What is the value of emission tomography studies in patients with a primary glioblastoma multiforme treated by 192Ir brachytherapy?
BACKGROUND
We studied the use of (201)Thallium SPECT and L-[1-(11)C]-tyrosine PET in patients with a primary glioblastoma multiforme treated with (192)Ir brachytherapy after surgery and external beam radiation therapy. We hypothesised that the patients most likely to benefit from further surgery after deterioration would be those with radiation necrosis and would be recognised by a negative emission tomography scan.


METHODS
Twenty-one patients underwent (201)Thallium SPECT performed before brachytherapy, and this was repeated in 19 patients when recurrence was suspected. Nine patients also underwent a PET scan at the same time. Nine patients underwent a second operation.


RESULTS
SPECT and PET were highly concordant concerning the prediction of radionecrosis and/or tumour recurrence. Repeat surgery did not lead to a significant increase in survival. There was no significant association between the duration of survival and tumour-to-background ratio but the number studied was small. Both SPECT and PET showed highly active lesions, which were proved to be recurrent tumour by clinical and histological follow-up.


CONCLUSIONS
Although PET and SPECT are both highly sensitive in detecting active tumour tissue, emission tomography was not clinically valuable in the investigation of patients with a primary glioblastoma treated with brachytherapy.
Koot
R W
RW
Academic Medical Center, Department of Neurosurgery, University of Amsterdam, Amsterdam, The Netherlands. r.w.koot@lumc.nl
Habraken
J B A
JB
Hulshof
M C C M
MC
Paans
A M J
AM
Bosch
D A
DA
Pruim
J
J
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D001921:Brain / Q000000981:diagnostic imaging / Q000528:radiation effects; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002250:Carbon Radioisotopes; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007496:Iridium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011832:Radiation Injuries / Q000000981:diagnostic imaging; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014443:Tyrosine
D002250:Carbon Radioisotopes; D007496:Iridium Radioisotopes; D013794:Thallium Radioisotopes; D014443:Tyrosine