Thallium-201 SPECT predicts response to intensity-modulated radiation therapy for recurrent oral squamous cell carcinoma

Summary

The aim of this study was designed to investigate the usefulness of thallium-201 single photon emission computed tomography (SPECT) in predicting response of intensitymodulated radiation therapy (IMRT) for recurrent oral squamous cell carcinoma (OSCC). Patients, methods: Thirty-one patients with histologically proven recurrent OSCC were recruited. Before IMRT, all patients underwent SPECT at 15 min and 120 min after intravenous injection 111 MBq of thallous chloride (²⁰¹Tl). Tumour uptake was measured with the semiquantitative early ratio (ER), delayed ratio (DR), and retention index (RI). The patients were classified into responder (complete response and partial response) and non-responder (stable disease and progressive disease) groups according to the tumour response evaluated by the Response Evaluation Criteria in Solid Tumors guidelines. Results: As comparing DR and RI between the two groups, both parameters were significantly higher in the responder group. When a DR of 1.75 was used as a cutoff value for the responders, the receiver operating characteristic (ROC) analyses revealed sensitivity and specificity of 79% and 75%, respectively. At a cutoff value for the responders of a RI of 78.5%, the ROC analyses showed sensitivity and specificity of 95% and 83%, respectively. Conclusion: Our results suggest that ²⁰¹Tl-SPECT, as measured by the DR or RI has clinical potential in predicting response of IMRT for patients with recurrent OSCC. The ROC curve analyses further suggest that RI may be superior to DR in distinguishing responders from non-responders.

Zusammenfassung

Ziel der Studie war die Untersuchung der Brauchbarkeit der Thallium-201-Single-Photon-Emissionscomputertomographie (SPECT) für die Vorhersage des Ansprechens auf die intensitätsmodulierte Radiotherapie (IMRT) bei rezidivierendem oralem Plattenepithelkarzinom (OSCC). Patienten, Methoden: Es wurden 31 Patienten mit histologisch gesichertem rezidivierendem OSCC rekrutiert. Vor der IMRT wurde bei allen Patienten 15 min und 120 min nach intravenöser Injektion von 111 MBq Thalliumchlorid (²⁰¹Tl) eine SPECT durchgeführt. Die Tumoraufnahme wurde mit der semiquantitativen ER (early ratio), der DR (delayed ratio) und dem RI (Retentionsindex) gemessen. Die Patienten wurden in Gruppen von Respondern (vollständiges Ansprechen und partielles Ansprechen) und Nonrespondern (stabile Krankheit und progressive Krankheit) entsprechend der Tumorresponse eingeteilt, die mittels der Response-Evaluation- Criteria-in-Solid-Tumors-Richtlinien ermittelt wurde. Ergebnisse: Beim Vergleich der DR und des RI zwischen den beiden Gruppen waren beide Parameter in der Respondergruppe signifikant höher. Bei Verwendung einer DR von 1,75 als Grenzwert für die Responder ergaben die Analysen der Empfänger-Arbeits-Charakteristik (ROC) eine Sensitivität und eine Spezifität von 79% bzw. 75%. Bei einem RI von 78,5% als Grenzwert für die Responder ergaben die ROC-Analysen eine Sensitivität und eine Spezifität von 95% bzw. 83%. Schlussfolgerung: Unsere Ergebnisse sprechen dafür, dass ²⁰¹Tl-SPECT, gemessen anhand der DR oder des RI das klinische Potenzial zur Vorhersage des Ansprechens der IMRT bei Patienten mit rezidivierendem OSCC besitzt. Die Analysen der ROC-Kurve sprechen darüber hinaus dafür, dass der RI der DR bei der Unterscheidung von Respondern von Nonrespondern überlegen ist.

Keywords

Thallium-201 SPECT - IMRT - recurrent oral cancer - therapeutic response

Schlüsselwörter

Thallium-201-SPECT - IMRT - rezidivierendes Karzinom der Mundhöhle - therapeutisches Ansprechen

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