Table 6 shows the relationship between the degree of uptake in lesions as assessed by scintigraphy and the detection of tumour by conventional CB-7598 imaging. Overall, 34 of 61 patients (56%) had positive scintigrams. Uptake was clear but faint in the majority of patients. Examples of octreotide uptake are shown in Figures 3 and and4.4. In general, the test was less sensitive than CT scanning in identifying HCC; however, it provided a noninvasive indication of the presence or absence of somatostatin receptors. In some instances (Figure 4), the tumour area showed less uptake than normal liver. Figure 3 (A) Octreotide scintigraphy (4-h image) showing uptake in an HCC in the dome of the right lobe of the liver (arrow): anterior image; (B) posterior image; normal octreotide uptake in spleen and kidneys; (C) SPECT transaxial section through the upper abdomen .

.. Figure 4 (A) Octreotide scintigraphy (4-h image) showing no evidence of uptake in an HCC in the right lobe of the liver: anterior image; (B) posterior image; (C) SPECT transaxial section through the upper abdomen showing reduced uptake in the HCC (arrows) compared … Table 6 Octreotide scintigraphy (61 patients) and conventional imaging (CT scanning, 63 patients) compared Immunohistochemistry for somatostatin receptors Positive controls (pancreatic islets, neuroendocrine tumours) showed clear staining. In the 20 tissue samples that were suitable for IHC analysis, there were not enough receptors for meaningful staining with the antiserum SS800, despite considerable efforts to optimise antibody staining.

Chromogranin A Figure 5 shows chromogranin A levels. We hypothesised that patients with high levels might be those with tumours, which displayed features of neuroendocrine differentiation and therefore hormone receptors. In turn, these might be those most likely to respond to therapy with the somatostatin ligand. We therefore analysed Brefeldin_A the relationships among chromogranin levels, scintigraphy results, and clinical outcomes. There was no clear relationship between scan positivity and chromogranin A levels. Similarly, there was no relationship between serum levels of chromogranin A and survival. Figure 5 Chromogranin A levels over time in each patient. Quality of life Most patients had adequate English skills to complete the HRQL forms (47 patients, 75%) and most did so at baseline (46 patients), but completing the forms decreased over follow-up, as expected. Fatigue, anxiety, pain, and insomnia were the symptoms rated as most severe at baseline. After 1 month of treatment, significantly more patients reported improvements than deteriorations on the Patient Benefit Form in vomiting, urinary symptoms, constipation, cough, irritability, and mood (Figure 6).