Prognostic value of metabolic parameters on baseline 18F-FDG PET/CT in small cell lung cancer.

BACKGROUND: Maximum standardized uptake value (SUVmax) is the primary quantitave parameter given in 18F-FDG PET/CT reports. Calculations derived from three dimensional metabolic volumetric images have been proposed to be more successful than SUVmax alone in prognostification with a lower interobserver variability in many cancers. We aimed to determine the prognostic value of metabolic parameters derived from 18F-FDG PET/CT studies in small cell lung cancer (SCLC) patient population with a long follow-up time. METHODS: In this study, 38 consecutive SCLC patients (34M, 4F, age:65.76 ±8.18 years) who were referred to 18F-FDG PET/CT for staging between October 2006-January 2011 were included. SUVmax, SUVmean, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Overall survival (OS) was calculated from the date of the initial PET/CT to death from any cause. Survival tables were obtained and Kaplan Meier curves were reconstructed. Mantel-Cox regression analysis was performed in order to investigate if any of these parameters have an effect on survival along with other clinical risk factors. RESULTS: Median SUVmax, SUVmean, SUVpeak, MTV, TLG and LDH values were calculated as 13.9 g/dL, 6.4 g/dL,10.69 g/dL, 147 cm3, 1898.52 and 375U/L respectively. Median follow-up was 761.23±873.21 days (25.37 months, range:110-3338 days). Since basal 18F-FDG PET/CT scans, all patients were lost in the follow-up except for two patients. MTV was a significant prognostic factor in SCLC patients. Estimated mean survival times were 261.0±45.6 (95% CI: 171.6-350.3) days in patients with MTV value above the calculated median 147, and 577.0±124.0 (95% CI: 333.7-820.2) days in patients with MTV<147. The difference was statistically significant with a P=0.037. CONCLUSIONS: Baseline whole body MTV reflecting total tumor load is a prognostic index in SCLC. SUV is insufficient to predict prognosis.

The efficacy of fluorine-18-choline PET/CT in comparison with 99mTc-MIBI SPECT/CT in the localization of a hyperfunctioning parathyroid gland in primary hyperparathyroidism.

AIM: The aim of this study was to determine the role of fluorine-18-choline (F-FCH) PET/CT in comparison with technetium-99m-methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) in primary hyperparathyroidism and to investigate whether maximum standardized uptake value (SUVmax) may be indicative of disease severity. PATIENTS AND METHODS: Thirty-five primary hyperparathyroidism patients (24 females, 11 males, mean age: 55.31±12.27, range: 25-72 years) who underwent Tc-MIBI SPECT/CT and F-FCH PET/CT and had inconclusive neck ultrasonography (USG) were studied. The diagnostic power of both modalities and the relationship between SUVmax and biochemical [serum parathormone (PTH), calcium, phosphorus, vitamin D3 levels, urinary calcium excretion/24 h] and clinical (bone mineral densitometry and urinary USG results) parameters were analyzed. RESULTS: In 29 of 35 patients, Tc-MIBI SPECT/CT and F-FCH were concordant (κ=0.64, P=0.001). In five of 35 patients with a negative SPECT/CT, F-FCH PET/CT accurately localized parathyroid adenomas. In one patient, F-FCH was false negative and Tc-MIBI SPECT/CT showed the lesion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tc-MIBI SPECT/CT and F-FCH PET/CT were calculated to be 78, 100, 100, 70, 86%, and 96, 100, 100, 93, and 97%, respectively. SUVmax was correlated with lumbal T scores (P=0.026). The mean serum PTH levels were significantly higher (P=0.026) and lumbal and femur T scores were significantly lower (P=0.04 and 0.008) in patients with SUVmax greater than 4.4 (i.e. the mean SUVmax calculated in positive cases). CONCLUSION: F-FCH PET/CT has a high diagnostic power in primary hyperparathyroidism and can be used for further evaluation of patients with inconclusive neck USG and Tc-MIBI SPECT/CT. SUVmax of the hyperfunctioning parathyroid gland seems to be predictive of disease severity in terms of serum PTH and bone mineral densitometry results. Studies with larger patient groups are needed to support these data.

