In:
Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 89, No. 1 ( 1998-07), p. 60-68
Abstract:
Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201 Tl and 99m Tc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201 Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99m Tc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I ( 201 Tl ratio 〈 2 and 99m Tc-HMPAO ratio 〈 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients ( 201 T1 ratio 〈 2 and 99m Tc-HMPAO ratio of ≥ 0.5 or 201 Tl ratio between 2 and 3.5 regardless of 99m Tc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III ( 201 Tl ratio 〉 3.5 and 99m Tc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p 〈 0.01); however, SPECT grouping was more closely associated with 1-year survival (p 〈 0.001) and was the only variable significantly associated with long-term survival (p 〈 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.
Type of Medium:
Online Resource
ISSN:
0022-3085
DOI:
10.3171/jns.1998.89.1.0060
Language:
Unknown
Publisher:
Journal of Neurosurgery Publishing Group (JNSPG)
Publication Date:
1998
detail.hit.zdb_id:
2026156-1
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