The Journal of Bone and Joint Surgery, Vol 75, Issue 4 526-531, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Thallium-201 scanning for the evaluation of osteosarcoma and soft-tissue sarcoma. A study of the evaluation and predictability of the histological response to chemotherapy
LR Menendez, BM Fideler and J Mirra
Department of Orthopaedic Surgery, University of Southern California, Los Angeles 90033-4608.
We evaluated sequential thallium scans, made before and after a period of
preoperative chemotherapy, for sixteen patients who had a high-grade
sarcoma of bone or soft tissue. The purpose was to determine whether this
technique could be used to ascertain accurately the amount of viable tumor
as well as to predict the response to chemotherapy. Nine of the ten
patients who had a reduced thallium uptake after chemotherapy also had a
marked histological response, with necrosis of the tumor of at least 95 per
cent. Six patients were seen to have no improvement on the thallium scans,
and this finding correlated with necrosis of the tumor of less than 95 per
cent. Thallium chloride has been shown to have an affinity for a variety of
osteosarcomas and soft-tissue sarcomas. The mechanism of intracellular
uptake is one of active transport, which makes thallium chloride a more
accurate barometer of the viability of the tumor cells and of metabolic
activity than scanning agents that are flow-dependent. We believe that
sequential thallium scintigraphy should be used in conjunction with other
imaging modalities in the diagnosis, planning of treatment, and follow-up
evaluation of patients who have a sarcoma of bone or soft tissue. This
technique appears to be useful in the prediction of the histological
response of high-grade osteosarcomas and soft-tissue sarcomas to
preoperative chemotherapy.
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