Comparison of survival, safety, and efficacy after transarterial chemoembolization and radioembolization of Barcelona Clinic Liver Cancer stage B-C hepatocellular cancer patients.

AIM: This study aimed to compare the overall survival (OS) times, long-term complications, and recurrence rates of chemoembolization and radioembolization for Barcelona Clinic Liver Cancer (BCLC) stage B-C hepatocellular cancer patients. MATERIALS AND METHODS: This retrospective study included 80 BCLC stage B-C hepatocellular cancer patients who received chemoembolization (group 1) or radioembolization (group 2). The OS times, long-term complications, and disease recurrence rates of the two groups were compared. The prognostic role of sex, age, presence of underlying chronic liver disease, BCLC stage, dimension and number of liver lesions, tumor load, and presence of extrahepatic disease were also analyzed for each group. RESULTS: Each group included 40 (67 men, 13 women, mean age: 41.9±21.9 years) patients. During the follow-up period, 22 patients died in group 2 and 30 patients died in group 1. The overall mean survival of the entire patient group was calculated to be 37.31±3.94 months [95% confidence interval (CI), 30.46-44.1 months], with 30.63±3.68 months (95% CI, 23.42-37.84 months) for group 1 and 39.24±4.62 months (95% CI, 30.18-48.29 months) for group 2 (P=0.014). The 1- and 2-year survival rates were 72 versus 74% and 47 versus 59% for groups 2 and 1, respectively. There was no significant difference between the chronic complication (P=0.32) and disease recurrence (P=0.65) rates of the groups. Whereas the dimension of the largest lesion was the most significant predictor (P=0.01) in group 2, female sex (P=0.008), dimension of the largest lesion (P=0.03), and BCLC stage (P=0.01) were significant in group 1. CONCLUSION: Although chemoembolization and radioembolization for BCLC Stage B-C patients have similar levels of safety and efficacy, they differ in OS. In this retrospective study, patients undergoing radioembolization had a longer survival rate.

The role of 18F-NaF PET/CT in metastatic bone disease.

AIM: To investigate the role of 18F-NaF PET/CT and compare it with 99m Tc-MDP whole body bone scintigraphy and 18F-FDG PET/CT in detecting the extent of metastatic bone disease and to present our first experience with 18F-NaF PET/CT in our country. MATERIALS AND METHODS: A total of 37 histopathologically proven cancer patients (22 male, 15 female) with bone metastasis detected on Tc-99m MDP whole body bone scan were prospectively enrolled Cebeci, following ethics committee approval. 18F-NaF PET/CT was performed to the participants in Ankara University Medical Faculty Nuclear Medicine Department for evaluation of symptomatic skeletal sites which were negative on Tc-99m MDP whole body bone scan. A lesion based comparison was made between 18F-NaF PET/CT and Tc-99m MDP whole body bone scan for each patient and between 18F-NaF PET/CT and 18F-FDG PET/CT in 12/37 patients. RESULTS: The number of lesions demonstrated by 99m Tc-MDP bone scan and 18F-NaF PET/CT was equal in 4/37 (%11) of the cases. 18F-NaF PET/CT showed a greater number of pathological foci in 89% of participants. 18F-NaF PET/CT was able to show both lytic and blastic lesions and small lesions were better visualized due to the advantage of sectional imaging with much better resolution and higher target/background ratio. 18F-NaF PET/CT demonstrated a greater number of metastases in 10/12 (83%) of the patients when compared to 18F-FDG PET/CT. In the other two patients, bone metastasis could be demonstrated only by 18F-NaF PET/CT. The uptake of 18F-FDG was variable in blastic lesions and cranial bone involvement was missed by 18F-FDG PET/CT in some cases due to physiological brain metabolism. CONCLUSION: Although further prospective clinical studies in specific cancer populations are indicated to set the place of 18F-NaF PET/CT in diagnostic scheme, the results of this pilot study from our country support the superiority of 18F-NaF PET/CT in investigation of bone metastasis over 99mTc-MDP bone scan and 18F-FDG PET/CT in various malignancies. 18F-NaF PET/CT is coming forward as a single step bone seeking study, considering all the advantages, but especially potential of detecting occult metastases and reliably directing patient management.

