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Tsuchiya K, Akisue T, Ehara S, Kawai A, Kawano H, Hiraga H, Hosono A, Hutani H, Morii T, Morioka H, Nishida Y, Oda Y, Ogose A, Shimose S, Yamaguchi T, Yamamoto T, Yoshida M. Japanese orthopaedic association (JOA) clinical practice guidelines on the management of malignant bone tumors - Secondary publication. J Orthop Sci 2024:S0949-2658(23)00321-4. [PMID: 39003183 DOI: 10.1016/j.jos.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 07/15/2024]
Abstract
BACKGROUND In Japan, there are currently no general guidelines for the treatment of primary malignant bone tumors. Therefore, the Japanese Orthopaedic Association established a committee to develop guidelines for the appropriate diagnosis and treatment of primary malignant bone tumors for medical professionals in clinical practice. METHODS The guidelines were developed in accordance with "Minds Clinical Practice Guideline Development Handbook 2014″ and "Minds Clinical Practice Guideline Development Manual 2017". The Japanese Orthopaedic Association's Bone and Soft Tissue Tumor Committee established guideline development and systematic review committees, drawing members from orthopedic specialists leading the diagnosis and treatment of bone and soft tissue tumors. Pediatricians, radiologists, and diagnostic pathologists were added to both committees because of the importance of multidisciplinary treatment. Based on the diagnosis and treatment algorithm for primary malignant bone tumors, important decision-making points were selected, and clinical questions (CQ) were determined. The strength of recommendation was rated on two levels and the strength of evidence was rated on four levels. The recommendations published were selected based on agreement by 70% or more of the voters. RESULTS The guideline development committee examined the important clinical issues in the clinical algorithm and selected 22 CQs. The systematic review committee reviewed the evidence concerning each CQ and a clinical value judgment was added by experts. Eventually, 25 questions were published and the text of each recommendation was determined. CONCLUSION Since primary malignant bone tumors are rare, there is a dearth of strong evidence based on randomized controlled trials, and recommendations cannot be applied to all the patients. In clinical practice, appropriate treatment of patients with primary malignant bone tumors should be based on the histopathological diagnosis and degree of progression of each case, using these guidelines as a reference.
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Affiliation(s)
- Kazuaki Tsuchiya
- Department of Orthopaedic Surgery, Toho University of Medicine, Japan.
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Japan
| | - Shigeru Ehara
- Department of Radiology, Japan Community Healthcare Organization (JCHO) Sendai Hospital, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University of Medicine, Japan
| | - Hiroaki Hiraga
- Department of Musculoskeletal Oncology, National Hospital Organization Hokkaido Cancer Center, Japan
| | - Ako Hosono
- Department of Pediatric Oncology, National Cancer Center Hospital East, Japan
| | - Hiroyuki Hutani
- Department of Orthopaedic Surgery, Hyogo Medical University, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Akira Ogose
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Shoji Shimose
- National Hospital Organization Kure Medical Center, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Dokkyo Medical University, Nikko Medical Center, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Hospital, Japan
| | - Masahiro Yoshida
- International University of Health and Welfare, Japan Council for Quality Health Care, Japan
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Wu C, Wang Q, Li Y. Prediction and evaluation of neoadjuvant chemotherapy using the dual mechanisms of 99mTc-MIBI scintigraphy in patients with osteosarcoma. J Bone Oncol 2019; 17:100250. [PMID: 31372331 PMCID: PMC6658932 DOI: 10.1016/j.jbo.2019.100250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the feasibility of applying the dual imaging mechanisms of 99mTc-MIBI scintigraphy in predicting and evaluating the response to neoadjuvant chemotherapy in patients with osteosarcoma. Materials and methods Thirty patients with osteosarcoma who underwent both pre-and post-chemotherapy 99mTc-MIBI scintigraphy were enrolled in the study. In each patient, the tumor to background ratio (T/B), tumor washout rate (WR) of MIBI and the alteration rate (AR) of tumor uptake after chemotherapy was calculated, respectively, on MIBI scintigraphy before or after