World Journal of Nuclear Medicine


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World Journal of Nuclear Medicine

  1. 1. World Journal of Nuclear Medicine Volume 4, Supplement 1, October 2005 Published by WFNMB Online: WORLD FEDERATION OF NUCLEAR MEDICINE AND BIOLOGY INTERNATIONAL CONFERENCE ON RADIOPHARMACEUTICAL THERAPY (ICRT-2005) 11-14 October 2005 Limassol, Cyprus
  2. 2. World Journal of Nuclear Medicine Volume 4, Supplement 1, October 2005 Editorial Padhy AK S-1 S-12 S-66 Therapeutic Nuclear Medicine: It is time to act WFNMB/WRPTC International Conference on Radiopharmaceutical Therapy Scientific Programme S-3 Abstracts Index of Authors World J Nucl Med 2005; 4: S1 - S67
  3. 3. General Information Target Group: Contents: a.General: b. Related to WFNMB: c. Related to IAEA and other International organizations: d. Research & Development: e. Windows for the Industry This will be a publication of the World Federation of Nuclear Medicine & Biology (WFNMB) with the support of the IAEA and will be published quarterly. The purposes of the journal are as follows: To be an official publication of the World Federation of Nuclear Medicine & Biology (WFNMB) with the active collaboration and support of the IAEA To promote research in nuclear medicine globally and in the developing countries in particular To promote good practice in nuclear medicine All members of the WFNMB All member states of IAEA Specialists belonging to various fields of nuclear medicine (Physicians, radiopharmacists, physicists, radioimmunoassayists, molecular biologists, etc.), technologists and nurses Manufacturers of equipment and reagents relevant to nuclear medicine Atomic Energy Commissions, Governmental and administrative personnel relevant to nuclear medicine practice in the various countries Reviews related to the good practice of nuclear medicine Newsletter Announcements Reports of working groups, etc. Editorials on WFNMB Planning & Strategy etc. Abstracts of Congresses Newsletter Announcements Reports of CRPs, RCMs, Seminars Abstracts of International Seminars Periodic world status reports Regional Windows Editorials Cochrane Reviews CMEs on Clinical subjects as well as on Science & Technology pertaining to nuclear medicine Original articles Letters to the editor (coloured pages) ! ! ! ! ! ! ! ! Display Commercial Advertising Editorial Office ISSN Number (print) 1450-1147 Production Cover Design Graphic Design Printers Jagannath Printing Press, New Delhi, India Electronic Edition WebMaster Copyright It is hoped that the nuclear medicine industry (radiopharmaceuticals, nuclear instrumentation, computer & reagents etc.) will view the journal as an effective means of advertising to the nuclear medicine community. In order that the journal can be self-sustaining, we invite the industry to provide significant support and to assist in raising the profile of this important journal, the first to specifically target the world-wide nuclear medicine community. Besides regular full, half and quarter page advertisements, the journal will also publish special features like "windows for the industry". All advertising materials accepted are expected to conform to ethical, medical and business standards. Acceptance does not imply endorsement by the journal. World Journal of Nuclear Medicine Nuclear Medicine Department KF Nuclear Diagnostics Filiou Zannetou 10 CY-3021 Lemesos Tel.:+357 25878725 Fax:+357 25871747 e-mail: KF Nuclear Diagnostics Ltd. Filiou Zannetou 10 CY-3021 Lemesos Cyprus Tel.:+357 25878725 Fax:+357 25871747 e-mail: Mr. Anatoli Bourykine (IAEA) Mr. Bankim Desai ISSN Number (online) 1607-3312 Marios Pieri, Nicosia, Cyprus © World Journal of Nuclear Medicine, 2005 World Journal of Nuclear Medicine
  4. 4. Editorial Board Editor in Chief : Executive Editors : Senior Editor : Editor (IAEA) : Treasurer : Regional Editors : Assistant Editors : K.E. Britton A.K. Padhy, H. Amaral, J.K. Chung S. Frangos M. Dondi W. Choe Africa: A. Ellmann, Asia: H. Sakahara, China & Fow East : M-Tian, Europe: A. Signore, N. America: C. Divgi, South and Central America: O. Estrella Anselmi, West Asia: M. Al-Zboun, A.Soricelli, G. Hinterleitner, N. Watanabe Members : Aas M (Norway) Abdel-Dayem H (USA) Abdul Khader MA (Malaysia) Adel Bakir M (Syria) Al-Nahhas A (UK) Alvarado N (Peru) Andreo P (Sweden) Barrenechea E (Philippines) Batista Cuellar JF (Cuba) Baum RP (Germany) Belohlavek O (Czech Republic) Bernal P (Colombia) Biersack H-J (Germany) Bouyoucef SE (Algeria) Buscombe J (UK) Chaiwatanarat T (Thailand) Chianelli M (Italy) Corstens FHM (The Netherlands) Duffy G (Ireland) Dziuk M (Poland) El-Desouki M (Saudi Arabia) El-Gazzar A-H (Kuwait) Fernandes O (Brazil) Fettich J (Slovenia) Fonseca Zamora CA (Costa Rica) Fraxedas R (Cuba) Garcia E (Mexico) Goldsmith SJ (USA) Gomo ZAR (Zimbawbe) Granowska (UK) He Zuo-Xiang (china) Henricksen JH (Denmark) Hesselwood S (UK) Hoeflin F (Switzerland) Horne T (Israel) Hussein K (Indonesia) Hatton B (UK) Jafri RA (Pakistan) Kabasakal L (Turkey) Karim MA (Bangladesh) Knapp FF (USA) Kouris K (Cyprus) Kropp J (Germany) Kumar V (Australia) Lass P (Poland) Lepej J (Slovakia) Lind P (Austria) Liu XJ (China) M'Timet S (Tunisia) Magzoub MAA (Sudan) Malamitsi J (Greece) Mather S (UK) Maunda KKY (Tanzania) McEwan AJW (Canada) Meneghetti JC (Brazil) Moustafa H (Egypt) Mut F (Uruguay) Obaldo J (Philippines) Obradovic V (Serbia & Montenegro) Olarrechea M (Bolivia) Oliva JP (Cuba) Orellana P (Chile) Palazzi F (Venezuela) Pant GS (India) Petrovici R (Romania) Piepsz AM (Belgium) Piperkova E (Bulgaria) Prigent A (France) Roca I (Spain) Rodrigues Radischat M (Austria) Rutland M (New Zeland) Saghari M (Iran) Salvatore M (Italy) Samuel AM (India) Sasaki Y (Japan) Sixt R (Sweden) Soroa V (Argentina) Srivastava S (USA) Stabin M (USA) Stare J (Slovenia) Sundram FX (Singapore) Szilvasi I (Hungary) Taiffeur R (Canada) Thakur ML (USA) Tonami N (Japan) Turner HJ (Australia) Vassilakos PJ (Greece) Vera Ruiz H (IAEA) Viera R (Portugal) Vinjamuri S (UK) Virgolini I (Austria) Watawana L (Sri Lanka) Wenzel K von (Namibia) Yonekura Y (Japan) Zakko S (UAE) Zanzonico P (USA) Zhang H (China)
  5. 5. World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 International Conference on Radiopharmaceutical Therapy (ICRT-2005) 11-14 October 2005 Venue: Organised by: In Collaboration with Limassol, Cyprus St Raphael Resort Limassol, Cyprus World Radiopharmaceutical Therapy Council A subsidiary body of World Federation of Nuclear Medicine & Biology (WFNMB) The Cyprus Society of Nuclear Medicine
  6. 6. December heralds the season of greetings and wishes. It is our great pleasure to invite you to theAnnual conference of Society of Nuclear Medicine(India) of the year 2005 which is scheduled for coming December 08 to 11th in Calicut, Kerala. The theme of the conference "Scroll in to the era of Fusion Imaging" has been chosen to reflect the rapid changes and the future opportunities of Nuclear Medicine in India with a global perspective. Being one of the most beautiful places on earth, Kerala promisesawonderfulexperiencetoyourexpectation. Dr.G.Rijju SecretaryGeneral SNMI2005 DepartmentofNuclearMedicine MalabarInstituteofMedicalSciences(MIMS) GovindapuramPO MiniBypassRoad Calicut-673016 Kerala.INDIA. Tel:0495-2744000 Fax:+914952741329 Mobile: 9387521555 E-mail:, Website: ForMoreDetailsContact: World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005
  7. 7. World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 A.K.Padhy Executive Editor, WJNM & Scientific Secretary-ICRT 2005 It is my great pleasure inviting you to the First International Conference on Radiopharmaceutical Therapy (ICRT-2005) being organised by the World Radiopharmaceutical Therapy Council (WRPTC). World Radiopharmaceutical Therapy Council is a subsidiary body of the World Federation of Nuclear Medicine and Biology (WFNM&B) with stake holders from all fields of nuclear medicine, several allied clinical specialties as well as from the industry including nuclear medicine physicians, radio- chemists, physicists, oncologists, rheumatologists, endocrinologists and scientists, who share research commitments to, and clinical practice in, therapeutic nuclear medicine. The major objective of the WRPTC includes setting standards for provision of radiopharmaceutical therapy, particularly in the development of uniform protocols for application worldwide. Radionuclides are being used extensively to provide palliative and curative treatment in a number of benign and malignant diseases. The potential of radionuclides for treating diseases has been recognized and put to use for the past several decades. It has been possible to exploit the physiology unique to an organ or a disease process to deliver the radionuclides selectively to the sites of abnormality. Radioiodine treatment of thyroid diseases (Thyroid cancer, Hyperthyroidism etc.), I-131 MIBG therapy of neuro-endocrine tumours, radio-immunotherapy of B-cell lymphoma, palliative treatment of metastatic bone pain using bone seeking radiopharmaceuticals, radiosynovectomy and intravascular radionuclide therapy using liquid sources of radioactivity to prevent restenosis in patients following percutaneous Tran-luminal coronary angioplasty (PTCA) have all been established in therapeutic nuclear medicine. The use of Rhenium 188 labelled compounds is rapidly increasing in the treatment of a number of benign and malignant disorders, including liver cancer (Re-188 Lipiodol), especially in developing countries. To-day radiopharmaceutical therapy is one of the fastest growing branches of nuclear medicine. However, its practice in developing countries is only beginning to gain ground after years of trailing behind its use in the developed world. The establishment and consolidation of radiopharmaceutical therapy has come about as a result of a gradual change in the realization of its importance, cost- effectiveness and practicality.Availability of new generator produced, beta emitting radiopharmaceuticals like Re-188 for use in hospital radiopharmacy facilities has also enhanced the scope and practice of radionuclide therapy using radiopharmaceuticals prepared on site within the nuclearmedicine-radiopharmacydispensaries. The objectives of this conference are to evaluate the current status of radiopharmaceutical therapy in the world in general and in the developing countries in particular, to exchange information on the current advances in the field between scientists from developed and developing countries; to interact with user groups (clinicians, oncologists, surgeons, radiopharmacists, medical physicists, etc.) and to bring them the most important informationinthefield,andtodefinefuturedirections. The Symposium will cover topics and issues on all aspects of radiopharmaceutical therapy through a number of plenary lectures, papers, panel discussions and interactive audiovisual sessions. The topics to be addressed at the symposium include reviews in therapeutic radiopha- rmaceuticals, development of new radiopharmaceuticals, clinical overviews of the current trends in radionuclide therapy, clinical applications (radionuclide therapy of primary cancers, treatment of metastatic disease, pain palliation and treatment of benign diseases like rheumatoid arthritis, haemophilic haemarthrosis, hyperthyroidism etc.), prognostication in cancer therapy, dosimetry, patient monitoring , molecular methods in radiopharmaceutical therapy, treatment planning, use of new instruments (PET/CT, dedicated cameras, hand held cameras, etc.) in radiopharmaceutical therapy planning, drug resistance, radio-immuno detection and therapy, infrastructure development , training and education. Through organization of this conference we expect to accomplish the following: 1. To carry out an evaluation of the current status of radiopharmaceutical therapy globally, 2. To help in the transfer of important information on the current trends in radiopharmaceutical therapy from developed to developing countries, 3.To publish a technical document based on the proceedings of the Symposium, 4. To promote radiopharmaceutical therapy globally in general, and in developing countries in particular and 5. To formulate a strategy document for promoting radiopharmaceutical therapy around the world. It is heartening to see overwhelming response to our efforts in the organization of this conference. We have a pre- conference registration of 175 participants and received 122 abstracts for presentation. This is considered remarkable for a conference of this type. It is also remarkable that 70% of the abstracts received are from the developing countries, which in itself is an indication that radionuclide therapy is slowly but steadily being accepted as a treatment modality in many parts of the developing world. It is expected that International organizations like Editorial Therapeutic Nuclear Medicine: It is time to act S-1
