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A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
THERAPY RESPONSE IN NUCLEAR MEDICINE
Guest Editor: Bombardieri E.
Castellani M. R. 1, Cefalo G. 2, Terenziani M. 2, Aliberti G. 1, Maccauro M. 1, Alessi A. 1, Villano C. 1, Bombardieri E. 1
1 Division of Nuclear Medicine, National Cancer Institute, Milan, Italy
2 Division of Paediatric Oncology, National Cancer Institute, Milan, Italy
Aim. The aim of the present paper is to describe the accuracy of gallium (67Ga) scintigraphy in adolescents and children with Hodgkin’s disease (HD). We have studied the diagnostic value of this nuclear imaging technique at disease presentation (staging) and its prognostic value based on changes in 67Ga uptake observed after treatment (response assessment).
Methods. From April 1985 to July 1999 74 consecutive untreated patients with a median age of 13 y underwent 67Ga scans 48-72 h after injection of 37-111 MBq of 67Ga-citrate. Planar whole-body scintigraphy was performed, supplemented with single photon emission tomography (SPET) of the mediastinum from 1996 onwards. Three patients did not undergo further scintigraphic examination because they were treated with radical surgery. After the 1st examination 71 of the 74 patients were monitored by 1-3 67Ga scans during the course of their disease. All of them had at least one 67Ga scintigraphy at the end of the induction phase of chemotherapy, before any other therapeutic regimens were planned.
Results. At disease presentation 67Ga scintigraphy was positive in all patients, detecting 285 of 335 (85.0%) lymph nodal sites of disease. The best sensitivity was observed in the mediastinum (100%; 63/63) and the laterocervical supraclavicular region (85.6%; 125/146); it was lower for axillary (72.7%; 16/22) and retroperitoneal (68.7%; 11/16) lymph node masses. In detecting visceral involvement the sensitivity of 67Ga scintigraphy was 66.6% (8/12) for lung and 80% (4/5) for bone involvement. Among 71 patients in follow-up, 2 showed rapid progression of disease during induction therapy while 69 patients were monitored for a long period. The response to therapy has been classified according to the changes observed on nuclear medicine or radiological images as complete response (CR) or partial response (PR). On the basis of 67Ga scans 55 patients (72.4%) were considered as having a CR, while with radiological modalities (chest X-ray, CT, MRI) CR was observed in only 29 patients (40.8%). PR or progression was found with 67Ga scintigraphy in 16 patients (22.5%) and with radiological modalities in 42 patients (59.1%). 67Ga scan was concordant with clinical outcome in 97% (28/29). The diagnostic effectiveness of this imaging technique has been analysed by comparing the scintigraphic or radiological changes at the 1st scintigraphic/radiological follow-up examination after induction therapy with the clinical outcome. In this population the relapse rate was 50% (8/16) in the group that did not achieve a CR according to post-treatment 67Ga scintigraphy, while it was only 10.9% (6/55) in the group that achieved a CR on the basis of scintigraphy findings. The overall survival (OS) and disease-free survival (DFS) were calculated by means of Kaplan-Meier cumulative survival plotting. When the 2 groups of patients with complete (CR) or incomplete normalisation (PR or progression) of 67Ga scintigraphy were compared, both OS and DFS were found to be statistically different (p=0.0001 and p=0.0004, respectively). By contrast, no statistical difference was found when the radiological findings were considered as the criterion for assessment of tumour response. On the basis of X-ray results the relapse rate was 13.7% in patients with negative post-therapy findings and 23.8% in patients with positive radiological imaging.
Conclusion. Our data demonstrate the high value of 67Ga scintigraphy in HD staging in paediatric patients. In addition, evaluation of the 67Ga uptake is very useful as a prognostic parameter; changes in 67Ga uptake after therapy indicate a favourable prognosis, whereas children still positive on post-treatment 67Ga scintigrams should be given more aggressive treatment.