Nuclear Medicine in Cancer Diagnosis and Therapy

Early cancer diagnosis remains one of the most actual problems of medicine, since it allows using the most effective methods of cancer treating. Unlike most diagnostic methods used in oncology, the methods of nuclear medicine allow assessing not so much the anatomic changes in the organ as the disturbance of metabolic processes in tumors and surrounding tissues. The authors describe the main radiopharmaceuticals used for diagnose and radiotherapy of malignant tumors

Nuclear Medicine in Breast Cancer Diagnostics: Primary Tumor and Lymphatic Metastasis

The purpose of the study: to assess the possibility of using nuclear medicine techniques at the stages of diagnosis and treatment of breast cancer. Materials and Methods: The study included 290 patients with breast cancer and 70 patients with benign breast tumors. The study was used as a radiopharmaceutical 99mTc-MIBI, 199Tl for imaging tumors and colloid 99mTc-Aloteh for visualization sentinel lymph nodes (SLN), colloid was injected peritumoral in four points to 80 MBq one day prior to the planned operation. Results: The sensitivity of SPECT using both 99mTc-MIBI and 199Tl for breast cancer detection was shown to be rather high, being 98.5% and 98%, respectively. It should be noted that the sensitivity of SPECT in detection of small tumors (less than 1 cm in diameter) and multicentric tumors was not high irrespective of the radioisotope used (60% and 65% with 99mTc-MIBI and 65% and 59% with 199Tl, respectively). The difference in the sensitivity was found between 99mTc-MIBI and 199T for the detection of regional lymph node metastasis (91% vs 70%). SLN were detected in 31 patients. The most commonly SLN were defined in the axillary region of 96.7%. In 22 (70.9%) patients there was no metastasis SLN. The sensitivity of the method was 91.2%, specificity of 100%. Conclusion: The specificity of SPECT with 199Tl was higher than that with 99mTc-MIBI. The data obtained show that SPECT with 199Tl can be recommended for its use as an additional breast cancer detection method in cases when other imaging techniques and histological findings are not accurate enough. The clinical study of 99mTc-Aloteh, a new radiopharmaceutical agent, has shown that the studied colloid has high uptake level in SLN and can be successfully used for visualization of SLN in patients with breast cancer

Nuclear Medicine in Breast Cancer Diagnostics: Primary Tumor and Lymphatic Metastasis

The purpose of the study: to assess the possibility of using nuclear medicine techniques at the stages of diagnosis and treatment of breast cancer. Materials and Methods: The study included 290 patients with breast cancer and 70 patients with benign breast tumors. The study was used as a radiopharmaceutical 99mTc-MIBI, 199Tl for imaging tumors and colloid 99mTc-Aloteh for visualization sentinel lymph nodes (SLN), colloid was injected peritumoral in four points to 80 MBq one day prior to the planned operation. Results: The sensitivity of SPECT using both 99mTc-MIBI and 199Tl for breast cancer detection was shown to be rather high, being 98.5% and 98%, respectively. It should be noted that the sensitivity of SPECT in detection of small tumors (less than 1 cm in diameter) and multicentric tumors was not high irrespective of the radioisotope used (60% and 65% with 99mTc-MIBI and 65% and 59% with 199Tl, respectively). The difference in the sensitivity was found between 99mTc-MIBI and 199T for the detection of regional lymph node metastasis (91% vs 70%). SLN were detected in 31 patients. The most commonly SLN were defined in the axillary region of 96.7%. In 22 (70.9%) patients there was no metastasis SLN. The sensitivity of the method was 91.2%, specificity of 100%. Conclusion: The specificity of SPECT with 199Tl was higher than that with 99mTc-MIBI. The data obtained show that SPECT with 199Tl can be recommended for its use as an additional breast cancer detection method in cases when other imaging techniques and histological findings are not accurate enough. The clinical study of 99mTc-Aloteh, a new radiopharmaceutical agent, has shown that the studied colloid has high uptake level in SLN and can be successfully used for visualization of SLN in patients with breast cancer