  8. 8. World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 WFNMB, IAEA, WRPTC, SNM, EANM, ALASBMN, A O F N M B a n d A R C C N M a s w e l l a s t h e radiopharmaceutical industry would rise to the occasion and take full advantage of this increasing awareness of therapeutic nuclear medicine. It is the time to act and provide the necessary impetus to this ever expanding branch of nuclear medicine. It is expected that meaningful discussions will be held in Cyprus during the conference and a solid road-map be created for the growth and development of radionuclide therapy in a global scale. This supplementary issue of the World Journal of Nuclear Medicine contains most of the abstracts of scientific papers and invited lectures to be presented at the ICRT-2005. The abstracts have been edited and formatted to the extent considered necessary for readers' assistance. The views expressed/ implied and the general style adopted remains however, the responsibility of the authors. I have really enjoyed immensely organizing this conference as its scientific secretary and I hope that we are going to have a wonderful time in Limassol celebrating ICRT-2005. Ajit Kumar Padhy S-2
  9. 9. Scientific Programme Monday: 10 October 2005 Tuesday: 11 October 2005 Time Abstract Title of Presentation Authors No. 0900-1600 Registration, as participants start arriving in Cyprus 1900-2200 Pre-conference get-together 0800-1600 Registration 0900-1030 Scientific Session-I: General Chairpersons: Hoefnagel C (The Netherlands), K. Kouris (Cyprus) USA-114 Future Directions in Bone-Localizing Srivastava S Therapeutic Radiopharmaceuticals USA-112 Therapeutic Applications of Rhenium- Knapp, Jr., F. F. 188 in Nuclear Medicine and Oncology - (Russ) Current Status and Expected Future Perspectives USA-117 Advances in targeted radioisotope Divgi C therapy in cancer. 1030-1100 Tea/ Coffee 1100-1300 Scientific Session-II: Thyroid-1 Chairpersons: San Luis TOL (Philippines), J. Kropp (Germany) UK-105 Radionuclide therapy of S. Vinjamuri Hyperthyroidism: An over view RSA-085 Treatment of Hyperthyroidism with Ellmann A Radioiodine: comparison of the efficacy of low, medium and high doses of I-131, with special emphasis on the socio- economic issues related to the treatment PHI-072 Therapeutic Options in the Management Barrenechea E et al. of Autonomously Functioning Thyroid Adenomas. CZR-021 Our experience with radioiodine therapy Kraft O of thyroid functional autonomies LAT-059 ¹³¹I therapy for euthyroid goitre in Berzina A et al. Latvia. MAL-063 Role of antithyroid drug treatment prior Das BK et al. to radioiodine therapy in hyperthyroidism IND-046 Incidence of micronuclei as biological Senthamizhchelvan dosimetry in differentiated thyroid S et al. carcinoma patients treated with 131I SLO-095 Recombinant Human TSH (rh TSH)- Schwarzbartl-Pevec aided radioiodine therapy in patients A et al. with differentiated thyroid carcinoma: Results 2002-4 Programme S-3 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005
  10. 10. Time Abstract Title of Presentation Authors No. Posters: Brief Reports BOH-123 Effect of radioiodine therapy on thyroid Rajkovca Z et al nodule size in patients with toxic adenomas BGD-010 Design & Development of a Lead Jar for Rahman Miah S et oral administration of radioiodine in al. hyperthyroid patients. IRA-052 Comparative Evaluation of the Two Esfahani AF et al. Fixed Dose Methods of Radioiodine Therapy (185 MBq and 370 MBq) for the Treatment of Graves' Disease. SER-087 Is drug-free period prior to radioiodine Han R et al. therapy decisive for treatment outcome in patients with multinodular toxic goitre? POL-078 A Retrospective Assessment of the Budlewski T et al. Effectiveness of Radioiodine Treatment of Hyperthyroid Patients from 1997 to 2003 in the North-Eastern Region of Poland. IND-048 Radioactive iodine (I-131) in treatment Sood A et al. of hyperthyroidism in Hilly Terrain Initial Experience. BGD-011 Radioiodine treatment for complicated Paul AK et al. hyperthyroidism using a fixed dose regime. CPR-020 Study of the therapeutic dose and the Dang Y et al. clinical effect on Graves' disease with 131I treatment LIT-060 Is it worth to calculate the dose of Mikalauskas V et al radioiodine? BGD-007 Experience and outcome of radioiodine Rahman Miah S et therapy in hyperthyroidism al. MON-064 Iodine-131 Therapy for the Treatment of Enkhtuya B et al. Hyperthyroidism 1300-1400 Lunch 1400-1600 Scientific Session-III Solid Tumour and Miscellaneous Therapy Chairpersons: B.A. Krishna (India), F.F. Knapp (USA) UK-103 Radiolabelled Aptamers for tumour A. Perkins imaging and therapy UK-100 Problems with antibody treatment of solid tumours Buscombe J GER-032 Intracoronary radiation therapy: Placebo Kropp J controlled study A Report. URU-111 Intravasular Radionuclide Therapy to Alonso O et al. prevent restenosis following PTCA JAP-057 Effect of Auger Electrons Internalized as Watanabe N et al. Indium-111 Labelled N-MYC Phosphorothionate Antisense Oligonucleotide (In-111-N-MYC-AS) on Human Neuroblastoma Cells: In vitro and In vivo studies S-4 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  11. 11. Time Abstract Title of Presentation Authors No. Posters: Brief Reports IRA-056 Dose calculations of 186Re for Taghizadeh-asl M et production and feasibility of use to al. intravascular brachyherapy after coronary Angioplasty POR-082 Therapeutic Radiopharmaceuticals Neves M et al. UK-106 Radioimmunotherapy of Pancreatic S. Vinjamuri cancer with monoclonal antibodies BGD-006 Studies of therapeutic effects of Beta- Afroz S et al. radiation on Onchomycosis. IND-039 188 Re(V)DMSA -PLGA micro-spheres Shukla J et al. for targeted therapy of neurogenic tumors GRE-034 Labeling of a Bombesin analog with Koumarianou E et Rhenium-186 al. IND-050 A single vial method of preparation of I- Snehlata et al. 131 MIBG IND-051 Tele consultation and tele follow up of Pradhan PK et al. thyroid cancer patients A pilot study POL-079 Intravascular radionuclide therapy using Birkenfeld B et al. Re-188 Perrhenate to prevent re-stenosis following PTCA: Initial Experience in Poland SLO-096 Another case of metastatic malignant Žagar I et al. Struma Ovarii? A case report of good response to radioiodine therapy. UKR-108 Radionuclide therapy of true Afanasieva NI et al. polycythaemia SER-088 32-P Orthophosphorus in the Treatment Jaukovic L et al. of Polycythaemia Vera and Essential Thrombocythaemia BGD-013 Post-operative beta-irradiation in the Jehan AH et al. management of pterygium BGD-012 Use of strontium-90 beta irradiation as Nisa L et al. an adjunctive therapy for the management of squamous cell carcinoma of the conjunctiva POL-080 Sentinel Lymph node mapping and Birkenfeld B et al. detection in patients of melanoma: Role in prognosis PHI-076 Incremental value of nitrate Duldulao M et al. enhancement in Tc99m Sestamibi myocardial perfusion imaging with SPECT in patients with coronary artery disease and previous myocardial infarction AZB-005 Distant gammatherapy results of patients Shiraliyev OK et al. with esophagus cancer S-5 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  12. 12. Time Abstract Title of Presentation Authors No. 1600-1730 Scientific Session-IV: Thyroid-2 Chairpersons: A. Perkins (UK), A. Staudenherz (Austria) CZR-023 International cooperation in the Kraft O et al. treatment of patients with differentiated thyroid cancers. IND-047 Optimizing the indications for Choudhury PS et al. radioiodine therapy as an adjuvant treatment in differentiated thyroid carcinoma. CPR-019 Retinoic acid in patients with Zheng R et al. radioiodine non-responsive differentiated thyroid carcinoma. ROM-083 Radioiodine therapy of differentiated Gherghe M et al. thyroid cancer in patients with negative diagnostic I 131 scintigraphy and high serum thyroglobulin level IND-043 Treatment of differentiated thyroid Krishna BA et al cancer using Recombinant TSH injection AUS-004 Statins As A New Therapeutic Approach Hofmann A et al. In Dedifferentiated Thyroid Cancer? A Case Report PHI-075 Prospective Randomized Trial for the Barrenechea EA et Evaluation of the Efficacy of Low Vs. al. High Dose I-131 for Post Operative Remnant Ablation in Differentiated Thyroid Cancer BUL-016 99mTc-MIBI and 131I scintigraphy in the Sergieva S et al. follow-up of differentiated thyroid carcinoma (DTC) patients after surgery. Posters: Brief Reports PHI-073 The Value of PET in DTC with Barrenechea EA et Negative WBS but Elevated al. Thyroglobulin levels IRA-055 Study of ablation efficiency of 3600 Takavar A et al. MBq of I-131 in the Treatment of Thyroid Carcinoma UKR-107 Sialoscintigraphy with 99m Tc- Korol P pertechnetate in evaluation of salivary gland function in patients with differentiated thyroid cancer after radioiodine therapy IRA-053 The Rate of Depression and its Risk Eftekhari M et al. Stratification in Patients With Differentiated Thyroid Cancers Treated With Radioactive Iodine BGD-008 Success of Repeated I-131 Therapy in Alam F et al cases of Metastatic Differentiated Thyroid Carcinoma S-6 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  13. 13. Time Abstract Title of Presentation Authors No. Wednesday: 12 October 2005 Thursday: 13 October 2005 IND-040 Our experience with the treatment of Anand YNI et al. 155 cases of carcinoma of the thyroid IND-049 Evaluation of medullary carcinoma Krishnakumar R thyroid. IND-044 Our Experience of High Dose I-131 Dougall P et al. Therapy in 75 patients with Well Differentiated Carcinoma Thyroid Followed Up Over 5 years UKR-109 Up to date programme of treatment and Afanasieva NI et al. long-term follow-up of the patients with differentiated thyroid carcinoma PER-071 Influence of T-3 produced by metastatic Mendoza G et al. thyroid tissue on I-131 treatment outcome. BGD-014 Second malignancies following the Yashmin S et al. treatment of differentiated thyroid carcinoma with radioiodine SRL-097 Radioiodine (I131) application in the Nanayakkara D management of differentiated thyroid cancer (DTC) Audit IND-045 Air Monitoring in Radioiodine Therapy Sarika et al. Ward 1900 Opening Ceremony Followed by: Gala Dinner 0800-1200 Pre-lunch Guided educational tour of Cyprus 1200-1400 Lunch at a Fish Taverna Scientific Session-V Luncheon Meeting : Special Session on WRPTC Chairpersons : Turner H (Australia), S. Srivastava (USA) Brainstorming : WRPTC: How to proceed from here, New Ideas, Future Directions (All Participants) 1400-1800 Post-lunch Guided educational tour of Cyprus 0830-1030 Scientific Session-VI: Bone Pain Palliation & Miscellaneous Chairpersons: A. Ellmann (S. Africa), E. Barrenechea (Philippines) USA-118 The role of imaging in planning therapy C. Divgi in cancer. S-7 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  14. 