Prognostic factors for prediction of survival of hepatocellular cancer patients after selective internal radiation therapy.

AIM: In this study, it was aimed to explore the prognostic factors in patients who received selective internal radiation therapy for hepatocellular cancer. MATERIALS AND METHODS: A retrospective evaluation was made of 28 (24 male, 4 female, mean age 65.4 ± 6.8 years) hepatocellular cancer patients who received selective internal radiation therapy with Y-90 resin microspheres. Using Cox proportional hazards regression analysis, the relationship between age, gender, MELD score, serum albumin and AFP levels, number of liver lesions, size of the largest lesion, absence of (18)F-FDG uptake, maximum standardized uptake value and overall survival times was analyzed. RESULTS: Treatment was applied to the right lobe in 22 and both in 6 patients. Mean treatment dose was 1.5 ± 0.2 GBq. Number of liver lesions were 1, <5 and multiple in 16, 5 and 7 patients, respectively, and the mean size of the largest lesion was 41.5 mm (min-max 15-160 mm). While (18)F-FDG uptake was seen in 24 patients, liver lesions were hypometabolic in 4 patients. Mean SUVmax of liver lesions was calculated as 5.3 ± 0.3. During the mean 17.8 (min-max 2-39) months follow-up period, 19 patients died. Median survival time was computed as 18 ± 5 months (95% CI 8.1-27.8). Age (p = 0.04), serum AFP level (p = 0.03) and size of the largest lesion (p = 0.02) had a significant negative effect on survival according to the Cox proportional hazards regression analysis. CONCLUSION: Age, serum AFP level and the size of the largest liver lesion have a negative significant effect on survival of hepatocellular cancer patients who received selective internal radiation therapy.

Assessment of recurrence rates in papillary thyroid microcarcinoma patients with and without histopathological risk factors after radioiodine ablation treatment.

AIM: We aimed to assess the recurrence rates of papillary thyroid microcarcinoma in patients with and without histopathological risk factors after radioiodine (RAI) ablation treatment. MATERIALS AND METHODS: A total of 357 papillary thyroid microcarcinoma patients who were referred to Ankara University Medical School, Department of Nuclear Medicine for RAI ablation treatment after total or near-total thyroidectomy were included in the study. All patients received RAI ablation treatment 4-6 weeks after surgery. After RAI ablation, patients were monitored every 3 months within the first 6 months and then every year. RESULTS: During follow-up, sixth-month iodine-131 (I-131) whole-body scans showed successful ablation in 333 (93.3%) patients. However, one (0.2%) patient had a focal lung uptake on the sixth-month I-131 whole-body scan, although the postablative scan gave no evidence of lung metastasis. Lung metastasis of this patient was treated with a second dose of RAI. The mean follow-up period was 124 (min-max: 6-216) months. No recurrence was detected in 344 (96.3%) patients during the follow-up period. However, in 13 (3.6%) patients, new recurrence or metastasis had developed. Lymph node metastasis was detected using fluorine-18 flourodeoxyglucose PET/computed tomography in four and using neck ultrasound in eight of them. The metastasis rates of patients with papillary microcarcinoma at a single focus with no thyroid capsule or lymphovascular invasion (n=268) and those of patients with thyroid capsule and/or lymphovascular invasion (n=89) were compared. Metastasis was seen in six and seven patients in those groups, respectively. The difference in metastasis rate between the two groups was statistically significant (2.2 vs. 9.2%, P=0.008). CONCLUSION: RAI ablation is beneficial in the management of papillary thyroid microcarcinoma patients with histopathological risk factors. It also improves the sensitivity of thyroglobulin and antithyroglobulin, facilitating easier and safer follow-up.

