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Systemic radionuclide therapy using indium-111-DTPA-D-Phe1-octreotide in midgut carcinoid syndrome.

Artikel i vetenskaplig tidskrift
Författare M Fjälling
P Andersson
Eva Forssell-Aronsson
J Grétarsdóttir
V Johansson
Lars-Eric Tisell
Bo Wängberg
Ola Nilsson
Gertrud Berg
A Michanek
G Lindstedt
Håkan Ahlman
Publicerad i Journal of nuclear medicine : official publication, Society of Nuclear Medicine
Volym 37
Nummer/häfte 9
Sidor 1519-21
ISSN 0161-5505
Publiceringsår 1996
Publicerad vid Institutionen för särskilda specialiteter, Avdelningen för onkologi
Institutionen för särskilda specialiteter, Avdelningen för radiofysik
Institutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi
Sidor 1519-21
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Female, Humans, Hydroxyindoleacetic Acid, urine, Indium Radioisotopes, diagnostic use, therapeutic use, Malignant Carcinoid Syndrome, radiography, radionuclide imaging, radiotherapy, Middle Aged, Octreotide, analogs & derivatives, diagnostic use, therapeutic use, Pentetic Acid, analogs & derivatives, diagnostic use, therapeutic use, Radiotherapy Dosage, Tomography, X-Ray Computed
Ämneskategorier Radiofysik, Kirurgi, Cancer och onkologi

Sammanfattning

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 (3.0, 3.5 and 3.1 GBq) 8 and 4 wk apart. After each therapy, the patient experienced facial flush and pain 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.

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