14. Time Abstract Title of Presentation Authors No. UK-104 C-595 Antibody: A potential vector for A. Perkins targeted alpha therapy GER-028 Radionuclide therapy in palliative Liepe K treatment of metastatic bone disease: Review IND-038 Sm-153 EDTMP therapy for bone pain Tripathy M et al palliation in skeletal metastases: AIIMS Experience. PAK-068 Formulation and evaluation of Beta- Muhammad S et al emitting radionuclide labelled EDTMP for bone pain palliation. ROM-084 Use of Sr-89 for bone pain palliation: Mititelu R et al. Experience in our department. PER-070 Impact of educational strategies in Seminario C et al. positioning Samarium-153 EDTMP as a treatment for pain due to bone metastases. LIT-062 Bone pain palliation with strontium-89 Tiskevicius S et al in cancer patients with bone metastases GRE-036 Comparative Study of Skeletal Papanikolos G et al. Dosimetry Methods in Therapeutic Schemes with Re186 HEDP and Sm 153 EDTMP Posters: Brief Reports POL-081 188W/188Re generator as a convenient Mikolajczak R et al. source of 188Re perrhenate solution and a kit for preparation of 188Re-HDEHP IRA-054 Strontium-89 in Palliative Treatment of Haddad P et al. Widespread Painful Bone Metastases: Response Rate and Duration UKR-110 Combination Radiation Therapy for Afanasieva NI et al. Bone Metastases in Thyroid Cancer SLO-093 Radionuclide Therapy in Slovenia Fettich J DOM-024 Radiopharmaceutical Therapy in de los Santos JO Dominican Republic. Present and Future UZB-121 Nuclear Medicine in Uzbekistan & Rasulova N et al. Current status of Radionuclide therapy in the country EGY-025 Osteosarcoma target therapy with stem Fawzy A cell transplant A case review 1030-1100 Tea/ coffee 1100-1300 Scientific Session-VII: Radiosynovectomy Chairpersons: AH Elgazzar (Kuwait), P. Bernal (Colombia) GER-030 Radiosynovectomy; A Review Liepe K VEN-122 Radiosynoviorthesis Fernando Palazzi F BRA-015 Use of Samarium 153 Hydroxyapatite Anselmi OE et al. for intra-articular therapy S-8 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  15. 15. Time Abstract Title of Presentation Authors No. PHI-074 Comparative evaluation of the efficacy Barrenechea EA et of radiosynovectomy with conventional al. intra-articular therapy in rheumatoid arthritis and haemophilic arthropathy (CERAHA) ALG-001 Use of radiosynoviorthesis with Y-90 in Bouyoucef SE et al. the treatment of Persistent knee hydarthrosis SLO-094 The Efficacy of Radiosynoviectomy in Grmek M et al. Hemophilic Hemarthrosis According to the Frequency of Joint Bleedings IND-037 Radiation synovectomy versus intra- Solav S articular steroid treatment in inflammatory arthritis Posters: Brief Reports MON-066 Radiation synovectomy with 188Re-tin Erdenechimeg S et colloid in histological study al. ARG-002 Two-year results of radiosynovectomy Soroa V et al in knee-joints of Hemophilic patients using locally developed P-32 colloid. SLK-092 Evaluation of the Efficacy of Vereb M et al. Radiosynovectomy in Rheumatoid Arthritis and Haemophilic Arthropathy (CERAHA): First Results of an IAEA Co-ordinated Research Project (CRP) EST-026 Radiosynovectomy: first results in Nazarenko S et al. Estonia CZR-022 Our experience with radiosynoviorthesis Kraft O et al. and re-radiosynoviorthesis of knees. IND-041 Comparison of musculoskeletal USG Ray S et al. and radionuclide soft tissue scintigraphy in the evaluation, selection and follow- up of patients for radiosynoviorthesis 1300-1400 Lunch 1400-1600 Scientific Session-VIII: Lymphoma/ Other Haematological Malignancies and Liver Cancer Chairpersons: H. Amaral (Chile), J. Buscombe (UK) USA-120 Role of Radionuclides in Therapy of Wiseman G Haematologic Malignancies. SIN-091 Radioimmunotherapy of Refractory B- Sundram FX Cell Lymphoma GER-033 Radionuclide Therapy of B-NHL with Kropp J 90-Y-Epratuzumab: A report of the multi-centre trial AST-003 I-131 Rituximab (chimeric anti CD 20 Turner JH Mab) radioimmunotherapy of non- Hodgkins lymphoma S-9 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  16. 16. Time Abstract Title of Presentation Authors No. IND-042 Impact of FDG-PET imaging in the Krishna BA treatment of Lymphomas: Indian experience UK-101 Radionuclide treatment of Liver Cancer Buscombe JH using I-131 Lipiodol A review UK-102 Use of Y-90 lanreotide and Y-90 Al-Nahhas A microsheres in treatment of liver tumours. SIN-090 Experimental therapy with P-32 for Goh A et al. hepatoma COL-018 Radionuclide treatment of Liver Cancer Bernal P et al. using Re-188 Lipiodol Posters: Brief Reports PAK-069 Trans-Arterial Radioconjugate Asghar S et al. Radionuclide Therapy For Hepatocellular Carcinoma; Feasibility & Applications In Pakistan PHI-077 Radionuclide treatment of Liver Cancer San Luis TOL et al. using Re-188 Lipiodol: Experience in Philippines SER-086 Possible Role of the Scintigraphic Artiko V et al. Estimation of the Relative Liver Perfusion in the Choice of Treatment of Liver Carcinomas. SIN-089 [Re(CO)3]-Chelates as Therappeutic Saw MM et al. Radiopharmaceuticals for the treatment of Hepatocellular Carcinoma MON-065 Treatment of HCC with Re-188 lipiodol Erdenechimeg S Initial experience in Mongolia THA-098 First Experiences in 90Y-Zevalin For Saesow N et al. Treatment of Non-Hodgkin's Lymphoma in Thailand. 1600-1730 Scientific Session-IX: Neuro-endocrine Tumours Chairpersons : M.C. Lee (Korea), V. Soroa (Argentina) UK-099 Pathophysiology and non-radionuclide therapy of neuroendocrine tumours Buscombe J GER-029 Peptide Receptor Radionuclide Therapy Baum R (PRRT) of Neuroendocrine Tumors Using Y-90 and Lu-177 Labeled Somatostatin Analogs: Principles, Technique and Clinical Results after 500 Treatments NET-067 Interventions in 131I-MIBG treatment of Hoefnagel CA neuroendocrine tumours GRE-035 Patient specific dosimetry of I-123 Lyra M et al. MIBG in diagnosis for improvement of dose estimation in I-131-MIBG adrenal tumours therapy S-10 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  17. 17. Time Abstract Title of Presentation Authors No. Friday; 14 October 2005 GER-031 Peptide Receptor Radionuclide Therapy Wehrmann C et al. (PRRT) of Neuroendocrine Tumors: First Comparative Results using the Somatostatin Analogues Lu-177 DOTA- NOC and Lu-177 DOTA-TATE Posters: Brief reports CHI-017 Peptide receptor radionuclide therapy Amaral H with Y-90 DOTATOC (Somatostatin analogue) in neuroendocrine tumours: The Chilean Experience LIT-061 Somatostatin receptor imaging and Kulakiene I et al. therapy an ever expanding choice EST-027 Our first experience in the application of Samarina G et al. 131I-MIBG in a patient with neuroblastoma (case report). BGD-009 Targeted therapy of neuroblastoma with Hussain R et al. I131 -MIBG: experience of 15 cases. 1930 Dinner & Cyprus Night 0830-1030 Scientific Session-X : Development of new radiopharmaceuticals, Intracellular targeted therapy and Molecular Imaging in Radionuclide Therapy Chairpersons: Baum R (Germany), Nazarenko S (Estonia) USA-113 Therapy with High LET Radioisotopes Knapp, Jr., F. F. Can Sufficient Levels of Attractive (Russ) Auger and Alpha Emitters be Produced to Make Their Use Practical? USA-116 Development and Evaluation of High Cutler CS et al Specific Activity Radioisotopes for Radiotherapy KOR-058 Role of PET for monitoring the Lee MC therapeutic response USA-119 Incorporating FDG PET Imaging in the Wiseman G Response Criteria for Non-Hodgkin's Lymphoma USA-115 Radiolabeled Adenoviral Sub-Unit Srivastava S Proteins for Molecular Imaging and Therapeutic Applications in Oncology 1030-1130 Closing S-11 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Programme
  18. 18. 001-ALG Use of Radiosynoviorthesis with Y-90 in the Treatment of Persistent Knee Hydarthrosis 1 2 3 3 Bouyoucef SE , Henni-Haddam F , Sellah M , Aouli S , 1 1 3 2 Benlabgaa R ,Hanzal A , Mansouri B , Abtroun S ; 1 Department of Nuclear Medicine, CHU Bab El Oued, Algiers; 2 Department of Rhumatology, CHU Bab El Oued, Algiers; 3 DepartmentofRadiology,CHUBabElOued,Algiers,Algeria 002-ARG: Two-year Results of Radiosynovectomy in Knee-joints of HemophilicPatientsUsingLocallyDevelopedP-32Colloid. Soroa V, Velázquez Espeche MH, Giannone C, Caviglia H, Galatros G, Nicolini JO Centro de Medicina Nuclear, Comisión Nacional de Energía Atómica Argentina, Buenos Aires, Argentina; Traumatology & Orthopedics, Htal. Municipal J. A. Fernández, Hemophilic Foundation, Buenos Aires, Argentina; Radiopharmacy, Lab. Bacon, BuenosAires,Argentina. The objective of this study is to determine the treatment success rates and factors predicting successful outcome when using yttrium-90 intra articular injections as treatment of persistent knee hydarthrosis refractory to other treatments. 68 patients, 41 with rheumatoid arthritis, 9 with ankylosing spondylarthritis, 6 with Behcet disease, 6 with psoriatic arthritis, and 6 patients with gonarthritis, with a total of 121 knees have been treated byYttrium 90 (Y90) for a persistent hydarthrosis. Mean duration of the knee effusion was 4.85 years(range 1 to 20 years) and mean number of intra articular steroid injection was 3.85 (range 1 to 20 steroid injections).According radiological classification of Steinbrocker, 68 knees were in stage I and 53 were in stage 2. Pain, mobility, volume effusion and needs to further intra articular steroid injection were the main parameters to evaluate the outcomes of the radiosynovectomy. Outcomes were assessed for each patients as 'excellent improvement', 'good improvement', 'fair improvement' or 'not improved' by review of the case notes at 3, 6,12,18,24 months. Excellent and good outcomes were equal to 63.2% at 3 months, 66% at 6 months, 65.9 % at 12 months, 59% at 18 months and 53% at 24 months. By aetiology, best score, for excellent and good outcomes, was observed for Behcet disease(100% at 12 and 24 months) and for rheumatoid arthritis (83% at 6 months). Best outcomes were also obtained when knees are classified at radiological stage 1 ( 66% at 6 and 12 months) and when knee effusion duration is inferior to 2 years ( 78% at 12 months). No significant improvement was observed for knees at stage 2 and ankylosing spondylo-arthritis (49% with no improvement at 6 months). Radiosynoviorthesis treats successfully patients with persistent knee effusion refractory to other therapies. Patients with Behcet disease and rheumatoid arthritis, less destructive radiographic changes, shorter duration of joint disease, tend to respondmorefavourablyandhavegoodoutcomes. The aim of this study was to assess the effects of radionuclide treatment of haemophilic arthropathy of knee joints refractory to conventional medical therapy with the locally developed P-32 colloidal suspension inArgentina, and compare the results with those of chemical synovectomy, and to assess the cost/ effective aspects of radiosynovectomy. It may be noted that other imported colloidal radiopharmaceuticals like Y-90 citrate, Re-186 sulfide or Er-160 citrate are expensive in Argentina. On the other hand we have the technology to prepare Ho-166 macro-aggregates inArgentina, but the radiopharmaceutical has not been approved for use on humans by the country'sregulatoryauthorities. Radiosynovectomy was performed using P-32 colloid in 58 male hemophilic patients, ages ranging from 4-52 years. Nine patients had re-treatments either in the same or in the contralateral knee, making it a total of 67 procedures in the study. In adults, a dose of 37-74 mCi was used, while 33% of this dose was used in children between 2-6 years, 50% in children between 6-10 years and 75% in children between 10-16 years of age. Patients with Grades II & III arthropathies were included in the study. Informed consents from adults and from the parents of children were obtained. Patients with large Bakers cyst, grade IV arthropathy, infection in the skin around the joint area and bleeding at the time of the procedure were excluded from the study. Documentation