recurrent disease with enhanced glucose metabolism, and 68Ga-DOTATOC PET/CT was used to identify SSTR expression. Dosimetric evaluation was performed with 111In-DOTATOC scintigraphy. Eleven patients were treated with PRRT receiving a fractionated injection of 1.5-3.7 GBq 90Y-DOTATOC/ administration. Serial 68Ga-DOTATOC PET/CT scans were performed in all treated patients to evaluate treatment response. Parameters provided by 68Ga-DOTATOC PET/CT were analyzed as potential therapeutic predictors to differentiate responding from nonresponding. In all treated patients, adverse events and toxicity were recorded. Results: 68Ga-DOTATOC PET/CT were positive in 24/41 of radioiodine-negative DTC patients. Based on the high expression of SSTR detected by 68Ga-DOTATOC PET/CT, 13 patients were suitable for PRRT. Two out of 13 patients were not treated due to the lack of fulfillment of other study inclusion criteria. PRRT induced disease control in 7/11 patients (two partial response and five stabilization) with a duration of response of 3.5-11.5 months. Objective response was associated with symptoms relief. Functional volume (FV) over time obtained by PET/CT was the only parameter demonstrating a significant difference between lesions responding and nonresponding to PRRT (p=0.001). Main PRRT adverse events were nausea, asthenia, and transient hematologic toxicity. One patient experienced permanent renal toxicity. Conclusions: In our series, SSTR imaging provided positive results in more than half of the cases with radioiodine-negative DTC, and about one third of patients were eligible for PRRT. 68Ga-DOTATOC PET/CT seems a reliable tool both for patient selection and evaluation of treatment response. In our experience, FV determination over time seems to represent a reliable parameter to determine tumor response to PRRT, although further investigations are needed to better define its role.

Original languageEnglish
Pages (from-to)715-726
Number of pages12
JournalThyroid
Volume24
Issue number4
DOIs
Publication statusPublished - Apr 1 2014

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Somatostatin
Thyroid Neoplasms
Peptide Receptors
Radioisotopes
Somatostatin Receptors
Therapeutics
Positron Emission Tomography Computed Tomography
Asthenia
Fluorodeoxyglucose F18
Ga(III)-DOTATOC
Radionuclide Imaging
Nausea
Patient Selection
Thyroid Gland

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Differentiated thyroid cancer : A new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients. / Versari, Annibale; Sollini, Martina; Frasoldati, Andrea; Fraternali, Alessandro; Filice, Angelina; Froio, Armando; Asti, Mattia; Fioroni, Federica; Cremonini, Nadia; Putzer, Daniel; Erba, Paola Anna.

In: Thyroid, Vol. 24, No. 4, 01.04.2014, p. 715-726.

Research output: Contribution to journalArticle

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author = "Annibale Versari and Martina Sollini and Andrea Frasoldati and Alessandro Fraternali and Angelina Filice and Armando Froio and Mattia Asti and Federica Fioroni and Nadia Cremonini and Daniel Putzer and Erba, {Paola Anna}",
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T2 - A new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients

AU - Versari, Annibale

AU - Sollini, Martina

AU - Frasoldati, Andrea

AU - Fraternali, Alessandro

AU - Filice, Angelina

AU - Froio, Armando

AU - Asti, Mattia

AU - Fioroni, Federica

AU - Cremonini, Nadia

AU - Putzer, Daniel

AU - Erba, Paola Anna

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N2 - Background: The expression of somatostatin receptors (SSTR) in thyroid cells may offer the possibility to identify metastatic lesions and to select patients for peptide receptor radionuclide therapy (PRRT). We investigated 68Ga-DOTATOC positron emission tomography/computed tomography (PET/CT) to select patients with progressive differentiated thyroid cancer (DTC) for PRRT as well as treatment response and toxicity in treated patients. Methods: We enrolled 41 patients with progressive radioiodine-negative DTC (24 women and 17 men; mean age=54.3 years, median=59 years, range=19-78 years). In all patients, [18F]FDG-PET/CT was performed to determine recurrent disease with enhanced glucose metabolism, and 68Ga-DOTATOC PET/CT was used to identify SSTR expression. Dosimetric evaluation was performed with 111In-DOTATOC scintigraphy. Eleven patients were treated with PRRT receiving a fractionated injection of 1.5-3.7 GBq 90Y-DOTATOC/ administration. Serial 68Ga-DOTATOC PET/CT scans were performed in all treated patients to evaluate treatment response. Parameters provided by 68Ga-DOTATOC PET/CT were analyzed as potential therapeutic predictors to differentiate responding from nonresponding. In all treated patients, adverse events and toxicity were recorded. Results: 68Ga-DOTATOC PET/CT were positive in 24/41 of radioiodine-negative DTC patients. Based on the high expression of SSTR detected by 68Ga-DOTATOC PET/CT, 13 patients were suitable for PRRT. Two out of 13 patients were not treated due to the lack of fulfillment of other study inclusion criteria. PRRT induced disease control in 7/11 patients (two partial response and five stabilization) with a duration of response of 3.5-11.5 months. Objective response was associated with symptoms relief. Functional volume (FV) over time obtained by PET/CT was the only parameter demonstrating a significant difference between lesions responding and nonresponding to PRRT (p=0.001). Main PRRT adverse events were nausea, asthenia, and transient hematologic toxicity. One patient experienced permanent renal toxicity. Conclusions: In our series, SSTR imaging provided positive results in more than half of the cases with radioiodine-negative DTC, and about one third of patients were eligible for PRRT. 68Ga-DOTATOC PET/CT seems a reliable tool both for patient selection and evaluation of treatment response. In our experience, FV determination over time seems to represent a reliable parameter to determine tumor response to PRRT, although further investigations are needed to better define its role.

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