Nuclear Medicine Imaging of Locally Advanced Laryngeal and Hypopharyngeal Cancer

The diagnostic capabilities of nuclear medicine imaging in the detection and assessment of the spread of laryngeal/hypopharyngeal cancer were studied. A total of 40 patients with histologically verified laryngeal and hypopharyngeal cancer and 20 patients with benign laryngeal lesions were included into the study. Submucosal injections of {99m}Tc-MIBI and {99m}Tc-Alotech were made around the tumor. Single photon emission computed tomography (SPECT) was performed 20 minutes after the injection of {99m}Tc-MIBI. Sentinel lymph nodes (SLNs) were detected in 26 patients. In 18 hours after the injection of {99m}Tc-Alotech, SPECT was performed. In 24 hours after the injection of {99m}Tc-Alotech, intraoperative SLN detection was performed using Gamma Finder II. SPECT with {99m}Tc-MIBI revealed laryngeal and hypopharyngeal tumors in 38 of the 40 patients. The {99m}Tc-MIBI uptake in metastatic lymph nodes was visualized in 2 (17%) of the 12 patients. Twenty eight SLNs were detected by SPECT and 31 SLNs were identified using the intraoperative gamma probe. The percentage of {99m}Tc-Alotech in the SLN was 5-10% of the radioactivity in the injection site by SPECT and 18-33% by intraoperative gamma probe detection. Thus, SPECT with {99m}Tc-MIBI is an effective tool for the diagnosis of laryngeal/hypopharyngeal cancer. The sensitivity, specificity and accuracy of this technique were 95%, 80% and 92%, respectively. The use of {99m}Tc-Alotech for the detection of SLNs in patients with laryngeal/hypopharyngeal cancer is characterized by 92.8% sensitivity

Clinical Significance of Sentinel Lymph Node Detection in Patients with Invasive Cervical Cancer

The clinical significance of determining sentinel lymph nodes (SLN) in patients with invasive cervical cancer was studied. From 2013 to 2014, 30 cervical cancer patients (T1a1NxM0-T1b1NxM0) were treated at the Gynecological Oncology Department of the Cancer Research Institute. The day before surgery, four submucosal injections of 99mTc Al2O3 at a total dose of 80 MBq were made in each quadrant around the cervical tumor. Patients were submitted to preoperative lymphoscintigraphy and intraoperative SLN detection. The feasibility of preserving the reproductive potential in patients after radical abdominal trachelectomy was assessed. The 3-year, overall, disease-free and metastasis-free survival rates were analyzed. Thirty-four SLNs were detected by single-photon emission computed tomography (SPECT) and 42 SLNs were identified by intraoperative gamma probe. The sensitivity in detecting SLNs was 100% for intraoperative SLN identification and 80% for SPECT image. The reproductive potential was preserved in 86% of patients. The 3-year overall and metastases-free survival rates were 100%. Recurrence occurred in 8.6% of cases

Development and Study of {99m}Tc-1-Thio-D-glucose for Visualization of Malignant Tumors

The preclinical studies of {99m}Tc-1-Thio-D-glucose, a new tumor-seeking agent based on technetium-99mlabeled glucose derivative, were conducted, and the feasibility of using this radiopharmaceutical for tumor visualization was studied. The preclinical studies were carried out strictly in accordance with the local legislation and were regulated by the generally accepted research standards. {99m}Tc-1-Thio-D-glucose was found to have optimal pharmacokinetic and physico-chemical properties for diagnostic imaging and was proved to belong to the low-toxic substances. The potential utility of {99m}Tc-1-thio-D-glucose for tumor imaging was studied in vitro and in vivo models. The present study demonstrated that {99m}Tc-1-Thio-D-glucose is a prospective radiopharmaceutical for cancer visualization

Development and Study of {99m}Tc-1-Thio-D-glucose for Visualization of Malignant Tumors

