Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.
Int J Clin Oncol. 2011 Aug;16(4):373-8. doi: 10.1007/s10147-011-0194-6. Epub 2011 Feb 18.
In the treatment of osteosarcoma, the chemotherapeutic effect influences decisions regarding the surgical margin, continuation of chemotherapy, and choice of anticancer drugs for further chemotherapy. Therefore, it is necessary to evaluate the response to chemotherapy in the middle of the chemotherapy course. In this study, we investigated the use of (99m)Tc-hexakis-2-methoxyisobutyl-isonitrile ((99m)Tc-MIBI) scintigraphy in evaluating the response to chemotherapy of patients with osteosarcoma in comparison with (201)Tl scintigraphy and angiography.
A total 45 patients with osteosarcoma were examined using (99m)Tc-MIBI scintigraphy, (201)Tl scintigraphy, and angiography to evaluate their response to chemotherapy. The percentage reduction in the uptake ratios (ΔUR) calculated as 100 × [(prechemotherapy value - postchemotherapy value)/prechemotherapy value] were compared with histological assessments. Similarly, changes in tumor vascularity assessed by angiograms were compared with histological assessments. On the angiographic findings, the results were classified as complete response (CR), partial response (PR), no change (NC), or progressive disease (PD). On the images, ΔUR in (99m)Tc-MIBI ≥ 30% and ΔUR in (201)Tl ≥ 30% were classified as responder, as were CR and PR in angiograms. The therapeutic effect was assessed by histopathological examination of the resected specimens. The tumors of poor responders showed less than 90% necrosis, whereas the tumors of good responders showed 90% or more necrosis.
Sensitivity, specificity, and accuracy were 73.9, 84.2, and 78.6%, respectively, for (99m)Tc-MIBI (κ = 0.57); 80.0, 61.1, and 72.1%, respectively, for (201)Tl (κ = 0.42); and 91.7, 35.0, and 65.9%, respectively for angiography (κ = 0.28).
(99m)Tc-MIBI could be effectively used to predict the final response to chemotherapy of osteosarcoma.
在骨肉瘤的治疗中，化疗效果影响着手术切缘、化疗继续与否以及进一步化疗抗癌药物的选择等决策。因此，有必要在化疗过程中对化疗反应进行评估。本研究通过与 201Tl 闪烁显像和血管造影比较，探讨 99mTc-甲氧基异丁基异腈（99mTc-MIBI）闪烁显像在骨肉瘤患者化疗反应评估中的应用。
45 例骨肉瘤患者分别进行 99mTc-MIBI 闪烁显像、201Tl 闪烁显像和血管造影检查，以评估其对化疗的反应。摄取比值的降低百分比（ΔUR）按 100×[(化疗前值-化疗后值)/化疗前值]计算，并与组织学评估进行比较。同样，血管造影评估的肿瘤血管变化也与组织学评估进行比较。在血管造影结果中，将结果分为完全缓解（CR）、部分缓解（PR）、无变化（NC）或进展（PD）。在图像上，99mTc-MIBI 的 ΔUR≥30%和 201Tl 的 ΔUR≥30%被归类为反应者，CR 和 PR 也被归类为血管造影的反应者。通过对切除标本的组织病理学检查评估治疗效果。反应差的肿瘤显示的坏死率小于 90%，而反应好的肿瘤显示的坏死率大于 90%。
99mTc-MIBI 的灵敏度、特异性和准确性分别为 73.9%、84.2%和 78.6%（κ=0.57）；201Tl 的灵敏度、特异性和准确性分别为 80.0%、61.1%和 72.1%（κ=0.42）；血管造影的灵敏度、特异性和准确性分别为 91.7%、35.0%和 65.9%（κ=0.28）。
99mTc-MIBI 可有效地用于预测骨肉瘤的最终化疗反应。
