18f-FDG-PET imaging as an early survival predictor in patients with high-grade soft tissue sarcomas undergoing neoadjuvant therapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10012-10012
Author(s):  
Ken Herrmann ◽  
Matthias R. Benz ◽  
Johannes Czernin ◽  
Martin Auerbach ◽  
William D. Tap ◽  
...  
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Neoadjuvant Therapy ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
Rank Test ◽  
High Grade ◽  
Initial Cycle

10012 Background: Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 18F-FDG PET/CT (PET) imaging after the initial cycle and after end of neoadjuvant therapy could predict overall survival in these patients. Methods: 76 patients (primary STS: n=57; metastatic disease: n=19) with high grade STS were included in this study. PET was performed prior to (n=76), after one cycle (n=52) and after the end of neoadjuvant therapy (n=74). Overall survival was correlated with changes of SUVpeak, RECIST, histopathological response and other parameters predictive of STS survival. Results: One-, two- and five- year survival rates were 95±3.0%, 86±4.6% and 68±6.6% for primary STS. Corresponding one- and two- year survival rates for recurrent/metastatic STS were 77±10.0% and 47±12.1%. Optimal cut-off for early decreases in SUV peak were significant predictors of survival in log-rank test (p=0.027 and p=0.043). However, late decreases in SUV peak were only predictive in primary STS (SUV peak decrease 57%; p=0.035) but not in recurrent/metastatic STS (SUV peak decrease 52%; p=0.057). In primary STS, 7/15 early PET non-responders but only 4/24 early PET responders died during follow up (p=0.068). Conclusions: 18F-FDG-PET seems feasible to predict survival after the initial cycle of neoadjuvant chemotherapy in both patients with primary STS and recurrent/metastatic STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.

Treatment-Induced Pathologic Necrosis: A Predictor of Local Recurrence and Survival in Patients Receiving Neoadjuvant Therapy for High-Grade Extremity Soft Tissue Sarcomas

2001 ◽  
Vol 19 (13) ◽  
pp. 3203-3209 ◽  
Author(s):  
Fritz C. Eilber ◽  
Gerald Rosen ◽  
Jeffery Eckardt ◽  
Charles Forscher ◽  
Scott D. Nelson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Neoadjuvant Therapy ◽  
Independent Predictor ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Recurrence Rates ◽  
Pathologic Assessment

PURPOSE: To determine whether treatment-induced pathologic necrosis correlates with local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. PATIENTS AND METHODS: Four hundred ninety-six patients with intermediate- to high-grade extremity soft tissue sarcomas received protocol neoadjuvant therapy. All patients underwent surgical resection after neoadjuvant therapy and had pathologic assessment of tumor necrosis in the resected specimens. RESULTS: The 5- and 10-year local recurrence rates for patients with ≥ 95% pathologic necrosis were significantly lower (6% and 11%, respectively) than the local recurrence rates for patients with less than 95% pathologic necrosis (17% and 23%, respectively). The 5- and 10-year survival rates for the patients with ≥ 95% pathologic necrosis were significantly higher (80% and 71%, respectively) than the survival rates for the patients with less than 95% pathologic necrosis (62% and 55%, respectively). Patients with less than 95% pathologic necrosis were 2.51 times more likely to develop a local recurrence and 1.86 times more likely to die of their disease as compared with patients with ≥ 95% pathologic necrosis. The percentage of patients who achieved ≥ 95% pathologic necrosis increased to 48% with the addition of ifosfamide as compared with 13% of the patients in all the other protocols combined. CONCLUSION: Treatment-induced pathologic necrosis is an independent predictor of both local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. A complete pathologic response (≥ 95% pathologic necrosis) correlated with a significantly lower rate of local recurrence and improved overall survival.

Change in quantitative FDG-PET was significantly more accurate than change in size at predicting histopathologic response to neoadjuvant therapy in high grade soft tissue sarcomas

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10017-10017
Author(s):  
V. Evilevitch ◽  
W. A. Weber ◽  
W. D. Tap ◽  
K. Chow ◽  
M. Allen-Auerbach ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Therapy ◽  
Tumor Size ◽  
Fdg Pet ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Fdg Uptake ◽  
Histopathologic Response ◽  
Pet Ct ◽  
Fdg Pet Ct

