title: Thallium-201 single-photon emission computed tomography as an early predictor of outcome in recurrent glioma.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  201Tl-SPECT is superior to conventional CT-MRI in the early prediction of overall survival and response to chemotherapy in patients with recurrent glioma.
authors.affiliation: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. mj.vos@vumc.nl.
authors.forename: Maaike J
authors.initials: MJ
authors.lastname: Vos
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Heimans
authors.forename: Cees J
authors.initials: CJ
authors.lastname: van Groeningen
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.forename: Tjeerd J
authors.initials: TJ
authors.lastname: Postma
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D013794:Thallium Radioisotopes