Prediction of myocutaneous adverse side effect due to intra-arterial chemotherapy by intra-arterial (99m)Tc-macroaggregated albumin administration in patients with bone and soft-tissue tumors.
In malignant bone and soft-tissue tumors, intra-arterial chemotherapy and limb-saving surgery have become popular. Myocutaneous inflammatory change and necrosis are the major local side effects of intra-arterial chemotherapy. (99m)Tc-macroaggregated albumin (MAA) imaging with intra-arterial tracer administration was performed to evaluate drug distribution, and the ability of (99m)Tc-MAA imaging to predict local side effects was assessed.


METHODS
In 24 patients, 42 (99m)Tc-MAA images were obtained with tracer injection through an intra-arterial catheter that was inserted into the proximal portion of the tumor-feeding artery. Abnormal uptake other than by tumor was assessed visually and quantitatively.


RESULTS
In visual analysis, abnormal (99m)Tc-MAA accumulation was observed in 21 of 42 images. In the first consecutive 13 of these 21 images, intra-arterial chemotherapy with cisplatin, doxorubicin, and caffeine was administered, and myocutaneous inflammation or necrosis in the area corresponding to the abnormal (99m)Tc-MAA uptake was observed in 11. In contrast, none of the 21 images without abnormal (99m)Tc-MAA uptake demonstrated any local adverse effect from intra-arterial chemotherapy. In the last consecutive 8 images with abnormal (99m)Tc-MAA uptake, intra-arterial chemotherapy was initiated with only cisplatin, and doxorubicin and caffeine administration was changed to the intravenous route. In all 8 of these images, no local adverse effects from chemotherapy were observed. Overall, the sensitivity, specificity, and accuracy of (99m)Tc-MAA imaging for the detection of myocutaneous damage were 100% (11/11), 91% (21/23), and 94% (32/34), respectively, and positive and negative predictive values were 85% (11/13) and 100% (21/21), respectively. In quantitative analysis, when the diagnostic threshold of the uptake ratio was set at 2.5, sensitivity, specificity, and accuracy for the detection of myocutaneous complications were 91% (10/11), 96% (22/23), and 94% (32/34), respectively, and positive and negative predictive values were 91% (10/11) and 96% (22/23), respectively.


CONCLUSIONS
(99m)Tc-MAA imaging with intra-arterial infusion before intra-arterial chemotherapy for bone and soft-tissue tumors can facilitate prediction of local myocutaneous adverse effects due to chemotherapy.
Taki
Junichi
J
Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences, Japan. taki@med.kanazawa-u.ac.jp
Sumiya
Hisashi
H
Higuchi
Takahiro
T
Tsuchiya
Hiroyuki
H
Takazawa
Koutaro
K
Tomita
Katsuro
K
Tonami
Norihisa
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007249:Inflammation; D007261:Infusions, Intra-Arterial / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012680:Sensitivity and Specificity; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage*
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D002945:Cisplatin