The preclinical studies of {99m}Tc-1-Thio-D-glucose, a new tumor-seeking agent based on technetium-99mlabeled glucose derivative, were conducted, and the feasibility of using this radiopharmaceutical for tumor visualization was studied. The preclinical studies were carried out strictly in accordance with the local legislation and were regulated by the generally accepted research standards. {99m}Tc-1-Thio-D-glucose was found to have optimal pharmacokinetic and physico-chemical properties for diagnostic imaging and was proved to belong to the low-toxic substances. The potential utility of {99m}Tc-1-thio-D-glucose for tumor imaging was studied in vitro and in vivo models. The present study demonstrated that {99m}Tc-1-Thio-D-glucose is a prospective radiopharmaceutical for cancer visualization

Experimental study of radiopharmaceuticals based on technetium-99m labeled derivative of glucose for tumor diagnosis

Purpose: to study the potential utility of 1-thio-D-glucose labeled with 99mTc for cancer imaging in laboratory animals. Materials and method: the study was carried out in cell cultures of normal CHO (Chinese hamster ovary cells CHO) and malignant tissues MCF-7 (human breast adenocarcinoma MCF-7). To evaluate the uptake of 99mTc-1-thio-D-glucose in normal and tumor tissue cells, 25 MBq of 1-thio-D-glucose labeled with 99mTc was added to the vials with 3 million cells and incubated for 30 minutes at room temperature. After centrifugation of the vials with cells, the supernatant was removed. Radioactivity in vials with normal and tumor cells was then measured. In addition, the study included 40 mice of C57B 1/6j lines with tumor lesion of the right femur. For neoplastic lesions, Lewis lung carcinoma model was used. Following anesthesia, mice were injected intravenously with 25MBq of 99mTc-1-thio-D-glucose. Planar scintigraphy was performed 15 minutes later in a matrix of 512x512 pixels for 5 minutes. Results: when measuring the radioactivity of normal and malignant cells after incubation with 99mTc-1-thio-D- glucose, it was found that the radioactivity of malignant cells was higher than that of normal cells. The mean values of radioactivity levels in normal and malignant cells were 0.3±0.15MBq and 1.07±0.6MBq, respectively. All examined animals had increased accumulation of 99mTc-1-thio- D-glucose at the tumor site. The accumulation of 99mTc-1-thio-D-glucose in the tumor was on average twice as high as compared to the symmetric region. Conclusion: The present study demonstrated that 99mTc-1-thio-D-glucose is a prospective radiopharmaceutical for cancer visualization. In addition, high accumulation of 99mTc-1-thio-D-glucose in the culture of cancer cells and in tumor tissue of animals demonstrates tumor tropism of the radiopharmaceutical