clinical history and AHF therapy was done in all cases. All patients underwent three phase bone scans before therapy and after therapy at 1, 3 6, 9 and 12 months. If required, joint aspiration was carried out. P-32 Bremsstrahlung emission was used in the scintigraphies for early and late imaging to confirm the presence or absence of leakage. All patients were subjected to immobilization of the treated joints and relative rest for a period of 72 hours following therapy. There were no local or systemic adverse effects following treatment. No leakage of radioactivity was detected in any of our patients. Intraarticular Rifampicin procedure required frequent injections. The follow-up evaluation demonstrated significant improvement of joint motion, diminished knee volume and less requirement and frequency of the use ofAnti-haemophilic Factors (AHF) in 80% of patients subjected to radiosynovectomy (54 /67 procedures), thus lowering treatment costs. Remission Indices (rate of change of lesion activity over time) calculated over the treated joints using sequential Tc-99m MDP soft tissue scintigraphy revealed significant reduction of lesion activity objectively. Overall it has been observed that one intra-articular knee radiosynovectomy procedure using P-32 colloid in patients with haemophilic arthropathy could provide relief from symptoms for a period of 3-6 months. We have found radiosynovectomy to be safe and cost-effective and recommend its use as an alternate therapeutic procedure where availability of AHF is difficult and expensive. Commercially available anti-CD 20 monoclonal antibody, rituximab (MabThera®) may be efficiently radioiodinated with 131I using standard Chloramine-T methodology in a hospital radiopharmacy, under appropriate regulatory authority approvals. Multicentre clinical trials of 131I-rituximab radioimmunotherapy have been performed in patients with relapsed or refractory low grade non-Hodgkins lymphoma with therapeutically effective administered activities being determined on the basis of individualised prospective patient dosimetry. A non- myeloablative regimen of 131I-radioimmunotherapy predicated upon a maximum prescribed dose of 0.75 Gy to whole body has been used to minimise myelotoxicity in patients undergoing radioimmuno-therapy, even when they have been heavily pretreated with chemotherapy and/or there is tumour infiltration of bone marrow greater than 25%. Provided that baseline leucocytes exceeded an absolute neutrophil count of 1.5 x 109/L and platelets > 100 x 109 /L, the incidence of grade IV haematological toxicity was 16% for neutrophils and 4 % for 003-AST I-131 Rituximab (Chimeric Anti Cd 20 Mab) Radioimmunotherapy of Non-Hodgkins Lymphoma Turner JH, The University of Western Australia, Fremantle Hospital,Alma Street, FremantleWA6160Australia S-12 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  19. 19. World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 platelets which was self-limited. The red marrow radiation absorbed dose in selected patients receiving 131I activities estimated to deliver 0.75 Gy to whole body was calculated to be less than 2 Gy using Monte Carlo methodology on post therapy CT/SPECTimaging. Predictive dosimetry was performed by serial whole body imaging following IVadministration of a standard 200 MBq 131I- rituximab tracer and determination of individual pharmacokinetics of the radiolabelled antibody in each patient. A standard dose of 375 mg/m2 unlabelled rituximab (MabThera®) was administered IV immediately prior to the tracer and therapy doses of 131I-rituximab to minimise nonspecific uptake of the radiolabelled antibody and to optimise the tumour to background activity. The administration of a standard course of 4 cycles of cold rituximab (MabThera®) in association with the prescribed maximum activity of 131I-rituximab constitutes radioimmunotherapy rather than antibody-targeted internal radiotherapy. Such treatment in 90 patients with relapsed/refractory follicular (grade I, II, III) (78) MALT (5) and small lymphocytic (7) lymphoma with 3 (1-8) median prior chemo-therapies, 60% stage III/IV, resulted in complete remission (CR) in 51% and partial response (PR) in 23% for an overall response rate (ORR) of 74%. In contrast to radiolabelled murine antibodies, the 131I-rituximab chimeric monoclonal antibody does not cause any immunogenic HAMA host response and repeated courses of 131I-rituximab radioimmunotherapy may be given for subsequent relapse. The median duration of response was 22 months in our patients who achieved CR and retreatment was performed in 8 patients, the majority of whom responded again to the repeat 131I-rituximab radioimmunotherapy. Median progression-free survival in our patients was 13 months and the 4 year actuarial survival of all our treated patients after 131I- rituximab radioimmunotherapy for non-Hodgkins lymphoma was 63%. Non-myeloablative radioimmunotherapy of mantle cell non- Hodgkins lymphoma with 131I-rituximab showed CR in 2 of 8 patients, but the reported results of myeloablative regimens and autologous stem cell rescue demonstrate CR in 6 or 7patients after 131I-rituximab treatment. Indolent non-Hodgkins lymphoma which transforms into more aggressive forms may also be treated with a myeloablative regimen combining standard dose 131I- rituximab radioimmunotherapy with BEAM chemotherapy for conditioning prior to stem cell autograft at 16 days. Three patients with transformed non-Hodgkins lymphoma treated with 131I- rituximab, BEAM chemotherapy and stem cell rescue all achieved CR of duration of at least 12 months. Refractory or relapsed aggressive non-Hodgkins lymphoma such as DLCBLmay also be treated with nonmyeloablative protocols complemented by long- term consolidation and maintenance MabThera immunotherapy, currently in clinical trial. Greater experience has been obtained with 131I tositumomab (Bexxar® ) in both marrow sparing radioimmunotherapy of relapsed and first line treatment of low grade non-Hodgkins lymphoma and in myeloablative protocols of radioimmunotherapy of aggressive or refractory non-Hodgkins lymphoma with bone marrow transplantation. This clinical experience with radioiodinated murine anti CD 20 Mab radioimmunotherapy will be compared with that of 131I- rituximab chimeric antibody radioimmunotherapy of non- Hodgkinslymphoma. 004-AUS Statins As A New Therapeutic Approach in Dedifferentiated ThyroidCancer? ACaseReport A. Hofmann, P. John, M.P. Schaffarich*, H. Sinzinger, A. Staudenherz Univ. Clinic of Nuclear Medicine, Medical University of Vienna, Austria & *Centre for Biomedical Engineering and Physics, MedicalUniversityofVienna 005-AZB Distant Gammatherapy Results of Patients With Esophagus Cancer. Shiraliyev O.K., Beibutov Sh.M., Quilieva A.O., Nasirova F.J. Dept. of Nuclear Medicine, Republic Diagnostic center & Azerbaijan, Dept. of Nuclear Medicine, National Cancer Centre, Azerbaijan In general differentiated thyroid tumours are removed surgically and afterwards treated with radioiodine. However, still about one third of patients with differentiated tumours, metastasise. Also 30 percent of recurrent thyroid carcinomas do not respond to iodine treatment due to loss of differentiation. Retinoic acid, biological metabolites of vitamin A, are considered to induce re- differentiation of the thyrocyte and thereby induce tumor regression. In follicular carcinoma cells, it also plays an important role in inducing iodine uptake. Retinoids, however, cannot be used in liver disease as they may induce hepatic enzyme increase. In addition 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are reported to induce on the one hand cellular apoptosis and on the other hand, in a lower dosage, differentiation in anaplastic thyroid carcinoma cells in vitro. We are presenting a 79 years old female patient with an oxyphilic follicular thyroid carcinoma and histologically verified autoimmune hepatitis.The first posttherapeutic scan, showed only focal cervical localized ioidine uptake. Also 3 months later no pathologic iodine uptake was recognized on the diagnostic scan, whereas the FDG-PET showed solid uptake of FDG cervical, in both lungs, in the mediastinum, the pelvis and the right hip. Due to contraindication for retinoic acid the patient was treated with usual dose statin for about 4 weeks to induce re-differentiation. Following, the patient was administered 9,25 GBq I-131 again and the posttherapeutic scan showed iodine uptake cervical and in the rightfemur. We conclude that the administration of Statins, at low dose (20 mg/day) even over a short period of time, only may induce re- differentiation as well as an antiproliferative effect in vivo The problem of esophagus cancer therapy gains the particular meaning for Azerbaijan where this disease incidence exceeds the parameters of neighboring countries by almost two times. 1240 patients with esophagus cancer were under our observation for more than 15 years who had been subjected to the distant static gamma therapy on apparatuses “Agat-R” and “Rockus M”. there were 732 men (59 % )and 508 women (41 %) . The patients' age ranged from 24-88 years. Disease duration since the appearance of the first symptoms till entering to the department was 4-8 months on the average. Esophagus cancer is often localized in the places of the physiological stenosis. So tumour was lacalised in the neck region esophagus in 45 patients (4.1%), in upper pectoral in 104 ones ( 9.5%), in middle pectoral in 594 ones (54.5%) in lower pectoral in 299 ones (27.4%) in abdominal regions of esophagus 48 S-13 Abstracts: ICRT-2005
  20. 20. patients(4.5%).The extent of dimensions of tumour esophagus was ranged within 2-13 cm, only it was less than 5 cm in 6.5% patients. The opportune surgical treatment ensures the perfect recovery. However, the early stage of the disease can develop st asymptomatically. The patients with the 1 stage of lesion were nd rd only 8 (0.8%) with the 2 one 408(37.4%), with the 3 one th 607(55.7%), with the 4 one 67(6.1%). Radiation therapy was applied in the cases of inoperable and also in patient who were older than 60 or refused operation. 1090patients (88%) finished the treatment course. Local summary doses have formed 50-70 Grey , the momentary ones-2-2.5 Grey on the medium. The rest of thepatientshaven'tfinishedthetreatmentduetoseveralreasons. The results of the treatment are as follows: We observed clinical cure in 389 patients (35.7%) , an improvement in 541 (499%), the process stabiliation or an absence of effect in 160 (14.3%). 