The prognostic value of quantitative parameters of 18F-FDG PET/CT in the evaluation of response to internal radiation therapy with yttrium-90 in patients with liver metastases of colorectal cancer.

INTRODUCTION: The aim of this study was to evaluate tumor response using fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients who received yttrium-90 selective internal radiation therapy (SIRT) for colorectal liver metastases. The initial and sixth-week tumor lesion glycolysis values were calculated to evaluate the success of the treatment and compare it with patient survival. MATERIALS AND METHODS: Thirty-five patients (15 female, 20 male, mean age: 61.9 ± 9.0 years, range: 33-76 years) who received SIRT treatment for unresectable colorectal cancer liver metastases in our hospital between June 2008 and May 2011 were included in the study. All patients included in the study had liver-only or liver-dominant disease. The treatment response was evaluated by 18F-FDG PET/CT in the sixth week after treatment. Response was evaluated according to the change in total lesion glycolysis (ΔTLG). The ΔTLG was calculated using the following formula: ΔTLG=100 ×[standardized uptake value (SUV) mean1 × total functional tumor volumes (FTVs)1-SUV mean2 × FTV2]/SUV mean1 × FTV1. RESULTS: Mean FTV1 and FTV2 values were calculated to be 235.7 ± 203 and 107.3 ± 67 mm3, respectively (P=0.04). The mean ΔTLG was 43 ± 35 (range: 0-100). Mean overall survival time was 12.7 ± 8.0 months (range: 3-31 months). The cutoff value of ΔTLG was calculated to be 26.5 using receiver operating characteristic analysis (sensitivity 64%; specificity 85%; AUC=0.717 ± 0.087, P=0.034). Patients were allocated into those having values greater than the cutoff value (group 1) and those having values lower than the cutoff value (group 2) in order to calculate the effect of ΔTLG on survival. Survival was 11.32 ± 1.18 (95% CI 9.02-13.62) months in group 2 and 20.76 ± 2.71 (95% CI 15.46-26.06) months in group 1 (P=0.016). ΔTLG was found to be a significant factor in univariate analysis (P=0.01). CONCLUSION: An 18F-FDG PET/CT scan with calculation of ΔSUVmax3, ΔFTV, and ΔTLG before and at the sixth week after SIRT may play an important role in evaluating early tumor response and survival expectancy in these patients and help decide whether these patients should be referred to other treatment modalities or to follow-up.

Prognostic importance of 18F-FDG uptake pattern of hepatocellular cancer patients who received SIRT.

PURPOSE: The aim of the study was to evaluate the effect of 18F-FDG uptake pattern of liver lesions to treatment response of patients who received yttrium-90 (Y-90) selective internal radiation therapy (SIRT) for hepatocellular cancer (HCC). PATIENTS AND METHODS: Nineteen patients (5F, 14M, mean age: 64.5 ± 14.7 years old, range: 57-73 years) who received SIRT treatment in our department for HCC between June 2008 and May 2011 were included in the study. All patients underwent 18F-FDG PET/CT before SIRT for evaluation of disease stage and metabolic activity of liver lesions. Patients were divided into 3 groups according to FDG uptake patterns of primary liver lesions (hypoactive, nonhomogenous, and focal intense). Progression-free survival (PFS) times of each group and patients with hepatic only and hepatic with extrahepatic disease were analyzed. Disease progression criteria were increase in tumor volume, progressive elevation of serum alpha-fetoprotein levels, and detection of extrahepatic metastases. Kaplan-Meier analysis was used for comparison of PFS times. RESULTS: The mean treatment dose was calculated as 1.4 ± 1.0 GBq. While liver lesions of 4 patients were hypoactive in pretreatment 18F-FDG PET/CT, liver lesions of 6 and 9 patients had nonhomogenous and intense FDG uptake, respectively. Mean PFS time of patients who had hypoactive liver lesions was 5.25 ± 1.52 months. In patients who had liver lesions with nonhomogenous uptake, mean PFS time was 12.3 ± 2.6 months. Lastly, in patients with intense uptake in liver lesions, PFS time was calculated as 19.8 ± 5.0 months. Difference between each group was statistically significant (P = 0.017). There was no significant difference in the PFS of the patients with limited hepatic disease and patients with extrahepatic involvement. CONCLUSION: In patients with unresectable HCC, higher SUVmax lesions unexpectedly had better PFS rates after SIRT, suggesting SIRT has a treatment advantage over other therapeutic options in these patients.

