9 december 2017: Bron: Am J Nucl Med Mol Imaging. 2017; 7(5): 228–235. Published online 2017 Nov 1.

Redent is deze studie gepubliceerd: Safety and accuracy of 68Ga-DOTATOC PET/CT in children and young adults with solid tumors

met uitstekende resultaten voor deze manier van inwendige bestraling op het gebied van veiligheid en diagnose.

Conclusie:

68Ga-DOTATOC PET/CT is veilig bij kinderen en jong volwassenen met een hoge accurate vaststelling van de receptoren gevoelig voor de somatostatin type 2 positieve tumoren.

Zie onderaan artikel abstract en referentielijst van genoemde studie.

Ook deze reviewsstudie: 68Ga-DOTATOC Imaging of Neuroendocrine Tumors: A Systematic Review and Metaanalysis bevestigt de uitstekende resultaten van Docatoc.

Results: The initial search yielded 468 papers. After detailed evaluation, 17 papers were finally selected. Five types of studies emerged: workup of patients with symptoms and biomarker findings suggestive of NET, but with negative conventional imaging (3 papers, yield was only 13%); sensitivity (12 papers; sensitivity, 92%) and specificity (7 papers; specificity, 82%); identification of site of unknown primary in patients with metastatic NET (4 papers, yield was 44%); impact on subsequent NET patient management (4 papers, change in management in 51%); and comparison with 111In-octreotide (2 papers, sensitivity of DOTATOC on a per-lesion basis was 100%, for 111In-octreotide it was 78.2%; specificity was not available). Safety was not explicitly addressed in any study, but there were no reports of adverse events.

Conclusion:68Ga-DOTATOC is useful for evaluating the presence and extent in disease for staging and restaging and for assisting in treatment decision making for patients with NET. It is also effective in locating the site of an unknown primary in NET patients who present with metastatic NET, but no known primary tumor. It also appears to be more accurate than 111In-octreotide. Although 68Ga-DOTATOC would seem to be useful in evaluating patients with suggestive symptoms and biomarker findings, it does not perform well in this setting and has low yield. Overall, it appears to be an excellent imaging agent to assess patients with known NET and frequently leads to a change in management.

Hier een beeld van een Docatoc beeldvorming bij een patient met al in de lever uitgezaaide neuro endocriene tumoren.

Figure 2

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Object name is ajnmmi0007-0228-f2.jpg

111In-DTPA-Octreotide and 68Ga-DOTATOC scans of a 16-year old patient with small bowel NET. The preoperative 111In-DTPA-Octreotide whole body (left column) and SPECT/CT images (not shown) showed the primary small bowel NET in the mid abdomen (dashed black arrow) and no metastatic site. Patient had resection of the primary tumor and underwent a 68Ga-DOTATOC PET/CT scan 2 months after the 111In-DTPA-Octreotide scan. The 68Ga-DOTATOC PET/CT scan (whole body maximum intensity projection images in the center and fused PET/CT in the right column) demonstrates previously unknown metastases in the liver (solid black arrows) and at C7 vertebra (dashed red arrows). Subsequent MRI confirmed the lesions; low signal C7 lesion on T1 weighted MRI is shown (dashed red arrow).

14 juni 2011: bron: Medscape

Een nieuwe manier van inwendige bestraling  met een lage dosis radio activiteit(213Bi-DOTATOC) met Alpha emitters, toont een spectaculaire werkzaamheid in het opsporen en vernietigen van neuro-endocriene tumoren zonder ernstige bijwerkingen. Dit blijkt uit een presentatie van onderzoekers van de universiteit van Heidelberg, Duitsland, op het jaarlijkse internationale congres van de Society for Nuclear Medicine 2011 

DOTATOC, is een specifiek op de tumor gerichte "probe - laser" gelabeld met verschillende "radionucliden", die pas bij het bereiken van de tumorcellen hun lading in werking brengen. Meestal worden daarvoor zogeheten beta-emitters gebruikt, maar in dit experimentele onderzoek wordt daarvoor de alfa-emitter-213 bismuth gebruikt. (vraag me niet wat dit is en wat het verschil is want dat weet ik niet). Wat ook de onderzoekers verraste is het opmerkelijke positieve effect van deze aanpak. Aan de studie doen alleen patienten mee die binnen de reguliere aanpak uitbehandeld waren en allemaal niet meer te behandelen neuro endocriene tumoren in de lever hadden. 

De 213Bi-DOTATOC werd gegeven als de laatst mogelijke behandelingsoptie omdat de patiënten niet meer reageerden op andere behandelingen, met inbegrip van Yttrium-90  en 177Lu-DOTATOC, aldus onderzoeksleider dr. Clemens Kratochwil van de universiteit van Heidelberg. Tijdens een tussenevaluatie na een half jaar bleken nog 9 van de 10 evalueerbare patienten in leven, waarbij bij 7 van de 9 patienten de tumoren minimaal 30% in volume waren afgenomen en heel belangrijk zonder noemenswaardige bijwerkingen, (slechts bijwerkingen met graad 0 -1 traden op). Normaal gesproken als patienten een inwendige bestraling krijgen zijn de bijwerkingen vaak hoog door vooral de bestraling van omliggend gezond weefsel. Volgens dr. Kratochwil zijn Alpha-emitters bijzonder aantrekkelijk voor een aanpak met inwendige radiotherapie vanwege hun zeer krachtige maar korte bereik straling,  "De deeltjes zijn zo krachtig dat slechts een enkel alfa-deeltje al een kankercel kan doden als het deze bereikt", zegt hij. Wel waarschuwt dr. Kratochwil dat zij nog niets weten over de effecten op langere termijn van deze manier van inwendige bestraling. "We waren verrast door zowel de lage acute toxiciteit en de relatief
goede respons. Echter, chronische (late) toxiciteit en, theoretisch, inductie van secundaire kanker kan een probleem zijn na blootstelling aan radioactiviteit." "Daarom kan deze behandeling nog niet worden gebruikt voor patiënten in een eerder stadium van de ziekte - in ieder geval niet totdat meer ervaring beschikbaar is," zei hij.
Daarvoor moet nog veel meer onderzoek worden gedaan.

