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Nuklearmedizin 2008; 47(03): 127-131
DOI: 10.3413/nukmed-0119
Originalarbeiten - Original Articles
Schattauer GmbH

Somatostatin receptor scintigraphy in advanced renal cell carcinoma

Results of a phase II-trial of somatostatine analogue therapy in patients with advanced RCCSomatostatinrezeptor-Szintigraphie bei fortgeschrittenem NierenzellkarzinomErgebnisse der Phase-IISomatostatinanalogtherapie bei Patienten mit fortgeschrittenem Nierenzellkarzinom
L. S. Freudenberg
1   Department of Nuclear Medicine (Director: Prof. Dr. med. Dr. rer. nat. A. Bockisch)
,
T. Gauler
2   Department of Internal Medicine (Cancer Research) (Director: Prof. Dr. med. Seeber)
,
R. Görges
1   Department of Nuclear Medicine (Director: Prof. Dr. med. Dr. rer. nat. A. Bockisch)
,
S. Bauer
2   Department of Internal Medicine (Cancer Research) (Director: Prof. Dr. med. Seeber)
,
H. Stergar
1   Department of Nuclear Medicine (Director: Prof. Dr. med. Dr. rer. nat. A. Bockisch)
,
G. Antoch
3   Department of Diagnostic and Interventional Radiology and Neuroradiology (Director: Prof. Dr. med. M. Forsting), University of Duisburg-Essen
,
A. Bockisch
1   Department of Nuclear Medicine (Director: Prof. Dr. med. Dr. rer. nat. A. Bockisch)
,
J. Schütte
4   Department of Medical Oncology/Hematology (Director: Prof. Dr. med. J. Schütte), Marien-Hospital Düsseldorf, Germany
› Institutsangaben
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Publikationsverlauf

Received: 11. Mai 2007

accepted in revised form: 17. September 2007

Publikationsdatum:
04. Januar 2018 (online)

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Summary

Aims: Objective of this prospective study was to evaluate the role of somatostatin receptor scintigraphy (SRS) in advanced renal cell carcinoma (RCC) with respect to potential therapy with somatostatin analogue (SST-A) and to assess the response rate under therapy with SST-A. Patients, methods: 16 patients with documented progression of histologically confirmed advanced RCC were included. Planar whole-body SRS was performed 4, 24 and 48h post i.v. injection of 175–200 MBq 111In-pentetreoide. 5 and 25 h p.i. SPECT of thorax and abdomen were performed. Documentation of somatostatin receptor expression via SRS in >50% of known tumour lesions was the criteria for treatment start with SST-A (Sandostatin LAR®-Depot 30mg i.m. every four weeks). Results: In 9/16 of the patients SRS showed at least one metastasis with moderate (n = 5) or intense (n = 4) tracer uptake. Lesion-based SRS evaluation showed only 12.1% (20/165) of all metastases. Most false-negative lesions were located in the lungs. In two patients, the majority of the known metastases was SRS positive and these patients received SST-A therapy. The first radiographic evaluation after a twomonth interval showed progressive disease in both patients. Conclusions: We conclude that SRS is of limited value in staging of advanced RCC. In our patients SST-A did not result in a growth control of RCC. Consequently, the use of SST-A in advanced RCC seems to be no relevant therapeutic option.

Zusammenfassung

Ziel: Diese prospektive Studie untersucht die Rolle der Somatostatinrezeptor- Szintigraphie (SRS) bei Patienten mit fortgeschrittenen Nierenzellkarzinomen (RCC) im Hinblick auf eine mögliche Therapie mit Somatostatinanaloga (SST-A) und deren Response-Rate. Patienten, Methoden: 16 Patienten mit dokumentiertem Progress eines histologisch gesicherten RCC wurden eingeschlossen. Die planare Ganzkörper-SRS erfolgte 4, 24 und 48 h nach i.v.-Injektion von 175–200 MBq 111In-Pentetreoid. Fünf und 25 h p.i. wurde je eine SPECT von Thorax und Abdomen akquiriert. Bei einer Somatostatinrezeptor-Expression via SRS in >50% der bekannten Tumorläsionen wurde eine Therapie mit SST-A (Sandostatin LAR®-Depot 30mg i.m. alle vier Wochen) begonnen. Ergebnisse: In 9/16 der Patienten zeigte die SRS mindestens eine Metastase mit moderater (n = 5) oder intensiver (n = 4) Traceranreicherung. In der läsionsbasierten Auswertung zeigten sich jedoch nur 12,1% (20/165) der Metastasen. Die meisten falsch-negativen Läsionen fanden sich in der Lunge. Zwei Patienten, bei denen die Mehrzahl der Metastasen SRS-positiv waren, erhielten eine Therapie mit SST-A. Die erste radiologische Kontrolle nach zwei Monaten zeigte einen Progress der Erkrankung in beiden Patienten. Schlussfolgerung: Die SRS ist im Restaging von Patienten mit fortgeschrittenem RCC nur von begrenztem Wert. In unseren Patienten konnte mit SST-A kein Effekt auf das Größenwachstum der RCC erreicht werden. Dementsprechend scheint SST-A bei fortgeschrittenem RCC keine relevante therapeutische Option zu sein.