Evaluation of the response to selective internal radiation therapy in patients with hepatocellular cancer according to pretreatment (99m)Tc-MAA uptake.

AIM: The aim of the study was to evaluate if there is a prognostic importance of pretreatment Tc-MAA uptake of liver lesion of patients who received Y selective internal radiation therapy (SIRT) treatment for hepatocellular cancer (HCC) or not. METHODS: Nineteen patients (5 female and 14 male patients; mean age, 64.5 ± 14.7 years; range, 57-73 years) who received SIRT treatment in our department for HCC between June 2008 and May 2011 were included in the study. All the patients have undergone Tc-MAA scintigraphy within 2 weeks' period before treatment for evaluation of presence of extrahepatic uptake. Patients were evaluated according to their lesions' Tc-MAA uptake patterns. Response to the treatment, presence of progression after treatment, and progression-free survival of all the patients were calculated. RESULTS: Treatment has been administered on the right and left lobes of the liver in 18 and 1 patient, respectively. The mean treatment dose was estimated as 1.4 + 1.0 GBq. In the pretreatment Tc-MAA scintigraphy, liver lesions of 5 patients were hypoactive, and 14 patients were hyperactive. In the hypoactive group, whereas 2 patients (40%) were responders to treatment, 3 were nonresponders (60%). In the hyperactive group, 8 (58%) and 6 (42%) patients were responders and nonresponders, respectively (P = 0.51). Disease progression was seen in 4 (80%) and 8 patients (58%) in the hypoactive group and hyperactive groups, respectively (P = 0.36). Progression-free survival of the hypoactive group was calculated as 8 ± 4.3 months and of the hyperactive group 11 ± 4.7 months (P = 0.22). CONCLUSIONS: Despite the small number of patients, this study revealed that there is no significance between tumor response and progression rates of patients who received SIRT for HCC with or without pretreatment Tc-MAA uptake in liver lesions. Selective internal radiation therapy could be safely performed in patients who have hypoactive lesions in Tc-MAA scintigraphy.

Impact of ¹8F-FDG PET/CT for detecting recurrence of medullary thyroid carcinoma.

OBJECTIVE: The aim of this study was to evaluate the value of fluorine-18 (¹8F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of recurrent medullary thyroid carcinoma (MTC) in patients with elevated calcitonin levels. METHODS: Thirty-three patients (nine men, 24 women; mean age: 50.3 ± 12 years) who were referred to undergo ¹8F-FDG PET/CT for restaging of MTC in patients with high calcitonin levels were included in this study. Five patients also had suspected lymph nodes detected by neck ultrasonography. The results of ¹8F-FDG PET/CT and clinical follow-up data were reviewed retrospectively. Histological analysis has been accepted as the gold standard in the confirmation of ¹8F-FDG PET/CT results. Patients were followed up for 45.6 ± 4.2 months. RESULTS: There were 14 negative and 19 positive scans for possible recurrence of MTC. In the positive scans, the possible recurrence sites were neck lymph nodes, thyroid bed, mediastinal lymph nodes, and the lung in 14, two, two, and one patient, respectively. Disease recurrence in 13 patients was confirmed histologically by surgical excision or fine-needle aspiration biopsy. In the remaining six patients, recurrence was excluded as it was reactive as a result of pathological examination. However, one patient had a negative scan, underwent neck lymph node excision after ¹8F-FDG PET/CT examination, and lymph node recurrence was detected histologically. According to these results, the sensitivity and specificity of PET/CT were calculated as 93 and 68%, respectively. According to the recommended calcitonin level by the American Thyroid Association (calcitonin levels higher than 150 pg/ml), sensitivity was calculated as 90%. Although the mean maximum standardized uptake values of the true-positive and false-positive groups were calculated as 4.72 ± 2.17 and 4.22 ± 1.02, respectively, the difference between the two groups was not statistically significant (P>0.05). CONCLUSION: PET/CT is a sensitive imaging tool in the detection of MTC recurrence, especially in patients with high calcitonin levels, and it gives additional information in one third of all patients on an average by detecting an occult disease or confirming findings of other imaging tools.

