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Guest Editor: Bombardieri E.

The Quarterly Journal of Nuclear Medicine 2003 March;47(1):22-30


lingua: Inglese

Gallium scan in adolescents and children with Hodgkin’s disease (HD). Treatment response assessment and prognostic value

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.

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