Celal Karlıkaya

99mTc-MIBI SPET in non-small cell lung cancer in relationship with Pgp and prognosis

Abstract Higher technetium-99m methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) has been reported to be associated with a positive response to chemotherapy. It has previously been found that in tumour cells, P-glycoprotein (Pgp) expression is of importance for tracer uptake. However, some studies have indicated that Pgp expression does not play an important role in 99mTc-MIBI uptake in NSCLC; indeed, a negative correlation between 99mTc-MIBI uptake and Pgp expression has been reported. Against the background of conflicting results, our aim was to evaluate the relationship between 99mTc-MIBI uptake, prognosis and Pgp expression in NSCLC. A total of 37 patients with NSCLC underwent 99mTc-MIBI single-photon emission tomography (SPET) before chemotherapy. In 19 patients both Pgp and p53 expression, and in two patients only p53 expression (due to the limited biopsy material), were measured with immunohistochemical staining. 99mTc-MIBI uptake was significantly higher in responders than in non-responders: 3.09±1.14 vs 2.24±0.88 (P<0.03) and 3.09±1.08 vs 2.37±1.06 (P<0.05) for the early ratio (ER) and the delayed ratio (DR), respectively. The wash-out rate (WR) of responders was not significantly different from that of non-responders. We found no significant differences in ER, DR and WR among the groups positive or negative for Pgp and p53 status. There was a significant positive correlation between the survival rate and both ER and DR: r=0.49 (P=0.003) and r=0.40 (P=0.018), respectively. Patients with ER and DR values above 3 showed significantly longer survival than those with values below 3: 14.7±8.5 months vs 7.3±5.1 months (P<0.009) and 13.2±8.4 months vs 7.4±5.3 months (P<0.04) for ER and DR, respectively. However, interestingly, and in contrast to expectations, patients with a Pgp score of +2 showed significantly longer survival (12.9±6.7 months) than those with Pgp scores of +1 (4.4±3.0 months) or – (negative) (3.8±2.2 months) (P<0.009 and P<0.02, respectively). Our results suggest that in NSCLC, patients with higher 99mTc-MIBI uptake tend to show a positive response to chemotherapy, and patients with ER and DR values above 3 have a significantly better prognosis. We also found that Pgp expression seems to play only a minor role in 99mTc-MIBI uptake. Our finding that patients with ER and DR values above 3 have a better prognosis needs to be confirmed in larger series of patients.

Thallium-201 SPECT in advanced non-small cell lung cancer: In relation with chemotherapeutic response, survival, distant metastasis and p53 status

Purpose: The aim of this study was to evaluate the relationship between201Tl tumor uptake, chemotherapeutic response, metastasis, p53 status and survival in non-small cell lung cancer (NSCLC).Methods: A total of 23 patients underwent201Tl SPECT. In 9 patients, 2nd201Tl SPECT study were performed 1 week after the 3rd cycle of chemotherapy (ChT), and early (ER) and delayed (DR) tumor/normal lung ratios and retention indices (RI) were obtained. In 15 patients p53 status was assayed with immuno-histochemical staining. The patients were divided into subgroups after the 3rd cycle of ChT; responders [R(+) (n=10)] and non-responders [R(−) (n=13)], distant metastasis [(M1) n=11] and [(M0) n=12], and mutant p53 status [p(+) n=7, p53(−) n=8].Results: The differences for ER, DR and RI values between all of the subgroups were not statistically significant. ER and DR of responders decreased significantly after ChT; from to 2.46 to 1.36 (p=0.04) and 2.29 to 1.53 (p=0.04), respectively. In the non-responder group, both ER and DR slightly increased after ChT (p>0.05).Conclusion: Our results suggest that in NSCLC, there was a weak correlation between higher201Tl ratios and positive response to chemotherapy, absence of distant metastasis, and p53(−) status. Significant201Tl uptake decrease after chemotherapy indicates that delayed201Tl uptake can be used in evaluating the chemotherapeutic response.

Mapping the tobacco retailers in edirne, Turkey.

OBJECTIVE The youth smoking rate is on the rise in Turkey. Although many marketing bans have been effectively implemented, regulations related to retail tobacco outlets have gone unnoticed and have not been effectively supervised. In this study, we aimed to show the lack of legal regulation related to the high retail tobacco outlet density with displays. MATERIAL AND METHODS In the center of Edirne, the marketing environment, numbers and geographical distribution of retail tobacco outlets were documented and mapped with geographical positions. RESULTS There were 569 retail tobacco points of sale in 520 stores. We calculated one tobacco retail outlet per 270 people. This retail outlet density rate is above the national average and about four times higher than the density in Istanbul. Products especially attracting children, such as chocolate, sweet candy and chewing gum, were set up near the tobacco stands and were easy for children to recognize and reach. It can be seen on the city map that 47% of retail tobacco outlets are within 100 m of education, health or sport facilities. CONCLUSION We concluded that one of the reasons for the increasing prevalence of cigarette use, especially among adolescents in Turkey, is deregulation of the retail tobacco marketing industry as a result of the privatization process of the national tobacco monopoly. Using mapping techniques can be useful in terms of controlling the retail marketing environment.