40.1% of patients lived for more than 1 year, 18.4% for more than 2 years,12.0% for more than 3 years and 7.0% for more than 5years. It was established that the best results were obtained in case of tumourlocationinthemiddleandlowerregionsofesophagus. We concluded that radiation has a palliate effect with the temporary stabiliztion, partial or nearly complete regression of tumour in most patients and saves a lot of patients suffering from the severe symptoms. Radiation treatment of esophagus cancer is recommendedasaroutineinoncologicalestablishments. Onychomycosis is the most frequent cause of nail disease and the most prevalent type of dermatophytosis in Bangladesh.The humid and warm climate of this tropical country is congenial for the growth of fungi. Therapeutic limitations of conventional antimycotic agents in respect of low cure rates, high relapse rate, inherent side effects, long duration of treatment and high cost in treating onychomycosis have provided clear incentives to explore alternative forms of treatment procedure. The objectives of the present thesis work were: (i) To use beta radiation as a curative therapy for Onychomycosis, optimisation of its dosages and to promote an innovative clinical development in the field of therapeutic applicationofnuclearmedicine (ii) To assess the efficacy of beta radiation either alone or in combinationwithconventionalantifungaltherapy;and (iii) To reduce the duration of drug exposure and cost of treatment foronychomycosis. This is a PhD research work under the University of Dhaka and was sponsored by the Ministry of Science and Information & CommunicationTechnology, Government of the people's republic of Bangladesh. This study is an open, randomised and controlled trial to verify the efficacy of beta radiation in patients with onychomycosis. Using the appropriate statistical formula, sample size of the study population was determined and in each group 92 patients were assigned. With an assumption of patients drop out and for better statistical analysis, a total of 330 patients, who fulfilled the inclusion criterion having diagnosed to have onychomycosis clinically and mycological were randomly allocated to enter in therapeutic regimen. Study population was 006-BGD Therapeutic Effect of Beta Radiation on Onychomycosis an InnovativeTreatment Afroz S, Islam N, Rashid H, Shahidullah M, Ali S, Islam S K M, HossainS, AliN Centre for Nuclear Medicine & Ultrasound, Dhaka Medical CollegeHospital,Dhaka-1000,Bangladesh randomised in three groups. Group A (n =110) received griseofulvin orally 500mg once daily for 12-16 weeks; Group B (n=110) received beta radiation, 500 rads bi-weekly for 3 weeks (total 2500 rads); and Group C (n=110) received combined beta radiation (total 2500 rads in 3 weeks) and griseofulvin (500 mg daily for 6 weeks). Patients were followed up for 24 weeks. Efficacy of the treatment was evaluated in all 287 patients while 43(13.03%)casesweredroppedoutfromtheinitialallocation. At the end of the follow up period (6 months after discontinuation of treatment) mycological cure rate was achieved 41 (42.70%), 36 (38.70%) and 65 (66.33%) in Group-A, Group-B and Group-C respectively. The mycological cure rate was highly significant (P=0.000) and considered to be the acceptable outcome of treatment. Clinical cure rate was considered as another way of assessment. Percentage of clinical cure rate was similar as mycological cure rate and equally significant (P=0.000). Recurrence rate of the disease was highest in griseofulvin-induced patients 21 (21.88%) and in beta radiation exposed patients was 14 (15.06%). This rate was least in combination therapy group of griseofulvin and beta radiation 4 (4.08%). Cure rate in Group C is significantlyhigherthanGroup AandBaswell(P=0.000). Several known side effects causing systemic involvement of oral drugs are already being experienced, side effects like blackening of surrounding soft tissue of nail were observed which were transient and self-limiting. Further to this, all sample population underwent for biochemical and haematological tests pre and post radiation application. No significant change of tests results were observed excluding any observable radiation side affects to this particular type of radiation application. It can be concluded that the proposed new beta radiation treatment modality for onychomycosis exhibited a low risk- benefit ratio. It is well-tolerated and efficacious method to treat onychomycosis. From the observations of the present study it may be considered worthy to comment that in Group C as the cure rate is highest, recurrent rate is the lowest, duration and cost of treatment are significantly less, this modality of treatment can be considered as the more acceptable procedure for management of onychomycosis in a developing country like Bangladesh. Group B (beta radiation only) can also be accepted in special occasions to replaceGroup A(Antifungal). This innovative treatment procedure could be introduced in other Nuclear Medicine Centres of the country with a view to expand the procedure, so that large number of patients could be beneficiary as endusers. 1 Afroz S . Director, Centre for Nuclear Medicine & Ultrasound, 2 Dhaka Medical College and Hospital (DMCH); Islam N . Professor and Chairman, Department of virology, BSSMU, 3 Dhaka; Rashid H . Principal Physicist, Centre for Nuclear 4 Medicine & Ultrasound-DMCH; Shahidullah M , Professor and Head, Department of Dermatology and veneriology-DMCH, Ali 5 S . Professor of Biochemistry, BSMMU & Member Public 6 Service Commission, Islam S K M .Associate Professor, Dept. of 7 Microbiology, SSMCH, Hossain S . Associate Professor, Centre 8 for Nuclear Medicine & Ultrasound-DMCH;Ali N . Biochemist, DepartmentofBiochemistry-DMCH. S-14 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  21. 21. 007-BGD Experience and outcome of Radioiodine Therapy in Hyperthyroidism Miah SH, PaulAK, Rahman HA Centre for Nuclear Medicine & Ultrasound, Khulna, Bangladesh Radioiodine is being increasingly used in the treatment of hyperthyroidism. The primary reasons for choosing radioiodine therapy are its effectiveness, ease of administration, relatively low cost and paucity of side effects. Here we presented our experiences and outcome of radioiodine therapy in hyperthyroidism in a divisional referral centre.We retrospectively analyzed 203 patients receiving radioiodine therapy for hyperthyroidism in Centre for Nuclear Medicine & Ultrasound, Khulna during the period from July 1994 to June 2004. All the patients had clinical signs and symptoms of hyperthyroidism as well as elevated triiodothyronine (T ), thyroxine (T ) and suppressed thyroid3 4 stimulating hormone (TSH).T ,T andTSH were done in all cases.3 4 Radionuclide scan and ultrasound of thyroid gland, radioactive iodine uptake (RAIU), thyroid microsomal antibody (TMAb) and fine needle aspiration cytology (FNAC) was done in selected cases. We assessed all patients prior to radioiodine therapy. Elderly patients and all those with cardiac complications and severe hyperthyroidism were pretreated with a short course of antithyroid drug in full dosages until they were clinically and biochemically euthyroid. Ninety five patients were on antithyroid medication (Neomercazole) prior to radioiodine therapy. Antithyroid medication were stopped 3 days before radioiodine therapy and restarted 3 days later and continued for 1 to 2 months depending on patient's symptoms. The rest of the patients received either no treatment or beta-blocker prior to radioiodine therapy. Menstrual history was taken in female patients and pregnancy was excluded by ultrasonography in doubtful cases before administering radioiodine. The likely consequences of the treatment were fully explained to the patients and attendants, the usual precautions for radiation protection of the public and the necessity of the follow-up were discussed and verbal consent was taken before administering radioiodine. Radioiodine was given 131 orally as Na I solution to all patients in modified fixed dose regime ranged from 5 mCi to 15 mCi.All the patients were advised to attend the centre if any complications arise and in regular follow up at 6 weeks, 3 months, 6 months, 9 months and 1 year and then annually. Clinical and biochemical evaluations were done in follow up visit. If the first dose was found to be ineffective in controlling the disease or hyperthyroidism persist, then the second dose, third dose or fourth dose was given after 6 months interval with proper clinical and biochemical evaluation. If even with fourth dose, hyperthyroidism was not controlled, the case was referred for surgical management. The amount of radioiodine given in the second dose and in subsequent third dose or fourth dose was same as first dose or higher. Early complications of radioiodine were only encountered when the patient attended the centre for such. During follow up, patients were classified as cured if the functional status was either euthyroid or hypothyroid within 1 year without further treatment of hyperthyroidism by antithyroid drugs or radioiodine. Patient was diagnosed as hypothyroid on the basis of clinical and biochemical criteria, including low T and4 high TSH. Total 203 patients with hyperthyroidism treated with radioiodine were studied. Among 203, 117 were female and 86 were male with female male ratio of 1.4:1. The mean age of the patients was 38.38 10.42 years (ranged 16 years to 70years). Among 203 cases, 190 (172 Graves' diseases, 8 solitary toxic nodule, 10 toxic multinodular goiter) patients attended regularly as per advice and 13 patients were lost to follow up. It was found that 18 patients became euthyroid within 3 months, 35 patients became euthyroid within 6 months, 19 patients became euthyroid within 9 months and 97 patients became euthyroid within 1 year. Thus the cure rate was found to be 88.95% (169/190). In 18 (9.47%) cases hyperthyroidism persisted with no clinical and biochemical improvement within 6 months in which 15 were Graves' disease, 1 solitary toxic nodule and 2 toxic multinodular goiter. After becoming euthyroidism, hyperthyroidism recurs in 3 (1.58 %) cases within 1 year. Recurrence of hyperthyroidism was also seen in 2 cases after 1 year of radioiodine treatment. These patients (persistent and recur cases) were treated with second dose and if needed third and/or fourth dose of radioiodine. Second dose was given in 23 cases, third dose given in 7 cases and fourth dose given in 2 cases. We referred 1 case for surgical treatment not for responding even with fourth dose of radioiodine. During our follow up period, 6 patients became hypothyroid within 3 months, 14 patients became hypothyroid within 6 months, 7 patients became hypothyroid within 9 months and 5 patients became hypothyroid within 1 year. Thus hypothyroidism within 1 year was found to be 16.84% (32/190). Other side effects such as iododerma were observed in 5 (2.63%) cases, radiation thyroiditis developed in 17 (8.95%) cases, thyroid storm developed in 2 (1.05%) cases. Out of 43 with ophthalmopathy, 2 (4.44%) deteriorated, 1 (2.32%) unchanged and the rest (93.02%) improved. New ophthalmopathy developed in 3 cases (3/147 i.e., 2.04%). None developed any malignancy or leukemia during our follow up period. We conclude that our experience revealed similar outcomes as have been reported by other workers with the exception of iododerma, one of the early complications of radioiodinetherapythatwenoticedduringourfollowupperiod. Differentiated Thyroid Carcinoma (DTC) is not an aggressive malignancy and its treatment is very promising. The treatment is performed by surgery only (in selective cases) or by surgery followed by I-131 therapy. Treatment of metastasis is equally effective but difficult in cases of lung and bone metastases. The objective of this study was to see the effectiveness of repeated dosesofI-131incasesofrecurrenceandmetastasis. In this study we had evaluated 24 DTC cases who were given 5 to 13 doses of I-131 for ablation, recurrence and metastasis (in lymph node, lung and bone). The ages of the patients were between 18 to 70 years. These patients were given treatment in between 1982 to 1993andwerefollowedupfor12-22years. It had been found that 6 cases out of 24 had bone metastases and all were follicular type of carcinoma except one who had mixed type. Not one of these cases was found completely disease free. Two patients were found scan negative in two consecutive scans, but again became scan positive. One patient died 10 years after detection of carcinoma after given 9 doses of I-131; another patient died 15 years after starting treatment with 13 doses. Another 2 patients had period of clinical improvement and deteriorationthatalsogotmorethan8doses. There were 4 cases of lung metastases (4 out 24) and only one had papillary carcinoma. Lung metastases were cured in 2 cases after 5 doses and was scan and Tg negative for 8 years; 2 cases of lung metastasis were in good clinical state but still they some 008-BGD Success of Repeated I-131 Therapy in Cases of Metastatic Differentiated Thyroid Carcinoma Alam F, Kabir MF, Karim MA. Institute of Nuclear Medicine, BAEC,BSMMU,Dhaka S-15 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  22. 