Originally published as JCO Early Release 10.1200/JCO.2003.01.001 on August 11 2003

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Thallium-201 Single-Photon Emission Computed Tomography As an Early Predictor of Outcome in Recurrent Glioma

From the Departments of Neurology, Nuclear Medicine, Radiology, Clinical Epidemiology and Biostatistics, Medical Oncology, Neurosurgery, and Radiotherapy, VU University Medical Center, Amsterdam, the Netherlands.

Address reprint requests to Maaike J. Vos, MD, Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; e-mail: mj.vos{at}vumc.nl.

Purpose: 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.

Patients and Methods: 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.

Results: 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.

Conclusion: ²⁰¹Tl-SPECT is superior to conventional CT-MRI in the early prediction of overall survival and response to chemotherapy in patients with recurrent glioma.

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