Selective intraarterial radionuclide therapy with Yttrium-90 (Y-90) microspheres for unresectable primary and metastatic liver tumors.

BACKGROUND: The aim of this study was to evaluate the success of selective intraarterial radionuclide therapy (SIRT) with Yttrium-90 (Y-90) microspheres in liver metastases of different tumors. We also interpreted the contribution of SIRT to survival times according to responder- non responder and hepatic- extra hepatic disease. METHODS: The clinical and follow-up data of 124 patients who were referred to our department for SIRT between June 2008 [corrected] and October 2010 were evaluated retrospectively. SIRT has been applied to 78 patients who were suitable for treatment. All the patients had primary liver tumor or unresectable liver metastasis of different malignancies. The treatment was repeated at least one more time in 5 patients to the same or other lobes. Metabolic treatment response evaluated by fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) in the 6th week after treatment. F18-FDG PET/CT was repeated in per six weeks periods. The response criterion had been described as at least 20% decrease of SUV value. Also in patients with neuroendocrine tumor serial Gallium-68 (Ga-68) PET/CT was used for evaluation of response. Patients were divided into 2 groups according to their treatment response. RESULTS: 68 patients received treatment for the right lobe, seven patients received treatment for the left lobe and 3 patients for both lobes. The mean treatment dose was estimated at 1.62 GBq. In the evaluation of treatment response; 43(55%) patients were responder (R) and 35 (45%) patients were non-responder (NR) in the sixth week F18-FDG PET/CT. Mean pretreatment SUVmax value of R group was 11.6 and NR group was 10.7. While only 11 (31%) out of 35 NR patients had H disease, 30 (69%) out of 43 R patients had H disease (p < 0.05). The mean overall survival time of R group was calculated as 25.63 ± 1.52 months and NR group's 20.45 ± 2.11 (p = 0.04). The mean overall survival time of H group was computed as 25.66 ± 1.52 months and EH group's 20.76 ± 1.97 (p = 0.09). CONCLUSIONS: SIRT is a useful treatment method which can contribute to the lengthening of survival times in patients with primary or metastatic unresectable liver malignancies. Also F18-FDG PET/CT is seen to be a successful imaging method in evaluating treatment response for predicting survival times in this patient group.

The role of 18F-FDG-PET/CT in the preoperative staging and posttherapy follow up of gastric cancer: comparison with spiral CT.

BACKGROUND: The aim of this study was to investigate the role of F-18 fluoro-deoxy-glucose (FDG) positron emission tomography and computed tomography (PET/CT) in the preoperative and posttherapy restaging of gastric cancer and to compare with spiral computerized tomography (CT). METHOD: A total of 42 PET/CT scans of 36 gastric cancer patients (28M, 8F; mean age: 56.0±15) were included in the study. A retrospective analysis of the PET/CT results of the patients were compared with concurrent CT results. Confirmation was made by clinical course and serial imaging studies in the follow up. The compatibility ratios were calculated and the accuracy of the PET/CT was assessed. Agreement between PET/CT and concurrent CT was calculated using kappa statistics. RESULTS: Patients were separated into 3 groups: the patients who were referred to our clinic for preoperative staging (4 patients), for posttherapy evaluation (24 patients) and for the suspicion of local recurrence and/or metastasis exploration after a disease free period (8 patients). Groups 1 and 3 included a small number of patients so they were omitted from the statistical analysis. Focusing on Goup 2, the overall concordance rate was 50% (12 patients). Region based analysis showed the rates of concordance for local recurrence, local lymph node metastasis and distant metastasis were 91% (Kappa: 0.70), 95% (Kappa: 0.86) and 50% (Kappa: 0.26) respectively. Distant metastases were also investigated in detail and the two techniques showed a concordance of 91% (Kappa: 0.75) for liver, 79% (Kappa:0.31) for distant lymph node, 79% (0.42) for lung, 87% (Kappa:0.33) for bone and 95% for intestinal wall metastasis. CONCLUSION: PET/CT is a complementary imaging method which can be successfully used in both preoperative and posttherapy evaluation of gastric cancer.