chemotherapy. Based on the tumor necrosis rate histologically confirmed by tumor resection after chemotherapy, the diagnostic performance of MIBI scintigraphy was assessed in predicting tumor response with the WR of pre-chemotherapy imaging, as well as evaluating tumor response with the AR of both pre-and post-chemotherapy imaging. Results On pre-chemotherapy MIBI imaging, no statistical difference was found in T/B values between patients with good response and those with poor response, but the WR in patients with good response was significantly lower. Tumor WR was negatively correlated with the tumor necrosis rate (r = −0.510, P = 0.004). When WR ≤ 25% was taken as the threshold for predicting good response, a sensitivity of 100%, a specificity of 91.7% and an accuracy of 95.8% would be yielded. On post-chemotherapy imaging, T/B values both on early and delayed phases were significantly lower in responders and AR of tumor uptake was significantly higher in these responders. When AR ≥ 38% was used as the threshold for a good response, a sensitivity of 91.7%, a specificity of 94.4% and an accuracy of 93.3% would be yielded. The diagnostic coincidence rate between WR for predicting chemotherapy response and AR for evaluating chemotherapy response was 90.0% (kappa = 0.789, P < 0.001). Conclusion 99mTc-MIBI imaging is a useful tool for the evaluation of neoadjuvant chemotherapy in patients with osteosarcoma, and its dual mechanisms could be simultaneously used in predicting and evaluating tumor response to chemotherapy.
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Affiliation(s)
- Caixia Wu
- Department of Nuclear Medicine, Peking University People's Hospital, 11th Xizhimen South St., Beijing 100044, China
| | - Qian Wang
- Department of Nuclear Medicine, Peking University People's Hospital, 11th Xizhimen South St., Beijing 100044, China
| | - Yuan Li
- Department of Nuclear Medicine, Peking University People's Hospital, 11th Xizhimen South St., Beijing 100044, China
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Lee I, Byun BH, Lim I, Kim BI, Kong CB, Song WS, Cho WH, Koh JS, Lim SM. Comparison of 99mTc-methyl diphosphonate bone scintigraphy and 18F-fluorodeoxyglucose positron emission tomography/computed tomography to predict histologic response to neoadjuvant chemotherapy in patients with osteosarcoma. Medicine (Baltimore) 2018; 97:e12318. [PMID: 30212975 PMCID: PMC6155965 DOI: 10.1097/md.0000000000012318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We compared the usefulness of Tc-methyl diphosphonate (Tc-MDP) bone scintigraphy and F-fluorodeoxyglucose (FDG) for positron emission tomography/computed tomography (PET/CT) in predicting histologic response in patients with osteosarcoma receiving neoadjuvant chemotherapy (NAC).We retrospectively reviewed 62 patients with high-grade osteosarcoma who had received 2 cycles of NAC and surgery. All patients underwent Tc-MDP bone scintigraphy and F-FDG PET/CT before and after NAC. Tc-MDP uptake in the primary tumor was measured quantitatively as the maximum tumor-to-nontumor ratio (T/NTmax) and F-FDG uptake was measured as the maximum standardized uptake value (SUVmax), before and after NAC. The percent changes of T/NTmax (percent changes of the maximum tumor-to-nontumor ratio [Δ%T/NTmax]) and SUVmax (percent changes of the maximum standardized uptake value [Δ%SUVmax]) after NAC were calculated and the correlations between these parameters were evaluated. After surgery, the effects of NAC were graded histopathologically (good vs poor) and the optimum cut-off values of Δ%T/NTmax and Δ%SUVmax for predicting histologic response were assessed using the receiver operating characteristic (ROC) curve analysis.Δ%T/NTmax and Δ%SUVmax were positively correlated with each other (r = 0.494, P < .01). Based on the ROC curve analysis, both Δ%T/NTmax (area under the curve [AUC] = .772, P < .01) and Δ%SUVmax (AUC = .829, P < .01) predicted good histologic response. However, there was no significant difference between the AUCs of Δ%T/NTmax and Δ%SUVmax (P = .44). The sensitivity and specificity for predicting good histologic response were 83.3% and 75.0%, for the criterion Δ%T/NTmax <-12.5%, and 80.0% and 81.3% for the criterion Δ%SUVmax <-49.0%, respectively.The Tc-MDP bone scan and F-FDG PET scan are non-inferior to each other in predicting the histologic response of osteosarcoma treatments. The Tc-MDP bone scan and F-FDG PET scan showed respective advantages with differing features. Therefore, physicians should consider which scan is appropriate for their own institute based on the advantages of each scan and the circumstances of the institute.