22. recurrence even after having more than 8 doses. One of these patients is surviving for 17 years after disease detection with scan positive state. Recurrence of diseases in thyroid bed have good prognosis but these patients sometimes needed more than 5 doses to get relieve from recurrence. In our study among the 24 cases 6 patients needed more than 5 doses. Radioactive iodine was also not so effective in lymph node metastasis but surgical management is successful in most cases This study showed that bone metastasis has least curative effect by I-131 and prognosis is worst. However, I-131 can still prolong life and it has also palliative effects in metastatic bone disease. I-131 MIBG has been proven to be an effective therapeutic option in neuroblastoma targeted both at the primary tumor and its distant metastasis. We describe our initial experience in the targeted treatment of 15 patients with neuroblastoma. The patients were grouped and treated according to three protocols. Group 1: patients were in the advanced stage of the disease with either metastatic or unresectable disease; Group II: patients were treated immediately after diagnosis before surgery or any other management. Group III patients were treated with combined I-131 MIBG and high dose chemotherapy. The method of administration was by slow infusion (120min). Dose varied from 4 to 12 GBq in a single dose. All patients were followed up with periodic blood counts, liver and kidney function tests, thyroid and adrenal function tests. The response rate in group-I was 38%, group-II patients showed 52% and in group-III the overall response rate was 72.6%. Responses depended on high tumoral I- 131 MIBG uptake and limited spread of the neoplasm.As regards toxicity, the major side effect observed was myelosuppression and this was found to be more severe in patients with bone marrow involvement and after chemotherapy. Toxicity was relatively mild in the neuroblastoma patients who were treated at diagnosis.There was no incidence of serious infections or significant bleeding in any of our patients. Extramedullary toxicity of hypothyroidism was observed in 1 patient. On the basis of the results, we can conclude that MIBG is an excellent pharmaceutical for the delivery of therapeutic doses of radioiodine for neuroblastoma. When combined with chemotherapy it is effective in obtaining a rapid response in heavily pre-treated patients who are resistant to othertherapies. Nuclear Medicine practices involve use of radioisotopes for diagnosis and treatment of diseases. Radioiodine is one of such radioisotopes, being used in the diagnosis and treatment of diseases since 1942. Handling of radioiodine involves radiation hazards both for the patients as well as for the technologists. 009-BGD Targeted Therapy of neuroblastoma with I-131 MIBG: Experiencein15Cases. HussainR, NisaL, KarimMA Institute of Nuclear Medicine & Ultrasound, BSMMU, Dhaka, Bangladesh;Centre for Nuclear Medicine & Ultrasound, Mitford, Dhaka, Bangladesh; Director, Bio-Sciences Division, BAEC, Dhaka,Bangladesh 010-BGD Design & Development of a Lead Jar For Oral Administration of Radioiodine In Hyperthyroid Patients. Rahman MS, PaulAK, Rahman HA, Begum F. Centre for Nuclear Medicine & Ultrasound, Khulna, Bangladesh Though radioiodine is supplied in a lead container, for treatment purpose, it is administered after dispensing into a glass jar that does not adequately protect radiation hazards. For this reason, we designed & developed a lead jar and radioiodine is dispensed into that lead jar to minimize radiation hazards. For oral administration of radioiodine to hyperthyroid patients, a lead jar was designed and developed with lead in Centre for Nuclear Medicine & Ultrasound, Khulna in December 2004 by own expertise and technologies in such a way that a glass jar could be introduced into that lead jar. The thickness of lead was 4.04 mm and the thickness of glass jar was 0.7 mm and thus the whole thickness of lead jar became 4.74 mm. The desired dose of radioiodine (8 mCi) that should be given to the patients were dispensed into that lead jar and administered orally to the patients. Radiation levels in 10 such cases were measured by Mini-Rad Series-1000 survey meter at 0.5 meter, 1 meter and 3 meters distances both lead jar and glass jar. The mean radiation level of lead jar and glass jar during oral 131 administration of 8 mCi of Na I solution in 10 cases at 0.5 meter, 1 meter and 3 meters distances were 62.4± 1.96 microSv/h, 17.7± 1.95 microSv/h, 3.39± .12 microSv/h and 20.3± 2.16 microSv/h, 79.8 ± 0.79 microSv/h, 1.97 ± 0.23 microSv/h respectively. We have found that radiation level reduced by 67.47%, 61.58%, and 41.89% with lead jar at 0.5 meter, 1 meter and 3 meters distances. In conclusion, the locally designed and developed lead jar is safe, easy to handle and reduces radiation burden significantly in oral administration of radioiodine to hyperthyroid patients and recommended for routine practices in all nuclear medicine establishments. 011-BGD Radioiodine Treatment for Complicated Hyperthyroidism Using a Fixed Dose Regime Paul AK, Rahman SH, Ansari SM Centre for Nuclear Medicine and Ultrasound, Khulna, Bangladesh Centre for Nuclear Medicine and Ultrasound, Bogra, Bangladesh Hyperthyroidism in the elderly and all those with cardiovascular and psychiatric problem has increased mortality and morbidity rate. These patients need special care to cure the disease promptly and permanently for avoidance of complications. Radioactive I- 131 is one of the accepted forms of treatment for hyperthyroidism and increasingly being considered for the patients in whom rapid and permanent control of disease is desirable. To evaluate the success of I-131 to cure disease in-patients with complicated hyperthyroidism, we prospectively studied the outcome of radioiodine therapy using a fixed dose regime. Ninety-three patients with toxic diffuse goitre (65 female, 28 male) age ranging from 29-67 years (mean ? SD 41.35 ? 11.02 years) were evaluated. The subjects included 71 cases with cardiovascular problem, 13 elderly patients, 5 with poor drug compliance and 4 with associated psychiatric disease. The individual was excluded from the study who had autonomous toxic nodule. Every patient was pretreated with antithyroid drugs for 4 weeks and the drug was discontinued for 3 days before administering I-131. No patients had post-treatment antithyroid drugs.All the patients were treated with a fixed oral dose of 15 mCi I-131 sodium iodide. Post- treatment follow-up examinations were done at 6 weeks without biochemical tests, at 3 months, 6 months, 9 months and 1 year and then annually with biochemical tests. Patients were classified as cured if the biochemical status was either euthyroid or hypothyroid at one year without further treatment by antithyroid drugs or radioiodine. Of the 93 cases, 82 patients became euthyroid or hypothyroid requiring no further treatment for S-16 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  23. 23. hyperthyroidism with an overall cure of 88.17%. Hypothyroidism was developed in 49 (52.69%) patients at one year of whom 39 became hypothyroid within 6 months and another 10 patients within 1 year. 4 patients were subclinical hyperthyroid at 6 months and still hyperthyroid at 9 months. 7 patients remained hyperthyroid 6 months after treatment.Thus, 11 (11.83%) patients remaining hyperthyroid 6 months following I-131 treatment and they were treated with a 2nd dose of 15 mCi I-131. No patient required more than two doses of I-131 in this study. In conclusion an initial dose15 mCi of I-131 is a simple, safe and effective means for the treatment of patient with complicated hyperthyroidism. 012-BGD Use of Strontium-90 Beta Irradiation as an Adjunctive Therapy For The Management of Squamous Cell Carcinoma of The Conjunctiva. NisaL,MomtaS,JehanAH, RahmanMU Center for Nuclear Medicine & Ultrasound, Mitford Hospital Campus, Dhaka. 013-BGD Post-Operative Beta-Irradiation in The Management of Pterygium JehanAH,NisaL,HossainR,YasmeenS,KarimMA Center for Nuclear Medicine & Ultrasound, Mitford; Institute of Nuclear Medicine & Ultrasound; Director, Bio-Science Division, BAEC. To evaluate the effectiveness of strontium-90 beta irradiation in management of squamous cell carcinoma of the conjunctiva. A retrospective analysis of the medical records of 5 patients treated with strontium-90 beta irradiation was done. Squamous cell carcinoma of the conjunctiva was histologically proved in all patients who had initial surgery to remove the major part of the lesion.This was followed by beta radiation within 48 hours with Sr -90 contact applicator obtained from Amersham International. The hand held Sr- 90 eye applicator was used after appropriately instilling the eyes with local anesthetics and a total of 5000cGy was delivered in seven fractions. Follow-up period was from 6 to 12months. Clinical response and side effects to the therapy were used as outcome measurements. Three patients showed good response with no evidence of tumor within 6 to 12 months of the follow-up period. One patient was lost to follow-up and one patient showed local recurrence within 4 months. In this patient the tumor was more extensive involving the limbal conjunctiva andthecornea. The early side effects of beta radiation reported by all five patients were temporary local irritation of the eyes with additional mild chemosis in four patients. None of the other three potentially cured patients showed any long-term adverse reactions. There were no incidence of late radiation induced complications such as corneal ulcerations, damage to cornea, eye pain, cataract or any other serious effects in these patients within the follow-up period. In conclusion, beta irradiation is an effective post-surgical therapy for local control of superficial conjunctival squamous cell carcinoma. The very low and minimum side -effects of Sr-90 irradiation is an advantage, which makes it a good alternative to externalbeamradiation,whichhasserioussideeffects. A retrospective analysis of the effectiveness of Sr-90 therapy in post-operative management of pterygium. Between June 1999 and May 2001 a total of 70 patients received beta radiation for treatment of pterygium at the Institute of Nuclear Medicine & Ultrasound, Dhaka.The patients were referred by the eye surgeons soon after excision of the lesion for beta radiation to the affected area. Hand held Sr-90 contact applicator from Amersham International was used to deliver a total dose of 2500 cGy radiation to the sclera surface in five fractions. Care was taken to anesthetize the eye(s) before each application. The patients were then followed up at one week, one month, six months and one-year interval after beta irradiation. The age range of the patients suffering from primary pterygium was 18 to 40 years.All patients underwent surgical excision with bare sclera technique. Of the patients treated 42 patients were completely lost to follow up, while 28 patients were followed up at different periods for up to 12 months. In these patients the local control rate of pterygium after irradiation was 94.6% after 12 months. Recurrence of the pterygium occurred in 5.4% of cases who were given a second course of strontium therapy. Follow- up after six months showed these patients to remain free of the disease. Associated complications were mild and included conjunctivitis. There was improvement of visual acuity in 21 patients with no evidence of cataract or ulceration noted in any of 28 patients during the 12- month follow-up period. In conclusion, beta irradiation with Sr-90 after surgical excision of pterygium was found to be a safe a nd cost- effective means of controlling