Diagnostic role of gallium scanning in the management of lymphoma with mediastinal involvement.
OBJECTIVE
Therapy of both Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) with mediastinal presentation at the time of diagnosis is frequently followed by radiological detection of residual masses. Computed tomography (CT) scanning is generally unable to detect the differences between tumor tissue and fibrosis. Gallium-67-citrate single photon emission ((67)GaSPECT) can potentially differentiate residual active tumor tissue from fibrosis.


METHODS
Seventy-five patients with HD or aggressive NHL presenting mediastinal involvement (64% with a bulky mass) were studied with CT and (67)GaSPECT at the end of combined modality therapy (chemo- and radiation therapy).


RESULTS
After treatment, 3/3 (100%) patients with positive (67)GaSPECT and negative CT scan relapsed while only 1/18 (6%) patients with both negative (67)GaSPECT and CT scan did so. At the same time, 54 patients had a positive restaging CT scan (abnormal mass < 10% of size of initial mass). Of these patients, 13 had a positive (67)GaSPECT, 10 of whom (77%) relapsed; 41 had a negative (67)GaSPECT of whom 5 (12%) relapsed. The 4-year actuarial relapse-free survival rate was 90% for those with negative scans compared with 23% for gallium-positive patients (p < 0.000000).


CONCLUSIONS
In lymphoma patients with mediastinal involvement, (67)GaSPECT should be considered, at least in patients who are CT positive, the imaging technique of choice for monitoring and differentiating the nature of any residual masses.
Istituto di Ematologia e Oncologia Medica "Seràgnoli", Policlinico S.Orsola, Via Massarenti 9, 40138 Bologna, Italy.
P L
PL
Zinzani
M
M
Magagnoli
R
R
Franchi
M
M
Zompatori
G
G
Frezza
R
R
Galassi
F
F
Gherlinzoni
M
M
Bendandi
P
P
Albertini
N
N
Monetti
S
S
Tura
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005708:Gallium; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon
D005708:Gallium