ДИАГНОСТИЧЕСКИЕ РАДИОФАРМАЦЕВТИЧЕСКИЕ ПРЕПАРАТЫ НА ОСНОВЕ ПРОИЗВОДНЫХ ГЛЮКОЗЫ В СОВРЕМЕННОЙ ОНКОЛОГИЧЕСКОЙ ПРАКТИКЕ

The purpose of the study was to review available literature on the efficacy of radiopharmaceuticals based on glucose derivatives labeled with radioactive isotopes for detection of various cancers. Material and methods. A systematic literature review was performed using the Scopus, Web of Science, MedLine, Cochrane Library, EMBASE, and Global Health databases from 2000 to 2016. Out of 900 papers in the field of nuclear medicine, 58 were included into the review. Results. 18F-fluoro-2-deoxy-D-glucose (18F-FDG) has been approved to be a powerful imaging tool for the detection of various cancers as well as for the assessment of tumor extent and therapy response. There is a continuous search for new more specific and effective radiopharmaceuticals for visualization of tumor tissue. Many studies are devoted to the development of radiopharmaceuticals based on technetium-99m labeled glucose derivatives for tumor visualization. Russian researches have made a significant progress in the development of imaging agents for single-photon emission computed tomography. Conclusion. Despite the widespread use of positron emission tomography technologies, which have proved to be effective, the specialists still have a great interest in radiopharmaceuticals based on technetium-99m. The literature review suggests that the emergence of a diagnostic radiopharmaceutical based on technetium-99m labeled glucose derivative will help to improve the availability of nuclear medicine methods and their effectiveness.Цель исследования – анализ имеющихся на сегодняшний день литературных данных об эффективности применения диагностических радиофармацевтических препаратов на основе меченных радиоактивными изотопами производных глюкозы в визуализации злокачественных новообразований различных локализаций. Материал и методы. Поиск соответствующих источников производился в системах Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health и РИНЦ, включались публикации с 2000 по 2016 г. Из 900 источников в обзор были включены 58 наиболее полных и фундаментальных трудов в области ядерной медицины. Результаты. В настоящее время в онкологии достаточно широко используется диагностический радиофармацевтический препарат на основе меченной фтором-18 производной глюкозы – 18F-дезоксиглюкоза (18F-ФДГ). Применение указанного радиофармпрепарата доказало свою эффективность в визуализации злокачественных новообразований различных локализаций, оценке распространенности опухолевого процесса и оценке эффективности проводимого лечения. При этом в мире идет поиск новых, более специфичных и эффективных радиофармпрепаратов для визуализации опухолевой ткани. Достаточно много трудов посвящено разработке радиофармацевтических препаратов на основе меченных технецием-99m производных глюкозы для визуализации опухолевой ткани. Значительных результатов в этой области достигли отечественные исследователи, разрабатывающие оригинальные препараты для однофотонной эмиссионной компьютерной томографии. Заключение. Несмотря на широкое распространение в мире технологий позитронно-эмиссионной томографии, доказавшей свою эффективность, у специалистов по- прежнему остается большой интерес к радиофармацевтическим препаратам на основе технеция-99m. Анализ литературы свидетельствует о том, что появление диагностического радиофармацевтического препарата на основе меченной технецием-99m производной глюкозы поможет повысить доступность методов ядерной медицины и их эффективность

Альтернативные каркасные белки в радионуклидной диагностике злокачественных образований

This review discusses a relatively new class of targeted molecules that is being actively studied for radionuclide diagnosis and treatment of malignancies. The full-size antibodies used so far have non-optimal pharmacological properties, slow distribution in the body, poor penetration into the tissue and kidney excretion, and high immunogenicity, which significantly complicates their use in clinical practice. Over the past decade, a new class of targeted molecules, called “non-immunoglobulin scaffolds” have become popular; they have all the requirements for optimal delivery of a radionuclide to tumor cells. Scaffolds usually are smaller in size in comparison with antibodies, but they are larger than peptides, and are characterized by high affinity and optimal biochemical, biophysical, biological, and economic features. The advantages of such proteins are their stable structure, good penetration into tissues, the possibility of additional functionalization and expression in the bacterial system, which ensures low production costs.The results of preclinical and clinical studies for diagnosis of malignancies using such proteins as affibody, adnectin, DARPins, etc., have demonstrated their high specificity, affinity, good tolerance and low immunogenicity. В настоящем обзоре обсуждается относительно новый класс направленных адресных молекул, активно исследующийся в отношении радионуклидной диагностики и лечения злокачественных образований. Используемые до настоящего времени полноразмерные антитела обладают неоптимальными фармакологическими свойствами, медленным распределением в организме, плохим проникновением в ткани, выведением почками и высокой иммуногенностью, что существенно затрудняет их применение в клинической практике. В течение последнего десятилетия большую популярность приобретают таргетные молекулы, получившие название «альтернативные каркасные белки» (АКБ) или «скаффолды» и отвечающие всем требованиям для оптимальной доставки радионуклида к опухолевым клеткам. Обычно АКБ имеют меньшие размеры по сравнению с антителом, но большие, чем пептиды, и характеризуются высокой аффинностью и оптимальными биохимическими, биофизическими, биологическими и экономическими характеристиками. Преимуществами таких белков являются их стабильная структура, хорошее проникновение в ткани, возможность дополнительной функционализации и ýкспрессия в бактериальной системе, обеспечивающая низкую стоимость производства.Результаты проведенных к настоящему моменту доклинических и клинических исследований для диагностики злокачественных образований с использованием таких представителей АКБ, как аффибоди, аднектин, дарпины и пр., продемонстрировали высокую специфичность, аффинность, хорошую переносимость и низкую иммуногенность используемых препаратов.