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Radiation Pneumonitis Imaged with Indium-111-Pentetreotide

Departments of Nuclear Medicine, Chest Oncology, Radiotherapy and Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

Correspondence: For correspondence or reprints contact: R.A. Valdés Olmos, MD, PhD, Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.

ABSTRACT

Early recognition of radiation pneumonitis enables adequate treatment with a reasonable chance to prevent late sequelae. The feasibility of ¹¹¹In-pentetreotide in detecting this condition was explored in this study. Methods: The degree of lung uptake of ¹¹¹In-pentetreotide, evaluated both visually and quantitatively by irradiated-to-nonirradiated area ratios (INIA ratio) from planar images after 24 hr, was analyzed in relation to the radiation field and compared with ventilation/perfusion (V/Q) images and chest radiographs or CT in 11 patients who had received radiotherapy to the mediastinum or to the internal mammary nodes, 10 of whom were suspected of having clinical radiation pneumonitis. Additional SPECT studies were used to map lung uptake distribution. Results: Indium-111-pentetreotide scans were positive in nine symptomatic patients examined 2–5 mo after radiotherapy; strongly or moderately positive in eight patients, one of whom was receiving steroid therapy without clinical response; and weakly positive in one patient with good steroid response. Indium-111-pentetreotide studies were negative in one asymptomatic patient examined 1 mo after radiotherapy and in one symptomatic patient, with subsequent diagnosis of aspecific viral pneumonitis, examined 4 mo after irradiation. Positive ¹¹¹In-pentetreotide scans delineated areas of radiation pneumonitis that adequately correlated with areas of decreased ventilation/perfusion and x-ray abnormalities. INIA ratios varied from 1.01 to 2.16 and, in irradiated areas with visible uptake, the lowest value was 1.29. SPECT showed lung uptake in both superficial and deep lying areas in patients with mantle irradiation fields, whereas distribution was limited to anterior areas in internal mammary lymph node chain irradiation. Conclusion: Indium-111-pentetreotide can detect radiation pneumonitis and may have a role in both the differential diagnosis of patients who have complaints after radiotherapy, and when supported by quantification in the monitoring of response to steroid therapy.

Key Words: radiation pneumonitis • indium-111-pentetreotide • lung uptake assessment

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