Journal of Clinical Oncology, Vol 11, 1092-1098, Copyright © 1993 by American Society of Clinical Oncology
Gallium scans in patients with mediastinal Hodgkin's disease treated with chemotherapy
DL Cooper, VJ Caride, M Zloty, J Germino, LR Farber and PB Hoffer
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510.
PURPOSE: To determine the predictive value of gallium scans in patients
with mediastinal Hodgkin's disease treated with chemotherapy or combined
modality treatment. PATIENTS AND METHODS: A retrospective study was
performed of 48 patients with mediastinal Hodgkin's disease treated with
chemotherapy or combined modality therapy. Patients were monitored with
whole-body planar scans (34 patients) or chest single- photon-emission
computed tomography (SPECT) plus planar abdominal imaging studies (14
patients). Scans were performed at diagnosis, following three to eight
cycles of chemotherapy, and after the end of treatment. The value of
gallium scans in modifying treatment and predicting outcome was assessed.
RESULTS: All patients studied at the time of diagnosis had abnormal gallium
accumulation in the mediastinum. After chemotherapy, four patients had
residual mediastinal activity; two patients with persistent activity on
planar scans failed to enter remission and died of disease; two other
patients with abnormal activity only seen on SPECT had therapy modified and
remain in remission. After chemotherapy, 44 patients had a normal gallium
scan. Twelve patients with negative scans relapsed, including nine patients
with recurrence above the diaphragm. CONCLUSION: The use of gallium scans
after several courses of chemotherapy resulted in a modification of
treatment in four patients, including two patients who are apparently
cured. However, after negative scans, 20% of patients relapsed above the
diaphragm. These results suggest that gallium imaging, including SPECT, is
of limited value in predicting disease sterilization, although the number
of patients studied with SPECT was small. At present, the major value of
gallium scans is to identify patients who may benefit from a modification
of treatment.
