GA-67 AND TECHNETIUM-99M-METHYLENE DIPHOSPHONATE SKELETAL SCINTIGRAPHY IN DETERMINING PROGNOSIS FOR CHILDREN WITH STAGE-IV NEUROBLASTOMA

Thirty-five children (aged 0-9 yr) who had presented with Stage IV neu roblastoma were studied to see if avidity for Ga-67 or Tc-99m-methylen e diphosphonate (MDP) uptake in both primary and secondary sites at di agnosis conferred any prognostic significance. Twenty-three percent of the patients were disease free and off treatment at the time of study . Crude survival did not differ between groups. Duration of survival a nd the likelihood of completing treatment were related to the scintigr aphic appearance at the time of diagnosis, after adjustment for potent ial confounding effects, using Cox's proportional hazards regression a nd multiple logistic regression. After adjustment for confounding infl uences, neither Ga-67 avidity nor uptake of Tc-99m-MDP was associated with a significantly worse prognosis, both in terms of adjusted surviv al and likelihood of completing treatment. Patients with Ga-67-avid sc ans at diagnosis did not demonstrate significantly worse survival (HR 1.47, 95% CI 0.43-5.11) than those without Ga-67 avidity. They were so mewhat less likely to complete treatment (OR 0.23, 95% CI 0.03-1.63), but this did not reach statistical significance. Similarly, although p atients with Tc-99m-MDP positive scans demonstrated somewhat worse sur vival (HR 2.47, 95% CI 0.45-13.54), this result did not reach statisti cal significance, nor were they less likely to complete treatment (OR 0.69, 95% CI 0.07-6.67) than those with Tc-99m-MDP negative scans. Upt ake of Tc-99m-MDP into extraosseous sites was also not associated with worse survival (HR 1.45, 95% CI 0.58-3.62) nor with decreased likelih ood of completing treatment (OR 0.78, 95% CI 0.12-5.09). Other than in dicating disease stage, these results do not support the hypothesis th at the scintigraphic appearance at diagnosis confers prognostic inform ation in children with advanced neuroblastoma.