The value of gallium imaging after therapy for Hodgkin's disease

Department of Radiation Oncology, State University of New York Health Science Center, Syracuse 13210, USA.
Cancer (Impact Factor: 4.89). 02/1998; 82(4):754-9. DOI: 10.1002/(SICI)1097-0142(19980215)82:4<754::AID-CNCR19>3.0.CO;2-X
Source: PubMed


Although it is used widely, the value of gallium imaging in managing Hodgkin's disease remains unclear.
A retrospective review of gallium imaging and treatment outcome in 60 patients with Hodgkin's disease treated between January 1990 and July 1995 was conducted. The minimum follow-up was 1 year.
Based on gallium imaging, 46 patients were in complete remission (CR) after initial treatment, 10 were in partial remission (PR), and 4 had persistent or progressive disease (NR). Ten of 29 patients (34%) with gallium CR after chemotherapy subsequently recurred, compared with no recurrences in 17 patients receiving initial radiotherapy or combined chemoradiation. Eight of ten patients received further therapy after gallium PR, and nine patients remained disease free at last follow-up. Survival did not differ in patients achieving a gallium CR or PR.
Gallium-67 imaging may help confirm the presence of active Hodgkin's disease, but was unreliable in defining disease remission after chemotherapy in this study population. Patients with a gallium PR may still have a good prognosis after additional therapy.

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Available from: Jeffrey A Bogart, Sep 19, 2014
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    ABSTRACT: We analysed the data of 56 patients retrospectively who got the diagnose of Morbus Hodgkin during the period of March 1985 to February 1994 at the Klinikum Rechts der Isar. The following entry criterias were set: A Gallium scan before treatment had to be positive. As for the patients characteristics we had a sexual division of 42% female and 58% male at an median age of 39. More than half of the patients were 21 to 42 years old. The nodular sclerosis and the mixed cellularity were the major histologic subtypswith an occurance of 70% and 22%. The clinical stages showed the following division: stage I 14%, stage II 38%, stage III 28% and stage IV 20%. Like Johnston 1977 we found a sensitivity of Gallium scans for each lymph node area which had to be considerated for the judgement of the scintigraphic pictures. The summed up sensitivities were about 65 % supradiaphragmal and 3 % infradiaphragmal. Until today the role of the Gallium scintigraphy for the primary diagnose is far behind all other procedures. The CT shows much better results in sensitivity as well as in specify. Generally our results are in good correlation to other publications that were made under the same conditions. The Gallium scans show a complete remission in 27 of 32 cases at the staging after therapy. All cases were judged as a complete clinical remission although partly in disagreement with the CT results. Two relapses occurred in this group during an average observing period of 53 months. There for the probability of a disease free survival with a negative Gallium scan is 93%. Gallium enrichments, that showed still active Hodgkin tissue, were found in five cases. Foue patients of those suffered a relapse which leads to a positive predictive result of 80%. The CT confirms a complete remission in 18 cases after therapy. One of those patients got a relapse. This results in a negative predictive rate of 95%. The CT of 14 patients after therapy still showed tissue in the meaning of a partial remission or a progression. Five of those suffered a relapse. This leads to a postive predictive value of 36%.
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    ABSTRACT: Primary refractory Hodgkin's disease may generally be defined as progression of disease during induction treatment or a partial or transient response (< 60 days) to induction therapy. Salvage chemotherapy is inadequate in this patient population; fewer than 10% of patients survive for 10 years or longer. Improved outcomes after failure of primary induction therapy have been reported with myeloablative therapy and autografting. The projected event-free survivals ranged from 18%-49% at four years. Highly selected patients may benefit from salvage radiotherapy, but this may be best accomplished in combination with transplantation. A number of strategies might be considered for increasing the cure rate for the small subset of patients with primary refractory Hodgkin's disease. Among these, identification of patients at high risk for induction failure and modifications of primary treatment to address this risk hold the greatest promise for success.
    Preview · Article · Feb 1998 · Annals of Oncology
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