the recurrence rate of pterygium. To see the incidence of second cancers in patients with well differentiated thyroid carcinoma after being treated with radioiodine. Medical records of 814 (417males, 397females) patients with differentiated thyroid cancer treated at Institute of Nuclear Medicine & Ultrasound, Dhaka were reviewed. The purpose was to investigate the incidence of second cancer in these patients after radioiodine therapy. The age range of the patient population treated with radioiodine was 9 to 69 years. Doses of radioiodine given were in the range of 30 to 100mCi for ablation and 150 to 250mCi for treatment of metastasis. The median follow-up period was 93.7± 15months. Eleven (1.35 %) of the 814 patients developed a second malignancy. Two patients (0.25%) developed chronic myelogenous leukemia within a latency period of 5years and after receiving a cumulative dose of 600- 670mCi. The over all incidence of second malignancy in the form of solid tumors was 1.10%. Of the nine patients with solid tumors, there were two patients with renal cell carcinoma, three patients with parotid gland tumor, one patient with pancreatic cancer, one with adenocarcinoma of the stomach, one with carcinoid tumor and one with small cell carcinoma of the lungs. The mean latency period for development of these tumors was 6.92 ± 3.934 years and the mean cumulative dose received by all these patients was 537.25± 120.55 mCi. Follow-up of a fairly large cohort of patients treated with radioiodine showed a low incidence of second neoplasm. No relation was observed between the cumulative dose received and the development of a second malignancy. Thyroid carcinoma is a polygenic disease, which may be associated with other malignancies. Common environmental or genetic factors as well as long-term carcinogenic effects of radioiodine therapy should be considered. 014-BGD Second Malignancies Following The Treatment of DifferentiatedThyroidCarcinomaWithRadioiodine Yasmin, S, Nisa L, Haque FS, Begum R. Institute of Nuclear Medicine & Ultrasound, Dhaka Center for Nuclear Medicine & Ultrasound, Mitford Hospital, Dhaka. S-17 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  24. 24. 015-BRA Use of Samarium 153 Hydroxyapatite for intra-articular therapy AnselmiOE 016-BUL Tc-99m MIBI and I-131 scintigraphy in the follow-up of differentiated thyroid carcinoma (DTC) patients aftersurgery Sergieva S, Hadjieva T, Botev V, Dudov A. Sofia Cancer Center, UH “Queen Joanna”, Sofia, Bulgaria 017-CHI Peptide Receptor Radionuclide Therapy With Y-90-Dotatoc (somatostatin Analog) in Neuroendocrine Tumours: The Chilean Experience 1-2 1 1 3 2 1 Amaral H , Pruzzo R , Morales B , Gil C , Coudeu I , Rojas A , 1-2 1-2 1-2 1 2 Majlis A , Kleinman S , Vogel C , Rossi R , de la Fuente H , 2 1 4 4 ReyesC ,VarasM ,ChinolM andPaganelliG 1 2 3 Clinica Alemana, Fundacion A. Lopez Perez, CGM Nuclear, 4 Santiago (Chile) and European Institute of Oncology, Milan (Italy). Abstract not received MIBI scan has been reported to be a highly sensitive imaging technique for detection of differentiated thyroid carcinoma (DTC) metastases that have lost the capability to take up I-131. The purpose of the present study was to evaluate retrospectively the value of theTc-99m MIBI scan and I-131 whole body scintigraphy using thyroglobulin (Tg) levels as a basis for comparison. Eighty four patients (63F/21M) with an age range of 17-74 yrs (mean age = 43.5 yr) of DTC (47 cases with papillary, 18 cases with follicular and 19 cases with mixed papillary-follicular ) were assessed. All of them had undergone total or near-total thyroidectomy and received radioiodine treatment for ablation of post surgical residual thyroid tissue. They were examined after L-thyroxin withdrawal over 4-5 weeks during the follow-up period. Planar and whole body images were acquired at 15 min and 180 min after i.v. administration of Tc-99m MIBI (555-740 MBq) and at 48 hours after p.o. administration of I-131 (111-185 MBq) onToshiba GCA gamma camera. Serum Tg assays were performed to clarify the presence of residual recurrent malignancy. All scintigraphic findings were compared with US, CT or MRT data. I-131 scans were positive in 55 patients showing thyroid remnants in 31 cases, lymph node metastases in 24 cases (17 in the neck, 7 to neck/mediastinum), pulmonary metastases in 6 cases and bone lesions in 2 cases. In 18 patients I-131 scans were negative andTg levels were undetectable, so patients were considered tumor-free. In 11 patients I-131 scans were negative while serum Tg levels were increased. These false negative results were observed predominantly in cases with less differentiated metastatic cells, especially after several courses of high-dose I-131 therapy. Tc- 99m MIBI scans revealed the presence of lymph node and/or lung metastases (non-functioning metastases) in 9 of them, false negative results were obtained in 2 cases. Serum Tg was increased in all patients with local lymph node and distant metastases, visualized by I-131 or by Tc-99m MIBI, but also in 18 patients with thyroid remnants only. Considering I-131 scan as the most specific standard procedure we may conclude that the combined Tc-99m MIBI scintigraphy and serum Tg assay appear to be an alternate method for large dose I-131 scan for demonstrating the extent of the disease in cases with DTC and elevatedTg. Most of neuroendocrine tumors (NT) and a few others have an over-expression of somatostatin receptors in their cellular surface allowing “in vivo” detection of both primary tumors and its metastasis by diagnostic scintigraphic images with Octreotide 111 labeled with In. Patients with inoperable, residual or metastatic NE tumors have typically a poor response to conventional radiotherapy or chemotherapy.Anew valid option for therapeutic purposes in such cases is the use of a similar peptide like DOTA- 90 D-Phe-Tyr-Octreotide labeled with Yttrium-90 ( Y-DOTATOC). This radiopharmaceutical is a pure beta emitter with specific affinity for subtype 2 somatostatin receptors allowing a high radiation dose to cellular level in NT. With the strong collaboration of the European Institute of Oncology, Milan (Italy), we have successfully incorporated this therapy in Chile including both the local labeling of the radiopharmaceutical and thedesignoftheclinicalprotocols. We have treated 23 patients, 11 men and 12 women (average 46.6 y.o. range 12-70), 22 with histologically confirmed residual or metastatic NT and 1 hepatoma. All of them had positive 111 somatostatin receptors demonstrated by In-Octreotide scintigraphy. The primary tumor was pancreatic (10), intestinal (5), medullary thyroid carcinoma (2), thymus (1), bronchial (1) and unknown origin (3). All patients received renal protection with crystalline amino acids immediately before the 90 radiopharmaceutical administration. The Y-DOTATOC, labeled 90 at CGM Nuclear in Santiago with Y from MDS Nordion (Canada) and peptides from Pichem (Austria), was administered intravenously in single doses between 25-240 mCi (maximum total individual dose of 537 mCi). The whole group received 66 single therapy doses. Until now 16 patients have received more than one dose, 2 doses in 6, 3 in 2, 4 in 2, 5 in 4, 6 in 1 and 7 in 1. Only this sub-group is considered for evaluation of treatment response. Radiochemical controls were done in minicolumns Sep-Pak C18 previously to the patient injections. Radiochemical control showed a labeling efficiency of the radiopharmaceutical higher than 99%. In 16 patients with more than one cycle there has been complete remission of the tumor activity in 1, significant partial remission in 10, partial remission in 3 with further relapse and progression in 2. The treatment was well tolerated in all the patients except in one in whom by causes not yet determined the “in vivo” biodistribution of DOTATOC was altered showing mainly bone marrow uptake (non-tumor) of 90 Ypresenting a severe but reversible hematological toxicity. This patient was considered non-treated since there was no selective tumor irradiation. The other patients showed mild reversible hematological toxicity. In a 36 y.o. female patient suffering a progressing pancreatic NT with multiple metastasis and severe bone marrow involvement presenting partial response and further relapse, a high rescue dose of 240 mCi was administered following a successful autologous stem cells transplantation. The patient is now asymptomatic with significant partial response. 90 These preliminary data indicate that the treatment with Y- DOTATOC, now available in Chile, is a valuable therapeutic option for these type tumors that frequently do not respond to conventional treatments like chemotherapy or external radiotherapy. Peptide receptor therapy should be considered as first line treatment in well-differentiated NT. S-18 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  25. 25. 018-COL Re-188LipiodolTherapyofHepatocellularCarcinoma Bernal P, Chau T, Erdenechimeg S, Kumar A, Srivastava D, Pusuwan P, Ang S, Barrenechea EA, Jeong JM, Onkhuudai P, Knapp FF, Sundram FX, Divgi C, Buscombe J, Dondi M, Padhy AK. (Based on the results of an International multi-centric study initiatedbytheIAEA) Hepatocellular carcinoma (HCC) is a malignant epithelial tumour arising from parenchymatous liver cells. It is one of the world's most common malignancies, causing almost one million deaths annually. About 315,000 new cases of HCC are reported per year which constitutes 5.6% of all cancers among males and 2.7% of all cancers among females. Control strategies to prevent occurrence of HCC are sub-optimal; this is evident by the rising incidence of HCC even in developed nations like the USA, where the prevalenceofthediseaseisoneofthe lowestintheworld. Currently, patients with HCC have an extremely poor prognosis with a five year survival rate of less than 5% . However, morbidity and mortality in such patients are not determined by the presence of HCC alone, but are also influenced by the activity of the underlying liver disease, as well as the functional status of the liver. The stage of the tumor (size, number, vascular invasion, extra hepatic spread) has been consistently documented to be an important determinant of the natural course of the disease. These factors are major variables that influence various therapeutic strategies directed against this tumor in recent times. Therefore, therapy in HCC needs to be optimized depending upon the above mentioned influences on the final outcome of the disease. Various forms of therapy such as surgical resection, orthotopic liver transplantation (OLT), percutaneous injection to induce coagulative necrosis of the tumor using agents like ethanol, acetic acid, hot saline, microwave and laser have been considered as radical treatment of HCC, aiming at curing the disease. The understanding of pathology, pathogenesis, natural course and risk factors of HCC during the last three decades has resulted in the development of multiple therapeutic approaches with promising yetvaryingresults. Most patients with hepatoma from the developing countries at the time of their presentation to the doctor fall into the intermediate/inoperable category , and for these, radionuclide methods to deliver high radiation doses to tumor must be considered. Uncontrolled studies using radioisotopes like I-131, Y-90, Ho-166, Re-186 conjugated to monoclonal antibodies, lipiodol or chemical compounds have shown promising results. However due to lack of prospectively designed randomised trials, their efficacy is yet to be optimally evaluated. There has also been reports (from one study only) on the usefulness of radionuclide therapy as an adjuvant treatment following resection of “curable” HCC. It has been shown that patients given a single administration of 1GBq. Of I-131 Lipiodol have significantly greater