10017 Background: Change in size by RECIST (Response Evaluation Criteria in Solid Tumors) has been the standard to assess response to therapy in non-GIST soft tissue sarcomas (STS). Although recent studies have demonstrated that Positron Emission Tomography with F18-fluorodeoxyglucose (FDG-PET) may be used to assess response, there has not been a direct comparison between these modalities. The aim of this study was to prospectively evaluate whether a change in quantitative FDG-PET or a change in size [computed tomography(CT)] was more accurate at predicting histopathologic response to neoadjuvant therapy in patients with high grade STS using a combined FDG-PET/CT scan. Methods: From 1/05 - 12/06 58 patients with resectable biopsy proven high grade STS scheduled to undergo neoadjuvant chemotherapy were prospectively enrolled in this study. Patients underwent FDG-PET/CT prior to and after neoadjuvant treatment (prior to surgery). Tumor FDG-uptake was quantified by standardized uptake values (SUV). Changes in tumor size were quantified according to RECIST. Following tumor resection, response was assessed histopathologically. Patients with = 10% viable tumor cells were classified as responders. To date, 36 patients have completed the study and are the subject of this analysis. Results: In histopathologic responders (n=10, 28%), reduction of tumor FDG-uptake was significantly greater (-64%) than in histopathologic non-responders (-37%), (p=0.005). Using a 50% decrease in tumor SUV as a threshold value resulted in a sensitivity of 90% and a specificity of 58% for assessment of histopathologic response (p=0.01). Response assessment per RECIST showed no significant correlation with histopathologic response (sensitivity 20%, specificity 89%, p=0.4). There was no correlation between changes in tumor size and histopathologic response (area under the ROC curve = 0.6, p=0.1). Conclusions: In patients with high grade STS, quantitative FDG-PET was significantly more accurate than size based criteria for assessment of histopathologic response to neoadjuvant therapy. FDG-PET should be considered as a modality to monitor treatment response is patients with high grade STS. No significant financial relationships to disclose.

scholarly journals FDG-PET/CT Imaging Predicts Histopathologic Treatment Responses after the Initial Cycle of Neoadjuvant Chemotherapy in High-Grade Soft-Tissue Sarcomas

2009 ◽  
Vol 15 (8) ◽  
pp. 2856-2863 ◽  
Author(s):  
Matthias R. Benz ◽  
Johannes Czernin ◽  
Martin S. Allen-Auerbach ◽  
William D. Tap ◽  
Sarah M. Dry ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Soft Tissue Sarcomas ◽  
Ct Imaging ◽  
High Grade ◽  
Pet Ct ◽  
Treatment Responses ◽  
Fdg Pet Ct ◽  
Initial Cycle

Tumor FDG-uptake after the initial cycle of chemotherapy and histopathologic response to neoadjuvant therapy in high-grade soft tissue sarcomas

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 10528-10528
Author(s):  
M. R. Benz ◽  
W. A. Weber ◽  
M. S. Allen-Auerbach ◽  
W. D. Tap ◽  
D. Elashoff ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Therapy ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Fdg Uptake ◽  
Histopathologic Response ◽  
Initial Cycle

scholarly journals 18F-FDG-PET/CT Imaging as an Early Survival Predictor in Patients with Primary High-Grade Soft Tissue Sarcomas Undergoing Neoadjuvant Therapy

2012 ◽  
Vol 18 (7) ◽  
pp. 2024-2031 ◽  
Author(s):  
Ken Herrmann ◽  
Matthias R. Benz ◽  
Johannes Czernin ◽  
Martin S. Allen-Auerbach ◽  
William D. Tap ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Therapy ◽  
Fdg Pet ◽  
Soft Tissue Sarcomas ◽  
Ct Imaging ◽  
High Grade ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Survival Predictor

A randomized trial for the treatment of high-grade soft-tissue sarcomas of the extremities: preliminary observations.

1986 ◽  
Vol 4 (4) ◽  
pp. 552-558 ◽  
Author(s):  
F Gherlinzoni ◽  
G Bacci ◽  
P Picci ◽  
R Capanna ◽  
P Calderoni ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Soft Tissue ◽  
Local Treatment ◽  
Soft Tissue Sarcomas ◽  
Rank Test ◽  
High Grade ◽  
Chemotherapy Group ◽  
The Difference ◽  
To Receive ◽  
Observation Period

A new trial for evaluating the effectiveness of adjuvant chemotherapy in high-grade soft-tissue sarcomas of the extremities in adult patients is presented. All patients after local treatment were randomized into two arms, one without further therapy and the other to receive adjuvant chemotherapy (Adriamycin [Farmitalia-Carlo Erba, Milan, Italy], 450 mg/m2). The preliminary results of the study are reported at a median observation period of 27.6 months. Of the 59 patients who entered the study, 79.1% in the chemotherapy group are without sign of disease, whereas the corresponding figure in the nonadjuvant chemotherapy group is 54.3%. The difference between the two groups is statistically significant (P less than .005, log rank test). These preliminary observations encourage continuation of the study.

