Alessio Annovazzi1, Virginia Ferraresi2,3, Vincenzo Anelli4, Renato Covello5, Sabrina Vari2, Carmine Zoccali6, Roberto Biagini6, Rosa Sciuto7. 1. Nuclear Medicine Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy. alessio.annovazzi@ifo.gov.it. 2. First Division of Medical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 3. Sarcomas and Rare Tumors Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 4. Radiology and Diagnostic Imaging Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 5. Department of Pathology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 6. Oncological Orthopaedics Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 7. Nuclear Medicine Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy.
Abstract
OBJECTIVE: The application of [18F]FDG PET/CT in predicting histologic response to induction chemotherapy in patients with Ewing sarcoma (EWS) has been proposed using the values of pre-post treatment SUVmax as a referral parameter, although with heterogeneous results. The aim of this retrospective study was to evaluate the diagnostic accuracy of [18F]FDG PET/CT volumetric parameters (metabolic tumour volume (MTV) and total lesion glycolysis (TLG)) as compared to SUVmax to predict response to chemotherapy and clinical outcome in patients with localised EWS of bone and soft-tissue. METHODS: Twenty-eight patients with non-metastatic EWS of bone (n = 20) and soft tissues (n = 8) who underwent a [18F]FDG PET/CT scan before (PET1) and after induction chemotherapy (PET2) were enclosed in the analysis. Values of PET metrics (SUVmax, MTV, TLG) at diagnosis and after neoadjuvant chemotherapy as well as the percentage change between PET1 and PET2 (ΔSUV, ΔMTV and ΔTLG) were correlated to histological response and to progression-free survival (PFS). RESULTS: ΔTLG (cut-off: -60%) is the best predictor for histologic response with 100% sensitivity and 77.8% specificity. MTV1 > 33.4 cm3 and TLG1 > 112 were also associated with a favourable histologic response (sensitivity 80% and specificity 77.8% for both). On multivariate analysis, SUV2 (> 3.3) and ΔTLG (< -18%) were independent predictors of worse PFS. CONCLUSIONS: [18F]FDG PET/CT could accurately predict histologic response to neoadjuvant chemotherapy in patients with EWS, also showing a possible prognostic value for future disease relapse. KEY POINTS: • The variation of the PET parameter tumour lesion glycolysis (TLG) can predict the histologic response to induction chemotherapy (sensitivity 100%, specificity 77.8%), in patients with Ewing sarcoma. • The percentage variation of TLG and the value of the SUVmax at PET scan after chemotherapy show a prognostic role for future disease relapse. The combination of both the parameters identifies three prognostic classes of patients with low, intermediate and high risk of disease relapse.
OBJECTIVE: The application of [18F]FDG PET/CT in predicting histologic response to induction chemotherapy in patients with Ewing sarcoma (EWS) has been proposed using the values of pre-post treatment SUVmax as a referral parameter, although with heterogeneous results. The aim of this retrospective study was to evaluate the diagnostic accuracy of [18F]FDG PET/CT volumetric parameters (metabolic tumour volume (MTV) and total lesion glycolysis (TLG)) as compared to SUVmax to predict response to chemotherapy and clinical outcome in patients with localised EWS of bone and soft-tissue. METHODS: Twenty-eight patients with non-metastatic EWS of bone (n = 20) and soft tissues (n = 8) who underwent a [18F]FDG PET/CT scan before (PET1) and after induction chemotherapy (PET2) were enclosed in the analysis. Values of PET metrics (SUVmax, MTV, TLG) at diagnosis and after neoadjuvant chemotherapy as well as the percentage change between PET1 and PET2 (ΔSUV, ΔMTV and ΔTLG) were correlated to histological response and to progression-free survival (PFS). RESULTS: ΔTLG (cut-off: -60%) is the best predictor for histologic response with 100% sensitivity and 77.8% specificity. MTV1 > 33.4 cm3 and TLG1 > 112 were also associated with a favourable histologic response (sensitivity 80% and specificity 77.8% for both). On multivariate analysis, SUV2 (> 3.3) and ΔTLG (< -18%) were independent predictors of worse PFS. CONCLUSIONS: [18F]FDG PET/CT could accurately predict histologic response to neoadjuvant chemotherapy in patients with EWS, also showing a possible prognostic value for future disease relapse. KEY POINTS: • The variation of the PET parameter tumour lesion glycolysis (TLG) can predict the histologic response to induction chemotherapy (sensitivity 100%, specificity 77.8%), in patients with Ewing sarcoma. • The percentage variation of TLG and the value of the SUVmax at PET scan after chemotherapy show a prognostic role for future disease relapse. The combination of both the parameters identifies three prognostic classes of patients with low, intermediate and high risk of disease relapse.
Authors: Patrick P Lin; Norman Jaffe; Cynthia E Herzog; Colleen M Costelloe; Michael T Deavers; Jeana S Kelly; Shreyaskumar R Patel; John E Madewell; Valerae O Lewis; Christopher P Cannon; Robert S Benjamin; Alan W Yasko Journal: Cancer Date: 2007-02-01 Impact factor: 6.860
Authors: Carlos Rodriguez-Galindo; Catherine A Billups; Larry E Kun; Bhaskar N Rao; Charles B Pratt; Thomas E Merchant; Victor M Santana; Alberto S Pappo Journal: Cancer Date: 2002-01-15 Impact factor: 6.860
Authors: P Picci; T Böhling; G Bacci; S Ferrari; L Sangiorgi; M Mercuri; P Ruggieri; M Manfrini; A Ferraro; R Casadei; M S Benassi; A F Mancini; P Rosito; A Cazzola; E Barbieri; A Tienghi; A Brach del Prever; A Comandone; P Bacchini; F Bertoni Journal: J Clin Oncol Date: 1997-04 Impact factor: 44.544
Authors: Thomas G P Grünewald; Florencia Cidre-Aranaz; Didier Surdez; Eleni M Tomazou; Enrique de Álava; Heinrich Kovar; Poul H Sorensen; Olivier Delattre; Uta Dirksen Journal: Nat Rev Dis Primers Date: 2018-07-05 Impact factor: 52.329
Authors: Nathalie Gaspar; Douglas S Hawkins; Uta Dirksen; Ian J Lewis; Stefano Ferrari; Marie-Cecile Le Deley; Heinrich Kovar; Robert Grimer; Jeremy Whelan; Line Claude; Olivier Delattre; Michael Paulussen; Piero Picci; Kirsten Sundby Hall; Hendrik van den Berg; Ruth Ladenstein; Jean Michon; Lars Hjorth; Ian Judson; Roberto Luksch; Mark L Bernstein; Perrine Marec-Bérard; Bernadette Brennan; Alan W Craft; Richard B Womer; Heribert Juergens; Odile Oberlin Journal: J Clin Oncol Date: 2015-08-24 Impact factor: 44.544
Authors: G Bacci; S Ferrari; A Longhi; D Donati; M De Paolis; C Forni; M Versari; E Setola; A Briccoli; E Barbieri Journal: Ann Oncol Date: 2003-11 Impact factor: 32.976
Authors: S E Bosma; C Lancia; A J Rueten-Budde; A Ranft; H Gelderblom; M Fiocco; M A J van de Sande; P D S Dijkstra; U Dirksen Journal: Sci Rep Date: 2019-07-29 Impact factor: 4.379