[18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial

Abstract Introduction This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [18F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX). Methods Bone or soft tissue sarcoma patients with (1) baseline [18F]FDG PET/CT within 4 weeks prior to the start of neo-CTX (PET1), (2) early interim [18F]FDG PET/CT (6 weeks after the start of neo-CTX (PET2), (3) evaluation of neo-CTX response by histology or MRI, and (4) definitive therapy after neo-CTX (surgery or radiation) were included. Semiquantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [18F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a subpopulation of patients with bone involvement only. Results Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had osteosarcoma, 13/34 (38%) Ewing's sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16–84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease, and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p < 0.02). ΔMTV was associated with tissue response to neo-CTX (p = 0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS. Conclusion [18F]FDG PET/CT performed 6 weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.

Download Full-text

[18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial

10.21203/rs.3.rs-36997/v2 ◽

2020 ◽

Author(s):

Giulia Polverari ◽

Francesco Ceci ◽

Roberto Passera ◽

Jacquelyn Crane ◽

Lin Du ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Fdg Pet ◽

Pediatric Patients ◽

Early Response ◽

Tissue Response ◽

Secondary Outcome ◽

Single Center ◽

Pet Ct ◽

Definitive Therapy ◽

Fdg Pet Ct

Abstract Introduction: This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [18F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX).Methods: Bone or soft tissue sarcoma patients with i) baseline [18F]FDG PET/CT within four weeks prior to the start of neo-CTX (PET1), ii) early interim [18F]FDG PET/CT (six weeks after the start of neo-CTX (PET2), iii) evaluation of neo-CTX response by histology or MRI, and iv) definitive therapy after neo-CTX (surgery or radiation) were included. Semi-quantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [18F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a sub-population of patients with bone involvement only.Results: Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had Osteosarcoma, 13/34 (38%) Ewing Sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16-84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p <0.02). ΔMTV was associated with tissue response to neo-CTX (p=0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS. Conclusion: [18F]FDG PET/CT performed six weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.

Download Full-text

FDG PET/CT for Evaluating Early Response to Neoadjuvant Chemotherapy in Pediatric Patients with Sarcoma: A Prospective Single-Center Trial

10.21203/rs.3.rs-36997/v1 ◽

2020 ◽

Author(s):

Giulia Polverari ◽

Francesco Ceci ◽

Roberto Passera ◽

Jacquelyn Crane ◽

Lin Du ◽

...

Keyword(s):

Soft Tissue ◽

Neoadjuvant Chemotherapy ◽

Soft Tissue Sarcoma ◽

Fdg Pet ◽

Pediatric Patients ◽

Early Response ◽

Secondary Outcome ◽

Single Center ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Introduction: This is a prospective, single-center trial (UCLA-IRB#10-000246) in pediatric patients with high-grade bone or soft tissue sarcoma. The aim was to evaluate FDG-PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX).Methods: Bone or soft tissue sarcoma patients with i) baseline FDG PET/CT within four weeks prior to the start of neo-CTX (PET1), ii) early interim FDG PET/CT (six weeks after the start of neo-CTX (PET2), iii) evaluation of neo-CTX response by histology or MRI, and iv) definitive therapy after neo-CTX (surgery or radiation) were included. Semi-quantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were calculated. Patients with necrosis ≥90% in the excised tumor tissue after surgery or with complete disappearance of the soft tissue component on MRI after neo-CTX were considered responders. The primary endpoint was to evaluate the predictive value of FDG PET/CT parameters at baseline and early during neo-CTX for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if FDG PET/CT can predict the response to neo-CTX assessed by percentage of necrosis in the resected tumor or post-treatment MRI. Primary and secondary outcomes were also evaluated in a sub-population of patients with bone involvement only.Results: Thirty-four consecutive patients were enrolled (10 females; 24 males; median age=15.1 years). 17/34 patients (50%) had Osteosarcoma, 13/34 (38%) Ewing Sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16-84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44.1%) and 19/34 (55.9%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p <0.02). ΔMTV was associated with tissue response to neo-CTX (p=0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS. Conclusion: FDG PET/CT performed six weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric bone and soft tissue sarcoma patients.

Download Full-text

Can FDG-PET/CT predict early response to neoadjuvant chemotherapy in breast cancer?

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2013.08.025 ◽

2013 ◽

Vol 39 (12) ◽

pp. 1358-1363 ◽

Cited By ~ 21

Author(s):

W.P. Andrade ◽

E.N.P. Lima ◽

C.A.B.T. Osório ◽

M. do Socorro Maciel ◽

G. Baiocchi ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Fdg Pet ◽

Early Response ◽

Pet Ct ◽

Fdg Pet Ct ◽

Response To Neoadjuvant Chemotherapy

Download Full-text

Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential 18 F-FDG PET/CT and MRI

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-014-2746-2 ◽

2014 ◽

Vol 41 (8) ◽

pp. 1553-1562 ◽

Cited By ~ 34

Author(s):

Byung Hyun Byun ◽

Chang-Bae Kong ◽

Ilhan Lim ◽

Byung Il Kim ◽

Chang Woon Choi ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Fdg Pet ◽

Early Response ◽

Response Monitoring ◽

Pet Ct ◽

Fdg Pet Ct ◽

Ct And Mri

Download Full-text

FDG-PET/CT as a predictor of pathological complete response (pCR) in breast cancer (BC) patients (pts) treated with neoadjuvant chemotherapy (NAC): a single center retrospective study

Annals of Oncology ◽

10.1093/annonc/mdv336.20 ◽

2015 ◽

Vol 26 ◽

pp. vi9

Author(s):

A. Inno ◽

G. Lunardi ◽

M. Turazza ◽

S. Pasetto ◽

F. Severi ◽

...

Keyword(s):

Breast Cancer ◽

Retrospective Study ◽

Neoadjuvant Chemotherapy ◽

Fdg Pet ◽

Pathological Complete Response ◽

Complete Response ◽

Single Center ◽

Pet Ct ◽

Fdg Pet Ct

Download Full-text

Usefulness of 18f-FDG PET-CT in Staging, Restaging, and Response Assessment in Pediatric Rhabdomyosarcoma

Diagnostics ◽

10.3390/diagnostics10121112 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1112

Author(s):

Davide Donner ◽

Paola Feraco ◽

Linda Meneghello ◽

Barbara Rombi ◽

Lorena Picori ◽

...

Keyword(s):

Fdg Pet ◽

Pediatric Patients ◽

Response Assessment ◽

Response To Therapy ◽

High Morbidity ◽

European Guidelines ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Clinical Advances

Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood. Despite clinical advances, subsets of these patients continue to suffer high morbidity and mortality rates associated with their disease. Following the European guidelines for 18F-FDG PET and PET-CT imaging in pediatric oncology, the routine use of 18F-FDG PET-CT may be useful for patients affected by rhabdomyosarcoma, in staging, in the evaluation of response to therapy, and for restaging/detection of relapse. The European Pediatric Protocols are very old, and for staging and restaging, they recommend only radionuclide bone scan. The 18F-FDG PET-CT exam is listed as an optional investigation prescribed according to local availability and local protocols in the investigations panel required at the end of the treatment. We present two cases highlighting the usefulness of 18F-FDG PET-CT in managing pediatric patients affected by rhabdomyosarcoma, providing some bibliographic references.

Download Full-text