Role of 99mTc labelled GHA in post treatment evaluation of brain tumours

Full text: Introduction: Biochemical investigations have a major role to play in the management of primary brain tumours. It is well known that major biochemical changes occur during cancerous transformation including changes in the energy metabolism of the cell. Changes take place in terms of utilization of glucose and other substrates, protein synthesis and expression of antigens and receptors. Changes also take place in disruption of transport mechanisms across cell membranes and other physiological boundaries like blood brain barrier. In the management of primary brain tumours positron emitting tracers have an undisputed role and the role of cationic tracers like Thallium-201, 99m-Tc MIBI and 99m-Tc tetrofosmin has been cited as an alternative to positron tracers in neuro oncology. It must be borne in mind that the cationic tracers are expensive to procure and facilities for positron emission tomography are not available in most of the developing countries. Tc-99m GHA Brain Imaging: Keeping in view the above, a cheaper alternative for PET radio tracers was evaluated. We have so far conducted more than 100 brain SPECT studies, using Tc-99m Glucoheptonic acid (GHA), in 60 patients of brain tumour, both at the time of their diagnosis, as well as after treatment during the follow-up period. Tc-99m Glucoheptonic acid (GHA) is a chemical glucose analogue. Avid concentration of the radiopharmaceutical was noted in viable tumor tissue in the SPECT images done one hour after injection of 740 MBq of 99m-Tc GHA. This was subsequently confirmed by histopathological examination in patients undergoing re-surgery for residual disease or follow up and clinical correlation in patients under remission. Avid tracer concentration was also well demonstrated in recurrent disease (proven by clinical examination, histopathology and/or magnetic resonance imaging (MRI). No significant tracer uptake was seen in areas of radiation induced necrosis. Non-specific uptake in the tumor bed was noticed in scans done in the early post operative period. However delayed imaging (3-4hr post injection) had been helpful in such situations. Findings have correlated well with thallium scans in the group of patients who had both the studies. Conclusions: The mechanism of uptake of GHA by viable tumour cells has not been well documented. Breach in the blood brain barrier is one mechanism but whether the radiopharmaceutical is incorporated in the tumour cells or it also acts as a glucose analogue biologically, needs to be evaluated further. Tc-99m GHA is inexpensive, easy to procure and has shown promising results, at least in our hands. In our opinion, it can be a cost effective viability agent, hence needs further attention. (author)