title: Prognostic value of Tc-99m-MIBI performed during middle course of preoperative chemotherapy in patients with malignant bone and soft-tissue tumors.
abstract: OBJECTIVE
  This study was aimed to determine whether Tc-99m-hexakis-2-methoxyisobutylisonitrile (MIBI) scintigraphy performed in the middle of preoperative chemotherapy has a prognostic value in patients with malignant bone and soft tissue tumors (MBST).
  
  
  METHODS
  In 90 patients with MBST, Tc-99m-MIBI scintigraphy was performed 15 minutes after tracer injection before the first and after the third chemotherapy cycles. After 5 cycles of chemotherapy and tumor resection, therapeutic effect was assessed by histopathology. The percent reduction of uptake ratio (ΔUR) was calculated according to the following equation: 100 × ([prechemotherapy UR - post-middle course of chemotherapy UR]/prechemotherapy UR).
  
  
  RESULTS
  The average follow-up for the entire population was 52 months. Twenty-one patients had clinically detectable metastases at initial presentation (primary metastasis). Kaplan-Meier analysis demonstrated that absence of metastasis was associated with good survival in all patients, in patients with bone tumor, and those with soft tissue tumor (P < 0.0001, P < 0.0001, and P = 0.0003, respectively), and ΔUR ≧30% was also associated with survival in all patients and patients with bone tumor (P = 0.011 and P = 0.047, respectively), but was marginal in those with soft tissue tumor (P = 0.091). Multivariate analysis showed that primary metastasis was the most powerful independent predictor of a lethal clinical outcome in all patients, in both patients with bone and soft tissue tumors (hazard ratio [HR]: 4.9, 95% confidence interval [CI]: 2.61-9.08, P < 0.0001; HR: 15.1, CI: 4.86-52.7, P < 0.0001; HR: 3.7, CI: 1.45-8.94, P = 0.0069, respectively) and showed that Tc-99m-MIBI scintigraphy had a good independent long-term prognostic value in all patients and patients with bone tumor (HR: 2.2, CI: 1.14-4.43, P = 0.017; HR: 6.0, CI: 2.01-21.6, P = 0.0009, respectively) but not in those with soft tissue tumor (HR: 1.5, CI: 0.61-4.09, P = 0.38). Good disease-free survival was associated with ΔUR ≧30% in all patients and patients with soft tissue tumor (P = 0.0093 and P = 0.017, respectively) but not in those with bone tumor (P = 0.19).
  
  
  CONCLUSIONS
  Tc-99m-MIBI scintigraphy at the middle course of preoperative chemotherapy could be used as a prognostic indicator in patients with MBST.
authors.affiliation: Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wakabayashi
authors.forename: Junichi
authors.initials: J
authors.lastname: Taki
authors.forename: Anri
authors.initials: A
authors.lastname: Inaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sumiya
authors.forename: Yoh
authors.initials: Y
authors.lastname: Zen
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
authors.forename: Seigo
authors.initials: S
authors.lastname: Kinuya
mesh_terms: D000293:Adolescent; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D011292:Premedication / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi