Role ofTc-99m Sestamibi and Triple phase bone scan in assessment of response of bone sarcomas to treatment
Raef Riad Kamel;
Abstract
Objective: Chemotherapy is the initial treatment in bone sarcoma which
may be followed by surgery or radiotherapy in patients with good response. Attempt to assess response to therapy in relation to
histopathologic evaluation is mandatory.
Material & methods: 28. patients with bone sarcoma ( 18 osteosarcoma,
10 Ewing sarcoma) with their age ranged 8-19 years were included. The
group is formed of 24 males and 4 females. Pre-chemotherapy assessment was done using 20 mCi of 99mTc-MDP WBS with imaging at I 0 min., 3 hours to assess the primary lesion and exclude metastatic spread. Whereas
99'"Tc-MIBI in a dose of 20 mCi with early images at 20 min. and late images at 2 hours were done before and after 3-4 courses of
chemotherapy. Correlation of Tc-MIBI scan with the percentage of necrosis histopathologicaly was possible in 19 patients following surgical removal of involved limb. The remaining 9 patients were assessed clinically and radiologically versus Tc-MIBI scan for a period ranging 6-
1:! months.
Results: Good response was evident in 12 patients with marked changes .
in qualitative images from high to no or mild uptake with significant decrease in mean 99"'Tc-MIBI ratio 2.57, 2.07 in early & late images to
0.95 & 0.89 (P < 0.01 ). 9 patients of osteosarcoma in this group showed
> 90% necrosis in the surgically removed limb, while the other 3 Ewing sarcoma had no viable tumor in 99111Tc-MIBI scan with no evidence of clinical or radiologic recurrence for 6-12 months. The second group with partial response showed some change in qualitative images from high to moderate degree in post chemotherapy scan. Also, mean quantitive Tc MIBI in early & late images were 5.03, 5.02 before chemotherapy and changed to 2.77, 2.43 following chemotherapy with significant difference (P< 0.05). The percentage of necrosis in this group ranged 50-90%. The third group with no response had no change in qualitative images before and after chemotherapy. Also, the mean early & late quantitive Tc-MIBI ratio before chemotherapy were 2.93, 2.69 with no change following chemotherapy with mean values of 3.8, 2.8 respectively. This group had
necrosis < 50% histopathologicaly.
To conclude: Tc-MIBI scan is a good methods for assessment of
chemotherapy response with significant correlation to histopathologic
chancre.
may be followed by surgery or radiotherapy in patients with good response. Attempt to assess response to therapy in relation to
histopathologic evaluation is mandatory.
Material & methods: 28. patients with bone sarcoma ( 18 osteosarcoma,
10 Ewing sarcoma) with their age ranged 8-19 years were included. The
group is formed of 24 males and 4 females. Pre-chemotherapy assessment was done using 20 mCi of 99mTc-MDP WBS with imaging at I 0 min., 3 hours to assess the primary lesion and exclude metastatic spread. Whereas
99'"Tc-MIBI in a dose of 20 mCi with early images at 20 min. and late images at 2 hours were done before and after 3-4 courses of
chemotherapy. Correlation of Tc-MIBI scan with the percentage of necrosis histopathologicaly was possible in 19 patients following surgical removal of involved limb. The remaining 9 patients were assessed clinically and radiologically versus Tc-MIBI scan for a period ranging 6-
1:! months.
Results: Good response was evident in 12 patients with marked changes .
in qualitative images from high to no or mild uptake with significant decrease in mean 99"'Tc-MIBI ratio 2.57, 2.07 in early & late images to
0.95 & 0.89 (P < 0.01 ). 9 patients of osteosarcoma in this group showed
> 90% necrosis in the surgically removed limb, while the other 3 Ewing sarcoma had no viable tumor in 99111Tc-MIBI scan with no evidence of clinical or radiologic recurrence for 6-12 months. The second group with partial response showed some change in qualitative images from high to moderate degree in post chemotherapy scan. Also, mean quantitive Tc MIBI in early & late images were 5.03, 5.02 before chemotherapy and changed to 2.77, 2.43 following chemotherapy with significant difference (P< 0.05). The percentage of necrosis in this group ranged 50-90%. The third group with no response had no change in qualitative images before and after chemotherapy. Also, the mean early & late quantitive Tc-MIBI ratio before chemotherapy were 2.93, 2.69 with no change following chemotherapy with mean values of 3.8, 2.8 respectively. This group had
necrosis < 50% histopathologicaly.
To conclude: Tc-MIBI scan is a good methods for assessment of
chemotherapy response with significant correlation to histopathologic
chancre.
Other data
| Title | Role ofTc-99m Sestamibi and Triple phase bone scan in assessment of response of bone sarcomas to treatment | Other Titles | دور التكنزيوم سيستاميبى والمسح الذري للعظام فى تقييم علاج أورام العظام السرطانية الاوليه | Authors | Raef Riad Kamel | Issue Date | 2001 |
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