Keywords

Somatostatin receptor scintigraphy - renal cell carcinoma - somatostatin analogue - phase-II-trial

Schlüsselwörter

Somatostatinrezeptor-Szintigraphie - Nierenzellkarzinom - Somatostatin-Analoga - Phase-II-Trial
 

  • References

  • 1 Arnold R, Trautmann ME, Creutzfeldt W. et al. Somatostatin analogue octreotide and inhibition of tumour growth in metastatic endocrine gastroen- teropancreatic tumours. Gut 1996; 38: 430-438.
    CrossrefPubMedSuche in Google Scholar
  • 2 Bajetta E, Carnaghi C, Ferrari L. et al. The role of somatostatin analogues in the treatment of gastro- enteropancreatic endocrine tumours. Digestion 1996; 57 (suppl) 72-76.
    CrossrefPubMedSuche in Google Scholar
  • 3 Cohen H T, McGovern F J. Medical Progress: Renal-Cell Carcinoma. N Engl J Med 2005; 353: 2477-2490.
    CrossrefPubMedSuche in Google Scholar
  • 4 Denzler B, Reubi JC. Expression of somatostatin receptors in peritumoral veins of human tumors. Cancer 1999; 85: 188-198.
    CrossrefPubMedSuche in Google Scholar
  • 5 Edgren M, Westlin JE, Kalkner KM. et al. (111In- DPTA-D-Phe1)-octreotide scintigraphy in the management of patients with advanced renal cell carcinoma. Cancer Biother Radiopharm 1999; 14: 59-64.
    CrossrefPubMedSuche in Google Scholar
  • 6 Escudier B, Szczylik C, Eisen T. et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 2007; 356: 125-134.
    CrossrefPubMedSuche in Google Scholar
  • 7 Flamen P, Bossuyt A, De Greve J. et al. Imaging of renal cell cancer with radiolabelled octreotide. Nucl Med Commun 1993; 14: 873-877.
    CrossrefPubMedSuche in Google Scholar
  • 8 Görges R, Mann K, Frilling A. et al. Mimikri einer multiplen endokrinen Neoplasie mit Schilddrüsenbeteiligung durch das Spätrezidiv eines Nier- enzellkarzinoms. Nuklearmedizin 2002; 41: N24-N26.
    PubMedSuche in Google Scholar
  • 9 Hudes G, Carducci M, Tomczak P. et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007; 356: 2271-2281.
    CrossrefPubMedSuche in Google Scholar
  • 10 Linehan WM, Shipley WU, Parkinson DR. Cancer ofthe kidney and ureter. In: De Vita VT. et al. (eds) Cancer-Principles and Practise of Oncology. JB Lippincott Co.; 1993: 1023-1051.
    Suche in Google Scholar
  • 11 Medical Research Council Renal Cancer Collaborators. Interferon-alpha and survival in meta-static renal carcinoma: early results of a randomised controlled trial. Lancet 1999; 353: 14-17.
    CrossrefPubMedSuche in Google Scholar
  • 12 Montravers F, Rousseau C, Doublet JD. et al. In vivo inaccessibility of somatostatin receptors to 111In-pentreotide in primary renal cell carcinoma. Nucl Med Commun 1998; 19: 953-961.
    CrossrefPubMedSuche in Google Scholar
  • 13 Motzer RJ, Bacik J, Schwartz LH. et al. Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol 2004; 22: 454-463.
    CrossrefPubMedSuche in Google Scholar
  • 14 Motzer RJ, Hutson TE, Tomczak P. et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356: 115-124.
    CrossrefPubMedSuche in Google Scholar
  • 15 Motzer RJ, Mazumdar M, Bacik J. et al. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999; 17: 2530-2540.
    CrossrefPubMedSuche in Google Scholar
  • 16 Motzer RJ, Mazumdar M, Bacik J. et al. Effect of cytokine therapy on survival for patients with advanced renal cell carcinoma. J Clin Oncol 2000; 18: 1928-1935.
    CrossrefPubMedSuche in Google Scholar
  • 17 Motzer RJ, Michaelson MD, Redman BG. et al. Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 2006; 24: 16-24.
    CrossrefPubMedSuche in Google Scholar
  • 18 Negrier S, Escudier B, Gomez F. et al. Prognostic factors of survival and rapid progression in 782 patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Français d'Immunothérapie. Ann Oncol 2002; 13: 1460-1468.
    CrossrefPubMedSuche in Google Scholar
  • 19 Negrier S, Escudier B, Lasset C. et al. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. N Engl J Med 1998; 338: 1272-1278.
    CrossrefPubMedSuche in Google Scholar
  • 20 Ratain MJ, Eisen T, Stadler MW. et al. Phase II Placebo-Controlled Randomized Discontinuation Trial of Sorafenib in Patients With Metastatic Renal Cell Carcinoma. J Clin Oncol 2006; 24: 2505-2512.
    CrossrefPubMedSuche in Google Scholar
  • 21 Reubi JC, Kvols L. Somatostatin receptors in human renal cell carcinomas. Cancer Res 1992; 52: 6074-6078.
    PubMedSuche in Google Scholar
  • 22 Saltz L, Trochanowski B, Buckley M. et al. Octreo- tide as an antineoplastic agent in the treatment of functional and nonfunctional neuroendocrine tumors. Cancer 1993; 72: 244-248.
    CrossrefPubMedSuche in Google Scholar
  • 23 Schillaci O, Massa R, Scopinaro F. 111In-pentet- reotide scintigraphy in the detection of insulinomas: importance of SPECT imaging. J Nucl Med 2000; 41: 459-462.
    PubMedSuche in Google Scholar
  • 24 Vikic-Topic S, Raisch KP, Kvols LK. et al. Expression of somatostatin receptor subtypes in breast carcinoma, carcinoid tumor, and renal cell carcinoma. J Clin Endocrinol Metab 1995; 80: 2974-2979.
    PubMedSuche in Google Scholar
  • 25 Yang JC, Sherry RM, Steinberg SM. et al. Randomized Study of High-Dose and Low-Dose In- terleukin-2 in Patients With Metastatic Renal Cancer. J Clin Oncol 2003; 21: 3127-3132.
    CrossrefPubMedSuche in Google Scholar