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Affiliation(s)
- Inki Lee
- Department of Nuclear Medicine Department of Orthopedic Surgery Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
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Yoneyama H, Nakajima K, Okuda K, Matsuo S, Onoguchi M, Kinuya S, Edenbrandt L. Reducing the small-heart effect in pediatric gated myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2017; 24:1378-1388. [PMID: 27197818 DOI: 10.1007/s12350-016-0518-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We compared two reconstruction algorisms and two cardiac functional evaluation software programs in terms of their accuracy for estimating ejection fraction (EF) of small hearts (SH). METHODS The study group consisted of 66 pediatric patients. Data were reconstructed using a filtered back projection (FBP) method without the resolution correction (RC) and an iterative method based on an ordered subset expectation maximization (OSEM) algorithm with the RC. EF was evaluated using two software programs of quantitative gated single-photon emission computed tomography (SPECT) (QGS) and cardioREPO. We compared the EF of gated myocardial perfusion SPECT to echocardiographic measurement (Echo). RESULTS Forty-eight of 66 patients had an end-systolic volume < 20 mL which was used as the criterion for being included in the SH group, and the SH effect led to an overestimation of EF. While significant differences were observed between Echo (66.9 ± 5.0%) and QGS-FBP without RC (76.9 ± 8.4%, P < .0001), QGS-OSEM with RC (76.6 ± 8.6%, P < .0001), and cardioREPO-FBP without RC (72.1 ± 10.0%, P = .0011), no significant difference was observed between Echo and cardioREPO-OSEM with RC (67.4 ± 6.1%) in SH group. CONCLUSIONS In pediatric gated myocardial perfusion SPECT, the SH effect can be significantly reduced when an OSEM algorithm is used with RC in combination with the specific cardioREPO algorithm.
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Affiliation(s)
- Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kanazawa, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Health Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Wakabayashi H, Saito J, Taki J, Hashimoto N, Tsuchiya H, Gabata T, Kinuya S. Triple-phase contrast-enhanced MRI for the prediction of preoperative chemotherapeutic effect in patients with osteosarcoma: comparison with (99m)Tc-MIBI scintigraphy. Skeletal Radiol 2016; 45:87-95. [PMID: 26385785 DOI: 10.1007/s00256-015-2250-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to determine whether (99m)Tc-MIBI scintigraphy and triple-phase contrast-enhanced magnetic resonance imaging (TCE-MRI) performed during and after preoperative chemotherapy have the power to predict final chemotherapeutic effects in patients with osteosarcoma (OS). MATERIALS AND METHODS Seventeen patients underwent (99m)Tc-MIBI scintigraphy and TCE-MRI before and after the middle and last courses of preoperative chemotherapy. As for (99m)Tc-MIBI scintigraphy, an uptake ratio (UR) and a reduction rate of UR (ΔUR(MIBI)) were calculated. As for TCE-MRI, a ratio of contrast to background (CTB) was calculated in the whole tumor area (WA) at each phase on dynamic T1-weighted fat suppression images. Then a ratio of signal (R(WA)) was calculated by dividing CTB at triple-phase by CTB at pre-phase. RESULTS Nine and eight patients showed good and poor response in histopathologic evaluation. The sensitivity, specificity, and accuracy for the prediction of histopathological chemotherapeutic effect was 44, 100, 69% in R(WA) at the first phase, 100, 75, 88% in ΔUR(MIBI) after the middle course, 88, 100, 94% in R(WA) at the first phase, and 100, 75, 88% in ΔUR(MIBI) after the last course of the preoperative chemotherapy, respectively. CONCLUSION Both (99m)Tc-MIBI scintigrapy and TCE-MRI can predict the tumor response in patients with OS after the completion of the preoperative chemotherapy.