survival and less recurrence than those not treated. It is important that the results of this study be verified and confirmed by reproducing the resultsinanotherprospectivetrial. It may be noted that the disease is most prevalent in those communities with least resources for setting up clinical trials. Hence the role of the International Organizations like IAEA and WHO are extremely important in assisting them in setting up such trials and coordinating them. For nuclear medicine and the IAEA- WHO to develop a key role in the treatment of HCC, new methods must be evolved, tested and standardized in full random controlled trials. Currently the only commercially available radiopharmaceutical for the treatment of liver cancer, I-131 Lipiodol, has been found to be prohibitively expensive, and it is virtually not practical to use this radiopharceutical on a routine basis in the poor and developing countries of the world. In the year 2001 the IAEA started a new coordinated research in order to identify and test a new cost-effective radiopharmaceutical for the treatment of liver cancer.With the help of scientists for Korea, Singapore and USAit has been possible to label Rhenium 188 with Lipiodol which has shown excellent concentration in the HCC when administered trans-arterially. Phase-1 study revealed that the right quantity of the radioconjugate can be delivered after 'scout' dose dosimetry studies have been done, to spare normal liver and lung from excess radiation dose. The phase-1 data showed that the treatment is safe with minimal side-effects, at a dose up to about 200 mCi of Re-188 lipiodol. The Phase-2 study in over 100 patients revealed excellent results. With a median follow-up time of 449 days, the results have demonstrated one-year survival rate of 56%, while at the time of the analysis (which was almost two years after treatment for some patients) the survival rate was found to be 40%; which is remarkable keeping in view the types of patients recruited,mostofwhowereend-stagedisease. For the treatment of differentiated thyroid cancer, surgery, radioiodide therapy, and thyrotropin-suppressive thyroxine application represent established therapeutic measures of proven efficiency, affording a good prognosis for this disease. However, in up to 30% of the cases, de-differentiation is observed, giving rise to tumours that are refractory to conventional treatment. Experimental data shows strong evidence that differentiated functions of iodine metabolism can be re-induced by retinoic acids (RA).The aim of our study was to assess the effects of retinoic acid therapy in patients with extensive thyroid tumor involvement, which lost radioiodine uptake ability. Twenty-five patients who received retinoic acid therapy between Feb. 1999 to Dec. 2004 were reviewed retrospectively. There were 15 males and 10 females with a mean age of 52.5 years (16-71 years). Most of them underwent total or near total thyroidectomy before I- 131treatment. Twenty-one patients were papillary carcinoma and four were follicular carcinoma. Twenty-two patients had lung metastasis and three had bone metastasis. Thyroid hormone medications were withdrawn for two weeks in case of triiodothyronine (T3) and five weeks in case of thyroxine (T4). For treatment of bone metastases, an amount of 7.4 GBq (200mCi) of I-131 was given every six months. For treatment of pulmonary metastases an amount of 5.55-7.4 GBq (150-200mCi) was given every six months. In 25 patients with advanced thyroid cancer, whose cancer foci did not concentrate radioiodine, retinoic acid was given for 6 weeks before radioiodine treatment, followed by I- 131 treatment. All patients had I-131 scans and thyroglobulin measurements 7 days after administration of I-131. X-ray, bone scan, and ultrasound of the neck were done one month after administration of I-131. One patient received RA therapy four times and two patients received RA twice. In the post-therapy radioiodine scans, radioiodine uptake was noted in 9 patients with lung metastases and in 2 patients with bone metastases. On the whole, in 44% (11/25) of patients re-induction of radioiodine 019-CPR Retinoic Acid in Patients with Radioiodine Non-Responsive DifferentiatedThyroidCarcinoma. Zheng R, Zhang W, Li J, Chen S. Department of Nuclear Medicine, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Beijing 100021, P. R. China S-19 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005
  26. 26. uptake was observed. Levels of thyroglobulin concentration before and after RA therapy did not differ significantly (P>0.05). In our study, all patients completed the treatment and the most frequent side effects were fatigue. Dry skin, mouth and lips occurred in 35% of patients. Most side effects were well tolerated by the patients and reversible following cessation of RA therapy. We conclude that retinoic acid can induce radioiodine uptake and the side effects are well tolerated. However, prospective studies in larger groups of patients are necessary to prove its clinical utility in routine practice. 020-CPR Study of the Therapeutic Dose and the Clinical Effect on Graves’ DiseaseWithI-131Treatment Y. Dang. Imaging Diagnostic Center of Nanfang Hospital, Southern Medical University, Guangzhou, China Graves’disease is being treated with I-131 for more than 40 years in China. Previously the dose of I-131 used to be calculated using the “Quimby” formula. We have now observed that the dose of I- 131 administered to patients is now lower in recent years than the early years.The radioactive iodine uptake by the thyroid gland has also changed significantly over a period of time. In this paper we intend to explore these reasons and to research the relationship between the dose and the effect as well as the main cause of the incidence of the hypothyroidism. The parameters in “Quimby” formula including I-131 uptake, effective half-life and thyroid weight were analyzed and compared with each year data from 1961 to 1988 and subjected to multiple regression analysis to determine the influence on the calculation of dose in 4465 patients. The therapeutic effects were compared with the data of the clinical follow-up of patients between 1961-1973 and 1978- 1988 in 748 patients. The factors which might lead to the hypothyroidism were investigated with the non-condition logistic regression. The I-131 uptake was repeatedly measured within one week in 100 patients to identify the changing pattern of the I-131 uptake and its influence on the administered therapeutic dose. We observed an increase in the value of I-131 uptake. The value of I- 131 uptake showed an increase after 1977, as well as a prolongation of effective half-life after 1973. The main reason for these changes being a replacement of the equipment in 1977 (G-M counter tube was replaced by scintillation counter), and the other reason being salt iodization in China in 1973. These two factors resulted in a significant reduction in the administered dose of I- 131 during the period 1974-1988 as compared to the previous period 1961-1973; the mean administered doses being 168.35MBq and 330.33MBq respectively. The result of multiple regression analyses suggested that the thyroid weight and the effective half-life were the most important factors to influence on the dose calculation. The therapeutic effects demonstrated that it was significantly different between 1961-1973 and 1978-1988. The incidence of hypothyroidism in 1961-1973 was obviously higher (58.58%) than in 1978-1988(19.01%). The non-condition logistic regression of the factors which lead to the hypothyroidism were analysed, which showed that the individual sensitivity and the higher administered doses were the main causes of hypothyroidism. The data also showed that the results were highly satisfactory when the administered doses were within 111- 222MBq or 2.59-4.07MBq/g. The coefficients of variation (CV) of the mean value of the two peak I-131 uptake values determined within one week in 100 patients was12.78. The biggest CV was 61.42%. There were 41% patients with CV=10%. The absolute difference mean value of the two peak I-131 uptake rate and calculating dose was 11.08%?44.03 MBq. The biggest different value was 44.26% and 446.59 MBq, respectively. To sum up, the dose and the therapeutic effect had a significant difference in the different period of the years although the therapeutic method and the calculating formula was the same.Therefore, the scientific and feasible function of the “Quimby” formula should be considered deeply. Moreover, the uptake rate of I-131 was changed significantly in a short period. In order to solve these problems, on the basis of our experience, according to the individual sensitivity and the exceeding dose were the main causes of the incidence of the hypothyroidism, we put forward to simplify the therapeutic method. We suggested to choose the thyroid weight as the only factor-thyroid weight times a fixed coefficient, to take into consideration the patient’s clinical condition and to choose the dose within the range of 111-222 MBq or 2.59-4.07MBq/g as a suitable optimal dose for therapy. 021-CZR Our Experience With Radioiodine Therapy of Thyroid FunctionalAutonomies Otakar Kraft. Department of Nuclear Medicine, University Hospital, Ostrava-Poruba, Czech Republic In this paper the author presents his experience with radioiodine therapy of thyroid functional autonomies. The objectives of this study were to establish the efficacy and determine the adverse effects of radioiodine therapy of patients with thyroid functional autonomies. The main pathologic attribute of thyroid functional autonomies is the loss of regulation in the axis of hypothalamus-hypophysis- thyroid. The main cause of functional autonomy of the thyroid is iodine deficiency. Over a period of 30 years (1974-2004) 799 patients (age from 33 to 86 years; average age 58.7 years; the female: male ration was 7.4:1) with unifocal functional autonomy (UFA), multifocal functional autonomy (MFA) and disseminated functional autonomy (DFA) received at least one treatment of radioiodine. For diagnostics and the evaluation of radioiodine therapeutic effect of functional autonomies a thyroid scintigraphy is the basic and necessary procedure. In some patients a common scintigraphy with special imaging modulation, in some patients a scintigraphy after suppression or stimulation by means of thyroid hormones or TSH were done. We have also performed a thyroid ultrasonography, an assessment of a serum level of a total and free thyroxine, total triiodothyronine, TSH, radioiodine accumulation test, estimation of radioiodine effective half-life, in some patients TRH-TSH test. The follow-up examinations were done in all patients after 4-6 months, another examination after one year in 545 patients and after two years in 254 patients. One therapeutic dose received 733 patients (91.74%) and it was sufficient for an elimination of functional autonomies. Some patients were re- treated if there was the evidence of small or no treatment effect and no elimination of functional autonomies. Two radioiodine treatments received 62 patients (7.76%) and three treatments 4 patients (0.5%). We advocate individual pre-therapeutic dosimetry to determine the activity necessary to achieve a targeted radiation dose in autonomously functioning tissue. The radioiodine amount administered was based on the volume of thyroid or the nodule, 24-hours radioiodine accumulation, the effective half-life of radioiodine, the absorbed dose of 500 Gy per gram of the nodule (UFA) or 300 Gy per gram of the whole thyroid (in patients with MFAand DFA). Before radioiodine therapy an average serum levels of total thyroxine was 164.6 nmol/l, of free thyroxine 20.8 pmol/l and S-20 World Journal of Nuclear Medicine, Volume 4, Supplement 1, October 2005 Abstracts: ICRT-2005