Risk assessment in high grade sarcoma patients during neoadjuvant chemotherapy using multiple tracer PET

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20006-20006
Author(s):  
J. F. Eary ◽  
E. Conrad ◽  
J. Link ◽  
A. Cizik ◽  
D. Mankoff ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Soft Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Soft Tissue Sarcoma ◽  
Pet Imaging ◽  
Cellular Proliferation ◽  
Soft Tissue Sarcomas ◽  
Response To Treatment ◽  
High Grade ◽  
Hypoxic Volume

20006 Background: Patients with high grade soft tissue sarcomas are treated with neoadjuvant chemotherapy. Sarcomas have biological features that may predict for poor outcome. Some of these features are tumor proliferation rate, level of tumor hypoxia, and upregulation of tumor drug resistance mechanisms. Methods: We have a group of specific PET imaging agents to quantify the level of activity of these tumor processes. Patients with soft tissue sarcomas receive [C-11]Thymidine (TdR) to assess cellular proliferation, [O-15] Water to quantify tumor blood flow and to serve as the input function for quantification of the other tracers, [C-11]Verapamil to assess drug resistance mechanism activity, and [F-18]Fluoromisonidazole) FMISO to quantify changes in tumor hypoxic volume in response to treatment. These studies are performed in a single PET imaging session prior to neoadjuvant chemotherapy, after the second of four cycles of therapy and in the week prior to resection. Results: An example of this complex study result, is demonstrated by a recent patient with a high grade soft tissue sarcoma. The tumor showed increased TdR uptake, a moderate hypoxic volume, and [C-11] verapamil uptake prior to initiation of neoadjuvant adriamycin based chemotherapy. After 2 cycles of therapy, there was a significant decrease in the maximum level and volume of TdR uptake and a large reduction in tumor hypoxic volume. Conclusions: These data would imply a high risk soft tissue sarcoma due the presence of increased cellular proliferation, a significant hypoxic volume and the absence of p-glycoprotein activity determined by the presence of [C-11]Verapamil uptake. However, early response is also suggested by the findings above. Patient outcome will be assessed and correlated with these tumor parameters to further understand what tumor biological risk factors can be quantified non-invasively and repeated throughout the clinical course in soft tissue sarcoma patients. Supported by NIH NCI PO1 42045–18 and S10 RR017229–01 [Table: see text] No significant financial relationships to disclose.

Use of FDG-PET (PET) to select patients for metastasectomy for high-grade soft tissue sarcomas (HG-STS)

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 10596-10596
Author(s):  
S. Aliberti ◽  
P. Allione ◽  
G. Grignani ◽  
F. Carnevale Schianca ◽  
M. Fizzotti ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Fdg Pet ◽  
Soft Tissue Sarcomas ◽  
High Grade

Impact of neoadjuvant therapy on histopathologic response and survival in patients with primary high-grade retroperitoneal soft tissue sarcomas

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 10510-10510
Author(s):  
T. R. Donahue ◽  
M. W. Kattan ◽  
S. D. Nelson ◽  
W. D. Tap ◽  
F. R. Eilber ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Therapy ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Histopathologic Response

Correlation of FDG PET-CT with histologic response after neoadjuvant chemotherapy for soft tissue sarcomas

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10583-10583
Author(s):  
E. Y. Cheng ◽  
J. W. Froelich ◽  
J. C. Manivel ◽  
B. J. Weigel ◽  
K. M. Skubitz
Keyword(s):  
Soft Tissue ◽  
Fdg Pet ◽  
Soft Tissue Sarcomas ◽  
Response To Treatment ◽  
Additional Patient ◽  
High Grade ◽  
Continuous Variables ◽  
Histologic Response ◽  
Pet Ct ◽  
Fdg Pet Ct

10583 Background: Surrogate endpoints for survival are needed to allow rapid assessment of new therapies without doing lengthy studies using a survival endpoint. Non-invasive assessment of treatment response is also needed to guide chemotherapy. FDG- PET-CT has potential for assessing response to treatment in sarcoma. This study's goal was to correlate FDG-PET-CT, along with standard CT, with histologic response after chemotherapy for high grade soft tissue sarcomas before resection. Methods: Patients with high grade soft tissue sarcomas > 5 cm were enrolled in a prospective clinical trial and given ifosfamide/doxorubicin before tumor excision. FDG-PET-CT was performed at baseline before treatment, after cycle 1, & just before surgery. Differences in both SUVmax (baseline to cycle 1 [B-1], baseline to surgery [B-3]) and CT criteria (RECIST 1 dimension [1D], RECIST 2D & Choi) were compared to histologic response (> or < 90%) upon excision. Results: 25 patients were enrolled and 4 had disease progression prior to completing all 3 PET-CT's yielding 21 evaluable cases. 5 patients had SUVmax change of <40%: 4/5 (80%) had histologic response < 90% & 1/5 (20%) had histologic response >90%. 16 patients had SUVmax change of >40%: 12/16 (75%) had histologic response >90% & 4/16 (25%) had histologic response <90%. A scatterplot of SUVmax change (baseline to surgery), & histologic response as continuous variables revealed a Spearman's correlation coefficient = 0.55 (p<0.01). Conclusions: A cutoff value of 40% reduction in SUVmax from baseline to surgery appeared to differentiate histologic responders. Using this to define PET response, a correlation between PET response, as well as RECIST 1D and 2D, and histologic response was observed. Additional patient follow-up & further study of FDG-PET-CT as a surrogate endpoint for histologic response and survival is warranted. [Table: see text] [Table: see text]

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