Role of Radionuclide Therapy as Adjuvant to Palliative External Beam Radiotherapy for Painful Multiple Skeletal Metastasis.

BACKGROUND: The aim of this study was to evaluate the palliative efficacy of localized external radiotherapy (RT) combined with systemic radionuclide (RN) therapy in patients who had multiple painful osseous metastases of different primary origins. METHODS: Thirty-three patients initially local external radiotherapy was delivered to the most symptomatic region in all patients. Then they received either Re 186 HEDP or Sm 153 EDTMP. The performance status was assessed according to ECOG scale. Before treatment, at the end of the radiotherapy and after the four weeks of systemic radionuclide therapy, analgesic intake and pain status were recorded by the RTOG scoring system, and EORTC QLQ C30 (Version 3.0 Turkish) questionnaire was performed to evaluate the quality of life. RESULTS: Improved performances of 33.3% for post radiation therapy and 50% for post radionuclide therapy in the ECOG scale were observed. Statistically significant correlations were found between the primary origins and decreased pain and analgesic intake (p < 0.05), but no differences were observed on the self assessment quality of life questionnaire. CONCLUSIONS: Both Re 186 HEDP, Sm 153 EDTMP are effective and safe in bone pain palliation as an adjuvant to local field radiation therapy of breast and prostate cancer patients, who also continued to receive chemotherapy and/or hormontherapy.

Clinical importance of anti-thyroglobulin auto-antibodies in patients with differentiated thyroid carcinoma: comparison with 99mTc-MIBI scans.

AIMS: (1) To investigate whether elevated serum anti-thyroglobulin antibody (ATG) reflects the recurrence of cancer in patients with differentiated thyroid carcinoma (DTC) in whom thyroglobulin was undetectable after radioiodine ablation. (2) To assess the sensitivity of disease detection for (99m)Tc-MIBI whole-body scans (WBSs) in these patients and investigate the correlation between MIBI WBS results and high serum ATG levels. MATERIALS AND METHODS: In this retrospective study, we evaluated 14 patients (13 women and 1 man; mean age 44 +/- 19 years) with DTC who underwent total or near-total thyroidectomy followed by an ablative dose of I at various time intervals. According to histopathological findings, 10 patients (71.4%) who were diagnosed as having papillary carcinoma and four patients (28.6%) as having follicular cell carcinoma, had high serum ATG concentrations (> 40 IU x ml(-1); range, 62-2000 IU x ml(-1)), but low serum thyroglobulin concentrations (< 1.6 ng x ml). Post-therapeutic and diagnostic (131)I WBSs and (99m)Tc-MIBI WBSs were performed. Scans were visually evaluated for detecting recurrence. If necessary, bone scans, chest X-rays, computerized tomography, ultrasonography and histopathological evaluation were performed. RESULTS: Recurrent and/or persistent disease was found in 12 of the patients. This was confirmed pathologically in four patients and by using other imaging methods in eight (bone scans, computerized tomography, ultrasonography). The sensitivity and specificity of disease detection for MIBI WBSs was 66.7% and 100%, respectively. For (131)I WBSs, the sensitivity of disease detection was 55.6%. Among these 12 patients, 10 responded to treatment (three underwent surgery, seven received radioiodine therapy, and two had surgery + radioiodine therapy). ATG levels decreased in eight of the 10 patients, but remained persistently elevated in two despite treatment. CONCLUSIONS: (1) Persistently elevated ATG levels appear to serve as a useful marker for recurrent or persistent DTC in patients with undetectable serum tyroglobulin levels. Thus, the routine measurement of ATG antibody in such patients is of great value. (2) In these patients, (99m)Tc-MIBI has a relatively high sensitivity in the diagnosis of a recurrence of thyroid cancer or metastases. So, in patients with elevated ATG but undetectable serum thyroglobulin levels, (99m)Tc-MIBI can be used to determine whether there is a recurrence of DTC or metastases.

