Vos Maaike J, Hoekstra Otto S, Barkhof Frederik, Berkhof Johannes, Heimans Jan J, van Groeningen Cees J, Vandertop W Peter, Slotman Ben J, Postma Tjeerd J
Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
J Clin Oncol. 2003 Oct 1;21(19):3559-65. doi: 10.1200/JCO.2003.01.001. Epub 2003 Aug 11.
With limited response rates and potential toxicity of chemotherapeutic treatment in patients with recurrent glioma, reliable response assessment is essential. Currently, the assessment of treatment response in glioma patients is based on the combination of radiologic and clinical findings. However, response monitoring with computed tomography (CT) or magnetic resonance imaging (MRI) is hampered by several pitfalls and is prone to interobserver variability. The aim of this study was to establish the value of thallium-201 single-photon emission computed tomography (201Tl-SPECT) as a predictor of overall survival and response to chemotherapy in recurrent glioma, and to compare the value of 201Tl-SPECT with that of CT and MRI.
We studied patients who underwent CT or MRI and 201Tl-SPECT before chemotherapy (n = 57), and patients who also had undergone CT or MRI and 201Tl-SPECT after two courses of chemotherapy (n = 44). The value of the radiologic variables (CT-MRI tumor size, 201Tl-SPECT tumor size, and maximal tumor intensity) at baseline and at follow-up in predicting overall survival, and the percentage of patients alive and progression-free at 6 months (APF6) were examined using Cox regression and logistic regression analysis.
Both at baseline and at follow-up, 201Tl-SPECT maximal tumor intensity was the strongest predictive variable and was inversely related to overall survival and APF6. In particular, progression of maximal tumor intensity after two courses of chemotherapy was a powerful predictor of poor outcome.
201Tl-SPECT is superior to conventional CT-MRI in the early prediction of overall survival and response to chemotherapy in patients with recurrent glioma.
复发性胶质瘤患者化疗的缓解率有限且存在潜在毒性，因此进行可靠的疗效评估至关重要。目前，胶质瘤患者治疗反应的评估基于影像学和临床检查结果的综合判断。然而，计算机断层扫描（CT）或磁共振成像（MRI）用于疗效监测存在一些缺陷，并且容易出现观察者间的差异。本研究的目的是确定铊 - 201单光子发射计算机断层扫描（201Tl - SPECT）作为复发性胶质瘤患者总生存期和化疗反应预测指标的价值，并将201Tl - SPECT的价值与CT和MRI的价值进行比较。
我们研究了化疗前接受CT或MRI以及201Tl - SPECT检查的患者（n = 57），以及接受两个疗程化疗后也接受CT或MRI以及201Tl - SPECT检查的患者（n = 44）。使用Cox回归和逻辑回归分析，检验基线和随访时影像学变量（CT - MRI肿瘤大小、201Tl - SPECT肿瘤大小和最大肿瘤强度）在预测总生存期方面的值，以及6个月时存活且无进展的患者百分比（APF6）。
在基线和随访时，201Tl - SPECT最大肿瘤强度都是最强的预测变量，并且与总生存期和APF6呈负相关。特别是，两个疗程化疗后最大肿瘤强度的进展是预后不良的有力预测指标。
在复发性胶质瘤患者总生存期和化疗反应的早期预测方面，201Tl - SPECT优于传统的CT - MRI。
