Receptor scintigraphy using the Tc-99M-labelled somatostatin analogue EDDA-TRYCINE-HYNIC-TOC: clinical results in different tumor types and comparison with In-111 DOTATOC during Y-90 DOTATOC radioreceptor therapy

Aim: To evaluate Tc-99m EDDA-TRYCINE-HYNIC-TOC in patients with somatostatin receptor positive tumours (staging, pre-therapeutic dosimetry for radioreceptor therapy and restaging after therapy) in comparison with In-111 DOTATOC. Material and Methods: The Tc-99m labelled somatostatin analogue was synthesized by an optimized procedure in our pharmaceutical laboratory using lyophilized kits (radiochemical purity by HPLC, TLC > 95%, product stability in vitro 4 to 6h). So far, 58 patients (60 examinations) were studied after injection of 580-890 MBq (median 673 MBq) EDDA-TRYCINE-HYNIC-TOC. The histologically proven tumours were neuroendocrine neoplasias, renal carcinomas, bronchial carcinoma, mesothelioma and malignant fibrous histiocytoma. The imaging protocol consisted of whole-body scans and planar images of the tumor region (15 min, 1 h, 2 h, 4 h, 8 h, 24 h p.i.) and additionally SPECT-images (1 h und 4 h p.i.). For semi-quantitative assessment, individual regions of interest (ROI) were drawn in order to generate time-activity curves and to calculate tumour-to-tissue/background ratios which were compared by visual grading (scala 0 to 3+). Furthermore, pharmacokinetic analyses were carried out (radioactivity kinetics in plasma and urine). In some selected patients, image fusion of whole-body scans was performed with CT and/or MRT and/or PET using a NUD software and a HERMES computer. Results: 10 out of 58 patients showed an intense tracer accumulation in the SSTR-positive tumours (visual 3+, tumour/background ratio >2,5). In these patients, radioreceptor therapy was carried out using Y-90 DOTATOC (simultaneous injection von 150 MBq In-111 DOTATOC). All pretherapeutic scans with the Tc-99m labelled ligand (4 h p.i.) showed a similar overall pattern of biodistribution and tumour uptake in comparison to the therapy scans with In-111 / Y-90 DOTATOC (24 h p.i.). The Tc-99m EDDA-TRYCINE-HYNIC-TOC scans (incl. SPECT) offered superior imaging properties with earlier tumour visualisation (all lesions were detected 1 h p.i.) as compared to the In-111 labelled analogue. Hence, the receptor scintigraphy with Tc-99m EDDA-TRYCINE-HYNIC-TOC enables to select patients suitable for radioreceptor therapy with Y-90 DOTATOC. Conclusion: Our results demonstrate the advantages of Tc-99m EDDA-TRYCINE-HYNIC-TOC for receptor scintigraphy of SSTR-positive tumours with superior image performance as compared to In-111 labelled SST-analogues (staging) , for an individual selection of patients suitable for a radio receptor therapy with Y-90 DOTATOC and for a post-therapeutic control (restaging)