Indian Journal of Nuclear Medicine
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Year : 2006  |  Volume : 21  |  Issue : 3  |  Page : 56-63

Assesment of response of limb sarcoma's to neoadjuvant chemotherapy with Tc-99m sesta MIBI

1 Dept. of Nuclear Medicine, Cancer Institute (WIA), Chennai - 600020, India
2 Formerly at Dept. of Nuclear Medicine, Cancer Institute (WIA), Chennai - 600020, India

Correspondence Address:
R Krishnakumar
Department of Nuclear Medicine, Cancer Institute (WIA), Chennai - 600020
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Source of Support: None, Conflict of Interest: None

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The advent of chemotherapy drugs (as neo adjuvant treatment) has facilitated conservative resection (limb salvage surgery) in limb tumors (bone and soft tissue tumors) .In previous decades mutilating surgeries like amputation used to be the mode of treatment for these patients. In this context we have studied the uptake ratio of Tc-99m Sestamibi (MIBI) in limb tumors before any treatment was given and again after the neoadjuvant chemotherapy. Both Osteosarcoma and Ewing's sarcoma were studied. It has been widely reported that Multi-drug Resistant gene (MDR1) expression in tumors can give rise to resistance to these drugs. We have correlated the response of these patients with the washout of MIBI from these tumors. Methods: 44 patients with limb tumors (34 Osteosarcoma and 10 Ewing's Sarcoma) were studied. In Osteosarcoma (OS) patients, the 1st study was done before any chemotherapy and 2nd study after 3-4 courses of chemotherapy. In Ewing's Sarcoma (ES) patients 1st study was done before any treatment was given, 2nd after 3 courses, 3rd after 6 courses and 4th after 12 courses of chemotherapy. The uptake ratio (UR) was calculated by dividing the number of counts in the involved tumor site by the number of counts in the contralateral symmetrical uninvolved site. Response ratio (RR) was calculated using uptake ratios in the first two studies in all patients. The wash out ratio of MIBI from the tumor site was also calculated in the first study. These ratios were correlated with clinical and histopathological responses. Results: 26 out of 34 OS patients had WR of more than 60 % over a period of 2 hours. Still 19 patients had responded clinically and had Limb salvage Surgery (LSS). Conclusion: There was no direct correlation between washout ratios and clinical responses in most of the patients. Those with high WR had responded clinically and had limb conservative surgery (LSS). This study has to be corroborated with further quantification of Pglycoprotein at molecular level.

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