Radioiodine whole-body scans, thyroglobulin levels, 99mTc-MIBI scans and computed tomography: results in patients with lung metastases from differentiated thyroid cancer.

OBJECTIVES: The correlation between a 131I whole-body scan (WBS), a 99mTc sestamibi (99mTc-MIBI) WBS, a computed tomography (CT) scan and the value of routine follow-up for 131I WBS and thyroglobulin (Tg) levels in patients with lung metastases from differentiated thyroid cancer was assessed. METHOD: Pulmonary metastases were detected in 32 patients out of 583 with differentiated thyroid cancer (DTC) who were admitted to our clinic between 1985 and 2004 (age range, 22-79 years; mean, 58 +/- 19 years; 15 women and 17 men). Pulmonary metastases were diagnosed by considering the 131I WBS, increased Tg levels and/or other positive radiological findings. Papillary carcinoma was diagnosed in 15/32 patients and follicular carcinoma in 13/32. A mixed type found in 4/32 patients was classified histopathologically. A total of 3.7-53.65 GBq (100-1450 mCi) 131I was given to each patient. The duration of follow-up ranged from 36 to 240 months. A 131I WBS, the determination of Tg levels and/or a CT scan were carried out in the assessment of a diagnosis and follow-up of patients with lung metastases. A 99mTc-MIBI WBS was performed on 19 patients who were chosen at random from the 583. RESULTS: Nineteen of 32 patients had lung metastases before they received the first 131I treatment. Six of the 32 had distant-organ metastases other than in the lungs. Four of these six patients had only lung and bone metastases. Pulmonary metastases were observed on the 131I WBS patients 31/32 (96.8%) whereas no pulmonary metastases, were detected on the CT scans in 3/32 patients. The last diagnostic whole-body scan (DWBS) was normal in 13/32 patients. At the first examination, the Tg levels in 27/32 (84.4%) patients were below 30 ng . ml(-1). At the final examination, 20/32 (62.5%) patients had Tg levels higher than 30 ng . ml(-1), while Tg levels were lower than 30 ng . ml(-1) in 12/32 patients. Tg levels decreased in 21/32 and increased in 3/32 patients. The 131I WBS continued to be abnormal in 2/3 patients with increased Tg levels but became normal in one patient whose CT scan still showed macro-nodular lesions. Tg levels did not change significantly in 8/32 patients. The 131I WBS became normal in 5/8 patients, while the CT scans for 4/5 showed micro-nodules. Metastases were detected in 12/19 patients who underwent 99mTc-MIBI whole-body scanning: 18/19 showed metastases on the 131I WBSs and 17/19 on the CT scans. Of the seven patients without a sign of metastasis on the 99mTc-MIBI WBS, one was negative in terms of metastasis on the 131I WBS and one on the CT scan. Fibrosis was observed on the CT scans of 2/32 patients. One patient developed dedifferentiation, as determined by the negative 131I WBS and positive CT scan. CONCLUSION: 131I whole-body scanning and the determination of Tg levels are the most important procedures for the evaluation of lung metastases in differentiated thyroid cancer. Computed tomography is a useful addition to 131I whole-body scanning. MIBI imaging alone may not be enough to detect lung metastases from differentiated thyroid cancer.