SPECT-CT Somatostatin-Receptor Scintigraphy in Medullary Thyroid Cancer (MTC)

Abstract

The medullar thyroid cancer (MDC) is a rare neuroendocrine tumour - made up of 5% to 8% of thyroid neoplasms. It arises from the parafollicular, calcitonin-secreting C-cells. The malignantly transformed thyroid C-cells eminent on the surface somatostatin receptors SSTR, based on their neuroendocrine component. During the last decades, the somatostatin receptor scintigraphy with 99mTc-EDDA/HYNIC-TOC (99mTc-Tektrotyd, Polatom) has been introduced for imaging of neuroendocrine tumors.

The purpose of this study was to determine the role of SPECT-CT with 99mTc-Tektrotyd in patients with MTC.

Twenty one patients, (14 females/7males) with MTC underwent somatostatin-receptor scintigraphy. Three of them were studied for initial pre-operative N/M-staging whereas 18 out of 21 were follow-up after total thyroidectomy. Plasma calcitonin level was measured as a tumor marker. Twenty-nine examinations including SPECT-CT studies of the neck and chest and/or abdomen and pelvis were carried out 2-4 hrs. post i.v. administration of average 740 MBq activity dose of 99mTc-EDDA/HYNIC-TOC (Tektrotyd, Polatom).

Somatostatin-receptor scintigraphy results were true positive in 16 patients, true negative in 5 patients and false positive in 1 case with high tracer uptake in the benign ovary cyst. False-negative results were obtained in 2 cases with positive cervical lymph node metastases but negative small 1-4 mm pulmonary military lesions. Sensitivity of SPECT-CT somatostatin-receptor scintigraphy with 99mTc Tektrotyd in the studied group was 88, 8% (16/18); specificity 83,3% (5/6) and accuracy 87.5% (21/24).

In conclusion our results showed that the main clinical applications of SPECT-CT somatostatin-receptor scintigraphy in MTC are as follows: 1) for pre- treatment correct N/M staging of MTC. 2) For early determination of recurrence/metastases in cases with clinical and biochemical indices for presence and extent of MTC. 3) To assess SSTR expression in order to predict an individual response to therapy if PRRT is considered.

 

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See also:

- Official Web Site: The Di Bella Method;

- The Di Bella Method (A Fixed Part - Somatostatin, Octreotide, Sandostatin LAR, analogues and/or derivatives);

- Somatostatin in oncology, the overlooked evidences - In vitro, review and in vivo publications;

- Publication, 2018 Jul: Over-Expression of GH/GHR in Breast Cancer and Oncosuppressor Role of Somatostatin as a Physiological Inhibitor (from Di Bella's Foundation);

- Publication, 2018 Sep: The over-expression of GH/GHR in tumour tissues with respect to healthy ones confirms its oncogenic role and the consequent oncosuppressor role of its physiological inhibitor, somatostatin: a review of the literature (from Di Bella's Foundation);

- Publication, 2019 Aug: The Entrapment of Somatostatin in a Lipid Formulation: Retarded Release and Free Radical Reactivity (from Di Bella's Foundation);

- Publication, 2019 Sep: Effects of Somatostatin and Vitamin C on the Fatty Acid Profile of Breast Cancer Cell Membranes (from Di Bella's Foundation);

- The Di Bella Method (A Fixed Part - Bromocriptine and/or Cabergoline);

- The Di Bella Method (A Fixed Part - Cyclophosphamide 50mg tablets and/or Hydroxyurea 500mg tablets, one or two per day);

- The Di Bella Method DBM improved survival objective response and performance status in a retrospective observational clinical study on 23 tumours of the head and neck;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in advanced non-small-cell lung cancer patients with low performance status;

- Somatostatin, retinoids, melatonin, vitamin D, bromocriptine, and cyclophosphamide in chemotherapy-pretreated patients with advanced lung adenocarcinoma and low performance status;

- Observations on the Report of a case of pulmonary adenocarcinoma with lymph node, hepatic and osseus metastasis;

- Neuroblastoma: Complete objective response to biological treatment;

- Oesophageal squamocellular carcinoma: a complete and objective response;

- Recurrent Glioblastoma Multiforme (grade IV – WHO 2007): a case of complete objective response achieved by means of the concomitant administration of Somatostatin and Octreotide – Retinoids – Vitamin E – Vitamin D3 – Vitamin C – Melatonin – D2 R agonists (Di Bella Method – DBM) associated with Temozolomide.