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Usefulness of ^99mTc-Sestamibi Scintigraphy in Suggesting the Therapeutic Effect of Chemotherapy against Gastric Cancer

Department of Surgery, Tazuke-Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan

Purpose: Imaging with ^99mTc-sestamibi (^99mTc-MIBI) has been used to assess 170-kDa P-glycoprotein (P-gp) expression and predict chemotherapy responses in several types of malignancy, such as breast and lung cancers. The purpose of this study was to evaluate the relationship between ^99mTc-MIBI accumulation in tumors and sensitivity to chemotherapy in gastric cancer patients.

Experimental Design: Thirty-six patients with advanced gastric cancer underwent ^99mTc-MIBI scintigraphy before chemotherapy. Patients also underwent endoscopic biopsy, and the expression of P-gp or multidrug resistance-associated protein was analyzed by immunohistochemical staining. The relationship between the accumulation of ^99mTc-MIBI in tumors and responses to chemotherapy with 5-fluorouracil/cis-diamminedichloroplatinum(II) or epirubicin was examined.

Results: Higher accumulation of ^9mTc-MIBI in tumors was observed in 25 and 23 of 36 gastric cancer patients at the early (30 min) and delayed (120 min) images, respectively. Accelerated accumulation of ^99mTc-MIBI negatively correlates with increased expression of P-gp, but not of multidrug resistance-associated protein, as determined by immunohistochemistry in gastric cancer tissues. The response rate to 5-fluorouracil/cis-diamminedichloroplatinum(II) chemotherapy in patients with high ^99mTc-MIBI accumulation (15.4%) was much lower than that in patients with low ^99mTc-MIBI accumulation (54.5%). In contrast, patients with high ^99mTc-MIBI accumulation show a higher response rate (41.7%) to chemotherapy with epirubicin, which is known to be a substrate of P-gp transporter.

Conclusions: ^99mTc-MIBI scintigraphy is useful to suggest the responses to chemotherapy of patients with advanced gastric cancer.

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