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This prospective clinical study used ^sup 99m^Tc-sestamibi (MIBI) brain SPECT to assess residual tumor volume and determine whether it would be prognostic of survival at the end of cranial irradiation in patients with malignant glioma. Methods: Fifty-seven patients with supratentorial malignant glioma were included in this clinical trial. Tomoscintigraphy was performed 4 h after an intravenous injection of MIBI (1,110 MBq). The images were obtained from a dual-head [gamma]-camera using fanbeam collimators. Transverse, coronal, and sagittal views were reconstructed. Metabolic tumor volume (MTV), using an ellipsoid model, was calculated from the 3 slices. The first posttherapeutic neuroradiologic evaluation was performed at the end of each patient's radiation therapy. Results: ^sup 99m^Tc-MIBI brain SPECT performed at the end of cranial irradiation provided data that allowed the identification of residual tumor and could be used to accurately predict survival of malignant glioma patients, taking into account the established prognostic factors. Patients with an MTV < 32 cm^sup 3^ had a median survival of 358 d, as opposed to 238 d in patients with an MTV > or = 32 cm^sup 3^ (P = 0.05). Moreover, half of CT scans performed at the same time were considered to show doubtful or only suggestive findings. No diagnosis of tumor progression or inflammatory changes was possible. Conclusion: ^sup 99m^Tc-MIBI brain SPECT may help in establishing the prognosis of glioma patients at the end of radiation therapy. Consequently, the management of patients can be adapted. These new data should be considered in the design of future clinical studies of malignant glioma patients as a way to quickly assess the efficiency of therapies.
Key Words: malignant glioma; radiation therapy; ^sup 99m^Tc-sestamibi brain SPECT; survival time
J Nucl Med 2004; 45:409-413
Malignant gliomas account for 60% of all primary brain tumors (1), and patients with this tumor type have a dismal prognosis. The standard for treatment has essentially been unchanged for many decades, that is, surgical resection of as much of the tumor as can safely be done, followed by radiation therapy and chemotherapy. Even under the best of circumstances, in those patients in whom essentially all of the tumor visualized through MRI is surgically resected or in whom high-grade gliomas have received the maximally tolerated doses of radiation and chemotherapy, the...