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Affiliation(s)
- Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Junko Saito
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Nanako Hashimoto
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Prognostic value of radiological response to chemotherapy in patients with osteosarcoma. PLoS One 2013; 8:e70015. [PMID: 23922892 PMCID: PMC3726455 DOI: 10.1371/journal.pone.0070015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chemotherapy is essential to improve the prognosis of the patients with osteosarcoma, and the response to chemotherapy is an important prognostic factor. In this study, the impact of various radiological examinations on overall survival (OS) and event-free survival (EFS) was evaluated. METHOD Eighty-two patients with high-grade osteosarcoma were included in this study, and we evaluated the following factors for prognostic significance: age (≥40 years), gender (male), tumor location (truncal site), metastatic disease, histological response to chemotherapy, radiological response to chemotherapy assessed using X-ray, angiography, CT, MRI, (201)Tl scintigraphy, and (99m)Tc-MIBI scintigraphy ((99m)Tc-MIBI), and combined radiological score (CRS). RESULTS Univariate analyses revealed that metastatic disease, histological response, (99m)Tc-MIBI, and CRS were significantly correlated with OS. Multivariate analyses showed that metastatic disease (OS: HR 35.9, P<0.001; EFS: HR 17.32, P<0.001) was an independent predictor of OS and EFS. Tumor location (HR 36.1, P = 0.003), histological response (HR 31.1, P = 0.036), and (99m)Tc-MIBI (HR 18.4, P = 0.038) were significant prognostic factors for OS. Moreover, CRS was a marginally significant predictor of OS and EFS. CONCLUSION The chemotherapeutic effects evaluated by (99m)Tc-MIBI and CRS could be considered as prognostic factors in osteosarcoma.
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Miwa S, Taki J, Yamamoto N, Shirai T, Nishida H, Hayashi K, Tanzawa Y, Kimura H, Takeuchi A, Igarashi K, Ooi A, Tsuchiya H. A novel combined radiological method for evaluation of the response to chemotherapy for primary bone sarcoma. J Surg Oncol 2012; 106:273-9. [PMID: 22389049 DOI: 10.1002/jso.23074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 02/06/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND In the treatment of bone sarcoma, evaluation of chemotherapeutic effects is extremely important. In this study, we compared radiological evaluations and histological response, and developed a combined radiological scoring system for assessing the response to chemotherapy. METHODS A total of 79 patients with primary bone sarcomas were examined by X-ray photography (Xp), angiography, MRI, 201Tl scintigraphy (Tl) and 99mTc-MIBI scintigraphy (MIBI) to evaluate their response to preoperative chemotherapy. Patients were classified as responders and non-responders according to radiological images. All resected tumors were evaluated histologically and classified as a good response (≥90% necrosis) or a poor response (≤90% necrosis). The sensitivity, specificity, accuracy, and kappa values in radiological evaluation were calculated. Furthermore, we developed a combined radiological scoring system that correlated the results of radiological images with histological response. RESULTS Sensitivity, specificity, and accuracy were 90.9%, 38.2%, and 67.5% (K = 0.31), respectively, for Xp; 91.7%, 33.3%, and 66.7% (K = 0.27) for angiography; 81.0%, 67.6%, and 75.0% (K = 0.49) for MRI; 78.9%, 72.4%, and 76.1% (K = 0.51) for Tl; 85.3%, 69.2%, and 78.3% (K = 0.55) for MIBI; and 93.3%, 76.5%, and 86.1% (K = 0.71) for combined radiological scoring. CONCLUSIONS Combined radiological evaluations showed high correlation with histological response for assessing the effects of chemotherapy.