Op dit moment worden 14 patienten behandeld met deze nieuwe experimentele manier en alle patiënten zijn nog in leven na een half jaar. Al deze patienten hebben neuro endocriene uitzaaiingen in de lever. Mocht deze aanpak tot blijvend succes leiden dan kunnen andere vormen van kanker ook met deze aanpak worden behandeld. 

Hier een citaat uit een artikel dat Medscape maakte over deze bijzondere aanpak. Het volledige artikel kunt u lezen als u hier klikt.

A novel and highly potent radiopeptide called 213Bi-DOTATOC shows efficacy in targeting neuroendocrine tumors and inducing the remission of metastases without causing severe toxicity

Bron: Medscape

Radiotherapies for the treatment of neuroendocrine cancer commonly use beta-emitting particles; however, researchers have been investigating alpha therapy in hard-to-treat cases because of its near-range and high-energy effect when injected.

Because the therapy has exceptionally high cytotoxicity, however, a key focus of the current research is on appropriate dosing, the investigators explain.

To further investigate the alpha-particle emitter, the researchers in Germany administered the therapy to 10 patients with neuroendocrine liver metastases who were not responsive to previous treatment with beta-particle peptide therapy.

The results indicated that the minimal effective dose for inducing partial remission (>30% of the tumor diameter) was 1 GBq 213Bi-DOTATOC.

Importantly, no acute kidney, endocrine, or hematologic toxicity higher than grade 0/1 was observed in the first steps of dosing increases (≤2.5 GBq cumulative activity; ≤1.5 GBq per cycle).

A short-term follow-up demonstrated reduced tumor perfusion (increase in time to peak intensity >25%) in 7 of 9 patients; the morphologic long-term response is pending.

Lead investigator Clemens Kratochwil, MD, said that as the study continues, the number of subjects enrolled in the study who have tolerated the therapy has increased.

"The 213Bi-DOTATOC was given as the last possible treatment option when the patients did not respond to standard therapies, including 90Y- and 177Lu-DOTATOC (beta-particle emitters)," said Dr. Kratochwil, who is from the University of Heidelberg and the Institute for Transuranium Elements, European Commission, Joint Research Centre, in Karlsruhe, Germany.

"Since it was well tolerated by the first patients and showed promising antitumor efficacy, we continued this alpha therapy. The study now includes 14 patients," he said.

"When writing the abstract, the mid-term follow-up (of about 6 months) was only done for the first 9 of 10 patients. Currently, none of the 14 patients who started the new treatment have dropped out or died." >>>>>read more

68Ga-DOTATOC PET/CT is safe in children and young adults with high accuracy for detection of somatostatin receptor type 2 positive tumors.

Am J Nucl Med Mol Imaging. 2017; 7(5): 228–235.
Published online 2017 Nov 1.
PMCID: PMC5698616

Safety and accuracy of 68Ga-DOTATOC PET/CT in children and young adults with solid tumors

Abstract

68Ga-DOTA-tyr3-Octreotide (68Ga-DOTATOC) PET/CT has been shown to have high accuracy in adults with neuroendocrine tumors, however has not been studied in pediatric patients. This study evaluated the safety and accuracy of 68Ga-DOTATOC PET/CT in children and young adults with solid tumors that express somatostatin receptor type 2. A series of three prospective, IRB approved, clinical trials evaluating safety and efficacy of 68Ga-DOTATOC PET/CT were conducted for subjects aged 6 months to 90 years. This study reports the results for the 26 children and young adults, aged 16 months to 29 years who participated in these trials. The administered activity of 68Ga-DOTATOC was 1.59 MBq/kg with an upper limit of 111 MBq for subjects < 18 years and 148 MBq for young adults. Safety was assessed with laboratory studies and patient/parent report of symptoms before and after the scan. Scans were interpreted in consensus by two board-certified nuclear medicine physicians. Each scan was categorized on a patient basis as true positive, true negative, false negative or false positive against a reference standard that included a combination of histopathology, other imaging modalities and clinical follow-up. Nine Grade I adverse events (AEs) occurred among 26 subjects, none of which were attributable to 68Ga-DOTATOC. Sensitivity of 68Ga-DOTATOC PET/CT was 88% (14 true positive, 2 false negative) and specificity was 100% (10 true negative, 0 false positive). 68Ga-DOTATOC PET/CT is safe and accurate in children and young adults with solid tumors expressing somatostatin receptor type 2.

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Articles from American Journal of Nuclear Medicine and Molecular Imaging are provided here courtesy of e-Century Publishing Corporation

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