Nuclear medicine in the assessment of adverse effects of cancer therapy in the lung, kidney, and gastrointestinal tract

Carles Artigas, Ignasi Carrió

Research output: Chapter in BookChapterResearchpeer-review

Abstract

© Springer Science+Business Media New York 2013. Radiotherapy or chemotherapy, and new drugs and strategies in oncology can produce damage in normal organs and tissues affecting the quality of life of the patient. Pulmonary toxicity is frequently seen in patients treated with bleomycin or other chemotherapeutic agents. The most common clinical form of bleomycin pulmonary toxicity is the subacute condition, which progresses to lung fi brosis and death, if not recognized and appropriately managed. The diagnosis is usually established by a combination of clinical, radiographic, and pulmonary function tests abnormalities. X-ray and high-resolution CT scan findings are used to identify pulmonary fibrosis.67Ga-citrate scintigraphy has been used to detect and assess the extent of pulmonary toxicity related to bleomycin in patients who otherwise have normal chest radiographs. Since conventional CT scanning is not able to distinguish fibrosis and active inflammation, [18F]FDG-PET has been suggested as a tool to indicate the resolution of disease activity. Moreover [18F]FDG-PET could be useful to detect early preclinical pneumonitis induced by bleomycin. As pulmonary permeability can be altered by chemotherapy,99mTc-DTPA aerosols can be used to assess a reduced epithelial permeability. Acute radiation lung injury can occur within 1–3 months after radiation therapy of the thorax, whereas lung fibrosis can develop 6–24 months later, leading to progressive impairment of pulmonary function. Clinical manifestations, chest radiographs, and pulmonary function tests may help to establish an early diagnosis. Scintigraphic abnormalities can be demonstrated in the acute phase often before radiologic changes become apparent by67Ga-citrate. Moreover,111In-pentetreotide may have a role in the differential diagnosis of patients with complaints after radiotherapy and in the monitoring of the response to corticosteroid therapy. [18F]FDG uptake in the irradiated region can be observed up to about 2 months following therapy. The persistence of activity beyond 8 weeks raises the likelihood of persistence of disease within the irradiated region. Lung scintigraphy with99mTc-DTPA aerosol or99mTc-MAA (macroaggregates of albumin) have been performed to assess radiation-induced ventilation/perfusion changes. Drugs for the treatment of abdominal malignancies, such as cisplatin and ifosfamide, and abdominal radiation can cause renal damage. Chemotherapy-induced nephropathy can be identified with quantitative measurement of glomerular filtration rate.99mTc-DTPA has become the preferred radiopharmaceutical because of availability and cost.99mTc-DMSA scintigraphy can be used to establish tubular dysfunction induced by nephrotoxic drugs. Nuclear medicine techniques offer also the possibility to follow the clinical evolution of radiation nephropathy. Bone scans using99mTc-MDP can show increased kidney uptake early after radiation in patients with radiation fields including kidneys. Over the succeeding 6–12 months the uptake decreases to normal or below normal levels, associated with the loss of function. Renography with99mTc-DTPA can be performed to assess radiation nephropathy.99mTc-DTPA Captopril renography test has been used to study the relation between small vessel injury due to radiation and hypertension. Nuclear medicine examinations can play a role in the detection of radiation-induced digestive tract damage. In cancers of the cervix, endometrium, ovary, prostate, bladder, or rectum, radiation therapy is often required. Radiation proctitis is usually self-limiting and resolves within a month after the conclusion of therapy. Damage of the small bowel is seen in 0.5–15% of the patients. Chronic injuries to the small bowel are manifest 6 and 24 months after radiation. Ileal dysfunction is due to bile acid malabsortion, to bacterial overgrowth in the small bowel or to the combination of both.75Se-homocholic acid conjugated with taurine (75SeHCAT) and14C-glycochol breath test can be used to differentiate between normal functioning ileum (both tests negative) and ileal dysfunction (one or both tests positive). The combination of both tests may allow the differentiation between bile acid malabsorption (75Se-HCAT positive) and bacterial overgrowth (75Se-HCAT negative). These techniques may also help to document the benefit of innovative therapeutic approaches such as the use of somatostatin analogs (SOM230). In cases of radiotherapy and chemotherapy-associated liver injury, radionuclide studies can be performed using99mTc iminodiacetic acid (IDA) or99mTc-colloid. In patients receiving radiotherapy, the most common finding is the loss of function of the part of the liver involved in the radiation field, with a reduced uptake in irradiated areas. Recently, acute radiation-induced hepatitis has been reported as a potential cause of false-positive findings of malignancy on [18F]FDG-PET scans. Moreover, esophagitis post-radiotherapy can be observed on [18F]FDG-PET scans. Leucocytes labeled with111In or with99mTc-HMPAO or [18F]FDG can be used in patients with suspected radiation enterocolitis.
Original languageEnglish
Title of host publicationNuclear Oncology: Pathophysiology and Clinical Applications
Pages783-794
Number of pages11
DOIs
Publication statusPublished - 1 Jan 2013

Keywords

  • Adverse effects
  • Liver damage in radiation
  • Nuclear medicine
  • Pulmonary toxicity with radiation
  • Radiation-induced digestive tract damage
  • Radiation-induced pulmonary toxicity
  • Radiationinduced renal damage
  • Renal damage in radiation Gastrointestinal tract damage in radiation

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