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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Wakabayashi H, Taki J, Inaki A, Sumiya H, Tsuchiya H, Kinuya S. Assessment of Doxorubicin Cardiac Toxicity Using Gated 99mTc-Hexakis-2-Methoxyisobutylisonitrile Myocardial Single Photon Emission Computed Tomography. Circ J 2012; 76:1190-6. [DOI: 10.1253/circj.cj-11-1174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Wakabayashi
- Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University Hospital
| | - Anri Inaki
- Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Hisashi Sumiya
- Department of Nuclear Medicine, Kanazawa University Hospital
| | | | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital
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Prognostic value of Tc-99m-MIBI performed during middle course of preoperative chemotherapy in patients with malignant bone and soft-tissue tumors. Clin Nucl Med 2011; 37:1-8. [PMID: 22157020 DOI: 10.1097/rlu.0b013e31823931d7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was aimed to determine whether Tc-99m-hexakis-2-methoxyisobutylisonitrile (MIBI) scintigraphy performed in the middle of preoperative chemotherapy has a prognostic value in patients with malignant bone and soft tissue tumors (MBST). MATERIALS AND METHODS In 90 patients with MBST, Tc-99m-MIBI scintigraphy was performed 15 minutes after tracer injection before the first and after the third chemotherapy cycles. After 5 cycles of chemotherapy and tumor resection, therapeutic effect was assessed by histopathology. The percent reduction of uptake ratio (ΔUR) was calculated according to the following equation: 100 × ([prechemotherapy UR - post-middle course of chemotherapy UR]/prechemotherapy UR). RESULTS The average follow-up for the entire population was 52 months. Twenty-one patients had clinically detectable metastases at initial presentation (primary metastasis). Kaplan-Meier analysis demonstrated that absence of metastasis was associated with good survival in all patients, in patients with bone tumor, and those with soft tissue tumor (P < 0.0001, P < 0.0001, and P = 0.0003, respectively), and ΔUR ≧30% was also associated with survival in all patients and patients with bone tumor (P = 0.011 and P = 0.047, respectively), but was marginal in those with soft tissue tumor (P = 0.091). Multivariate analysis showed that primary metastasis was the most powerful independent predictor of a lethal clinical outcome in all patients, in both patients with bone and soft tissue tumors (hazard ratio [HR]: 4.9, 95% confidence interval [CI]: 2.61-9.08, P < 0.0001; HR: 15.1, CI: 4.86-52.7, P < 0.0001; HR: 3.7, CI: 1.45-8.94, P = 0.0069, respectively) and showed that Tc-99m-MIBI scintigraphy had a good independent long-term prognostic value in all patients and patients with bone tumor (HR: 2.2, CI: 1.14-4.43, P = 0.017; HR: 6.0, CI: 2.01-21.6, P = 0.0009, respectively) but not in those with soft tissue tumor (HR: 1.5, CI: 0.61-4.09, P = 0.38). Good disease-free survival was associated with ΔUR ≧30% in all patients and patients with soft tissue tumor (P = 0.0093 and P = 0.017, respectively) but not in those with bone tumor (P = 0.19). CONCLUSIONS Tc-99m-MIBI scintigraphy at the middle course of preoperative chemotherapy could be used as a prognostic indicator in patients with MBST.
