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Systemic Radionuclide Therapy Using Indium-111-DTPA-D-Phe¹-Octreotide in Midgut Carcinoid Syndrome

Departments of Nuclear Medicine, Radiation Physics, Surgery, Pathology, Oncology and Clinical Chemistry, Sahlgrenska University Hospital, Göteborg, Sweden

Correspondence: For correspondence or reprints contact: M. Fjälling, MD, Department of Nuclear Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

ABSTRACT

A 55-yr-old woman with a midgut carcinoid syndrome due to metastatic spread of an ileal tumor to the liver, paraortic and mediastinal lymph nodes and to the skeleton was given systemic radionuclide therapy with ¹¹¹In-DTPA-D-Phe¹-octreotide. Before therapy, dosimetric calculations were performed on Whole-body scintigraphs and ¹¹¹In retention was shown to be long-lasting. Excretion was mainly seen during the first 24 hr after injection; thereafter whole-body retention remained stationary at 30%. Indium-111 activity in tumor biopsies and blood was measured using a gamma counter. Very high tumor-to-blood ratios were obtained: 150 for the primary tumor and 400–650 for liver metastases, which further justified radiation therapy. Indium-111-DTPA-D-Phe¹-octreotide treatment was given on three separate occasions (3.O, 3.5 and 3.1 GBq) 8 and 4 wk apart. After each therapy, the patient experienced facial flush and pan over the Skeletal lesions followed by symptomatic relief, even though no objective tumor regression was found radiologically after 5 mo. After initiation of octreotide treatment, there was a 14% reduction of the main tumor marker, urinary 5-HIAA. After three subsequent radionuclide therapies, there was a further 31% reduction of 5-HIAA levels. No adverse reactions, other than a slight decrease in leukocyte counts, were seen. The mean absorbed radiation dose after the three treatments was estimated to be about 10–12 Gy in liver metastases and 3–6 Gy in other tumors, depending on the size and location of the metastases. Assuming internalization of ¹¹¹In into tumor cells and a radiobiological effect from short range Auger and conversion electrons, there might be a therapeutic effect on the tumor.

Key Words: Indium-111-DTPA-D-Phe¹-octreotide • systemic radionuclide therapy • midgut carcinoid

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