Congjin Liu

Efficacy and safety of 177Lu-EDTMP in bone metastatic pain palliation in breast cancer and hormone refractory prostate cancer: a phase II study.

Purpose 177Lu-labeled ethylenediamine-N,N,N′,N′-tetrakis methylene phosphonic acid (177Lu-EDTMP), was used to palliate metastatic bone pain as a new bone-seeking radiopharmaceutical. In this phase II study, we assessed the efficacy and safety of 177Lu-EDTMP for bone pain palliation in patients with breast cancer and hormone refractory prostate cancer with bone metastases. Methods Sixteen patients were enrolled in the trial and were subsequently divided into 2 groups, the low-dose group (1295 MBq) and the high dose group (2590 MBq) to determine differences in toxicities and response rates. Pain scores, Karnofsky indices, mobility scores, and requirement of analgesic administration were assessed at 0, 2, 4, 6, 8, and 12 weeks after injection of 177Lu-EDTMP. Toxicity was assessed by analyzing hemoglobin, leukocyte, and platelet counts. Results An obvious reduction in the mean pain score was observed at 2 to 6 weeks after the administration of 177Lu-EDTMP. The rate of complete responses in bone pain palliation was 55% in group 1 and 80% in group 2 at 6 weeks after treatment. Of the 5 patients who required additional analgesics, all were able to reduce or completely stop taking these medications by 4 weeks after therapy. Mean (SD) Karnofsky indices of 58.18 (9.82) (range, 50–70) and 56.00 (8.94) (range, 50–70) at baseline increased to 82.73 (9.05) (range, 60–90) at 6 weeks after 177Lu-EDTMP treatment in group 1 and 85.00 (5.77) (range, 80–90) at 8 weeks after injection in group 2, respectively. Mobility scores decreased from 2.91 (1.04) (range, 1–4) and 2.80 (0.84) (range, 2–4) at baseline to 1.00 (0.67) (range, 0–2) and 0.50 (0.58) (range, 0–1) at 8 weeks after administration of 177Lu-EDTMP in groups 1 and 2, respectively, primarily owing to improved mobility. In group 1, 1 patient experienced grade III toxicity in both hemoglobin and platelet counts. No grade IV toxicities were observed. In group 2, there were no grade III or IV toxicities found in hemoglobin, platelets, or leukocytes counts. Moreover, no clinically significant adverse effects were observed, and no significant differences in either efficacy or safety were detected between the 2 dose levels. Conclusions This study indicated that 177Lu-EDTMP was an effective and safe treatment for palliation of metastatic bone pain in patients with prostate or breast cancer. A dose of 1295 MBq (35 mCi) was sufficient for bone pain palliation therapy, and doses as high as 2590 MBq (70 mCi) were well tolerated.

99mTc‐TRODAT‐1 SPECT study in early Parkinson's disease and essential tremor

Objective –  The clinical differentiation between early Parkinsons disease (PD) and essential tremor (ET) could be difficult, therefore, the aim of this study was to investigate 99mTc‐TRODAT‐1 SPECT as an applicable tool in this field.

Dopamine transporter dysfunction in Han Chinese people with chronic methamphetamine dependence after a short-term abstinence.

Single-photon emission-computed tomography (SPECT) after the administration of (99m)Tc-TRODAT-1 was performed on healthy subjects and subjects with methamphetamine (METH)dependence at time 1 (T1) after 24-48 h of abstinence, time 2 (T2) after 2 weeks of abstinence, and time 3 (T3) after 4 weeks of abstinence. In contrast to values in controls, the values of the striatal DAT specific uptake ratios (SURs) in subjects with METH dependence were significantly lower at T1 (n=25), T2 (n=9), and T3 (n=8); a mild increase in SURs was observed at T2 and T3, but values were still significantly lower than those in controls. In subjects with METH dependence, there was a trend for a negative correlation of striatal DAT SURs and craving for METH at T1. METH craving, anxiety and depression scores significantly decreased from T1 to T2 to T3. We conclude that Han Chinese people with METH dependence experience significant striatal DAT dysfunction, and that these changes may be mildly reversible after 4 weeks of abstinence, but that DAT levels still remain significantly lower than those in healthy subjects. The mild recovery of striatal DAT may parallel improvements in craving, anxiety and depression.

Timing and optimized acquisition parameters for the whole-body imaging of 177Lu-EDTMP toward performing bone pain palliation treatment

ObjectivesLutetium-177-labeled ethylenediamine-N,N,N′,N′-tetrakis (methylene phosphonic acid) (177Lu-EDTMP), a beta-emitting bone-seeking therapeutic radiopharmaceutical being assessed as an agent for palliation of bone pain, can emit suitable gamma-photons for scintigraphy. This investigation sought to characterize its optimal conditions for whole-body gamma camera imaging in patients. Materials and methodsEleven patients with bone metastases underwent whole-body bone scanning using both 99mTc-methyl-diphosphonate (99mTc-MDP) and 177Lu-EDTMP (29.4±12.5 MBq/kg BW) utilizing a dual-head camera. For lutetium-177 imaging, two types of collimators, low-energy high-resolution (LEHR) and medium-energy general-purpose (MEGP), and two different peak energies of 113 and 208 keV were used. ResultsThe femur-to-muscle uptake ratio (F/M) of 99mTc-MDP was 2.69±1.06. For 177Lu-EDTMP, the significantly highest F/Ms were found at 24 h (12.59±5.73) and 48 h (12.54±5.23) by applying MEGP collimators and collecting the 208 keV photons. In all the combinations of collimator and peak energy, the F/Ms at 24 and 48 h are significantly higher than those at 1 h, except the combination of LEHR collimator and 208 keV peak energy. Lesion-to-normal bone uptake ratios of the 99mTc-MDP bone scan and images at the 24 and the 48-h phases of 177Lu-EDTMP were analyzed. MEGP and 208 keV had significantly higher values in lesion-to-normal bone uptake ratios. The combination of LEHR and 208 keV provided the poorest images. Conclusion177Lu-EDTMP can provide fine whole-body images with the best results when applying medium-energy collimation and collecting the 208 keV energy photons and alternatively by collecting both 208 and 113 keV photons for higher count statistics. The most appropriate time point for imaging is around 24 h after injection.

Comparable investigation in dopamine transporters with 99mTc-TRODAT-1 and 131I-FP-CIT SPECT in Parkinson's disease patients

Abstract Dopamine transporter (DAT) mediates the regulation of dopaminergic function. Two agents of TRODAT-1 and FP-CIT were observed in evaluating DAT change of Parkinsons disease (PD). The relationship between them was also evaluated. The results suggested that 99m Tc-TRODAT-1 SPECT and 131 I-FP-CIT SPECT may serve as sensitive and objective in vivo markers to reflect the severity of PD. The 99c Tc-TRODAT-1 image is more accurate and clearer compared with 131 I-FP-CIT.