A Raciborska1, K Bilska2, K Drabko3, E Michalak4, R Chaber5, M Pogorzała6, K Połczyńska7, G Sobol8, M Wieczorek9, K Muszyńska-Rosłan10, M Rychlowska-Pruszyńska2, C Rodriguez-Galindo11, M Dziuk12. 1. Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Ul. Kasprzaka 17a, 01-211, Warsaw, Poland. anna.raciborska@hoga.pl. 2. Department of Surgical Oncology for Children and Youth, Institute of Mother and Child, Ul. Kasprzaka 17a, 01-211, Warsaw, Poland. 3. Department of Pediatric Hematology, Oncology and Transplant, Medical University of Lublin, Lublin, Poland. 4. Department of Pathology, Institute of Mother and Child, Warsaw, Poland. 5. Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland. 6. Department of Pediatric Hematology and Oncology Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. 7. Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland. 8. Unit of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice, Poland. 9. Department of Pediatrics and Oncology, Pediatric and Oncological Children's Centre, Chorzow, Poland. 10. Department of Pediatric Oncology and Hematology, Medical University of Bialystok Children's, Clinical Hospital of L. Zamenhof, Bialystok, Poland. 11. Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA. 12. Nuclear Medicine Department, Military Institute of Medicine, PET-CT Department, Mazovian Medical Centre, Warsaw, Poland.
Abstract
BACKGROUND: Response to chemotherapy is a prognostic factor in patients with Ewing sarcoma (ES); the role of FDG PET to predict response in these patients has not been thoroughly investigated. We evaluated the diagnostic accuracy and the potential of FDG PET to predict response to chemotherapy (CHT). MATERIALS AND METHODS: We analyzed data of 50 patients with ES (median age 12.6 years). All patients were treated with neoadjuvant CHT, and underwent surgery for local control. All patients had (18)F-FDG PET/CT at diagnosis and after induction CHT, prior to local control. We compared response assessed by histopathology with FDG PET using standard uptake values (SUVs). RESULTS: Median SUV at diagnosis (SUV I) was 5 (range 1.2-17), and median SUV after neoadjuvant chemotherapy (SUV II) was 1.8 (range 0-8.4). Median SUV II/I ratio was 0.3 (range 0-1). SUV at diagnosis was significantly lower in patients with good histological response than in patients with poor histological response (median 3.8 vs. 7.2, p 0.02). We found a significant correlation between SUV II and outcome; the positive predictive value of an SUV II ≤ 2.5 for favorable response was 84.21 %, and the median SUV II was significantly higher in patients with disease progression (2.3 vs. 1.6, p = 0.04). In multivariate analysis, necrosis and SUV II were significant predictors of outcome. CONCLUSIONS: (18)F-FDG PET demonstrates high diagnostic accuracy for response to initial chemotherapy in patients with ES and it correlates with outcome. The role of FDG PET in predicting response and outcome should be further investigated.
BACKGROUND: Response to chemotherapy is a prognostic factor in patients with Ewing sarcoma (ES); the role of FDG PET to predict response in these patients has not been thoroughly investigated. We evaluated the diagnostic accuracy and the potential of FDG PET to predict response to chemotherapy (CHT). MATERIALS AND METHODS: We analyzed data of 50 patients with ES (median age 12.6 years). All patients were treated with neoadjuvant CHT, and underwent surgery for local control. All patients had (18)F-FDG PET/CT at diagnosis and after induction CHT, prior to local control. We compared response assessed by histopathology with FDG PET using standard uptake values (SUVs). RESULTS: Median SUV at diagnosis (SUV I) was 5 (range 1.2-17), and median SUV after neoadjuvant chemotherapy (SUV II) was 1.8 (range 0-8.4). Median SUV II/I ratio was 0.3 (range 0-1). SUV at diagnosis was significantly lower in patients with good histological response than in patients with poor histological response (median 3.8 vs. 7.2, p 0.02). We found a significant correlation between SUV II and outcome; the positive predictive value of an SUV II ≤ 2.5 for favorable response was 84.21 %, and the median SUV II was significantly higher in patients with disease progression (2.3 vs. 1.6, p = 0.04). In multivariate analysis, necrosis and SUV II were significant predictors of outcome. CONCLUSIONS: (18)F-FDG PET demonstrates high diagnostic accuracy for response to initial chemotherapy in patients with ES and it correlates with outcome. The role of FDG PET in predicting response and outcome should be further investigated.
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