Differentiated thyroid cancer: A new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients

TY - JOUR

T1 - Differentiated thyroid cancer

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

PY - 2014/4/1

Y1 - 2014/4/1

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.

AB - 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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U2 - 10.1089/thy.2013.0225

DO - 10.1089/thy.2013.0225

M3 - Article

C2 - 24102584

AN - SCOPUS:84898492814

VL - 24

SP - 715

EP - 726

JO - Thyroid

JF - Thyroid

SN - 1050-7256

IS - 4

ER -