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Miwa S, Shirai T, Taki J, Sumiya H, Nishida H, Hayashi K, Takeuchi A, Ooi A, Tsuchiya H. Use of 99mTc-MIBI scintigraphy in the evaluation of the response to chemotherapy for osteosarcoma: comparison with 201Tl scintigraphy and angiography. Int J Clin Oncol 2011; 16:373-8. [PMID: 21331769 DOI: 10.1007/s10147-011-0194-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 01/19/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the treatment of osteosarcoma, the chemotherapeutic effect influences decisions regarding the surgical margin, continuation of chemotherapy, and choice of anticancer drugs for further chemotherapy. Therefore, it is necessary to evaluate the response to chemotherapy in the middle of the chemotherapy course. In this study, we investigated the use of (99m)Tc-hexakis-2-methoxyisobutyl-isonitrile ((99m)Tc-MIBI) scintigraphy in evaluating the response to chemotherapy of patients with osteosarcoma in comparison with (201)Tl scintigraphy and angiography. METHODS A total 45 patients with osteosarcoma were examined using (99m)Tc-MIBI scintigraphy, (201)Tl scintigraphy, and angiography to evaluate their response to chemotherapy. The percentage reduction in the uptake ratios (ΔUR) calculated as 100 × [(prechemotherapy value - postchemotherapy value)/prechemotherapy value] were compared with histological assessments. Similarly, changes in tumor vascularity assessed by angiograms were compared with histological assessments. On the angiographic findings, the results were classified as complete response (CR), partial response (PR), no change (NC), or progressive disease (PD). On the images, ΔUR in (99m)Tc-MIBI ≥ 30% and ΔUR in (201)Tl ≥ 30% were classified as responder, as were CR and PR in angiograms. The therapeutic effect was assessed by histopathological examination of the resected specimens. The tumors of poor responders showed less than 90% necrosis, whereas the tumors of good responders showed 90% or more necrosis. RESULTS Sensitivity, specificity, and accuracy were 73.9, 84.2, and 78.6%, respectively, for (99m)Tc-MIBI (κ = 0.57); 80.0, 61.1, and 72.1%, respectively, for (201)Tl (κ = 0.42); and 91.7, 35.0, and 65.9%, respectively for angiography (κ = 0.28). CONCLUSION (99m)Tc-MIBI could be effectively used to predict the final response to chemotherapy of osteosarcoma.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
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Early prediction of histopathological tumor response to preoperative chemotherapy by Tc-99m MIBI imaging in bone and soft tissue sarcomas. Clin Nucl Med 2010; 35:154-9. [PMID: 20173444 DOI: 10.1097/rlu.0b013e3181cc637d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Tc-99m-methoxyisobutylisonitrile (MIBI) accumulates in only viable cells. In patients with bone and soft tissue sarcomas, preoperative chemotherapy is essential and the early prediction of the tumor response to chemotherapy would be beneficial for the planning of treatment strategy. The purpose of this study was to assess whether the change of Tc-99m-MIBI images from the prechemotherapy state to the early to midportion of chemotherapy can predict the final histopathological tumor response as accurately as the change of imaging after completion of chemotherapy. METHODS Seventy-three patients with bone and soft tissue sarcomas underwent Tc-99m-MIBI scintigraphy before chemotherapy and at least 2 times after the second or third or fifth course of chemotherapy. The changes of the tracer uptake (DeltaUR) and perfusion (DeltaPI) from prechemotherapy to postchemotherapy were compared with histologic response. RESULTS The sensitivity, specificity, and accuracy for the prediction of effective chemotherapy in DeltaPI were 88%, 83%, 85% after second, 85%, 72%, 78% after third, and 81%, 71%, 76% after 5th chemotherapy, and those in DeltaUR were 88%, 83%, 85% after 2nd, 85%, 92%, 89% after 3rd, and 94%, 77%, 85% after fifth chemotherapy, respectively. The area under the receiver operator characteristic curve of the DeltaPI after second, third, and fifth chemotherapy were similarly good (0.842, 0.858, 0.811, respectively) and those of DeltaUR were similarly excellent (0.915, 0.936, 0.931, respectively). CONCLUSION In patients with bone and soft tissue sarcomas, the change of Tc-99m-MIBI images from prechemotherapy to early to middle of chemotherapy can predict the final histopathological tumor response to chemotherapy as accurately as the change of Tc-99m-MIBI images from prechemotherapy to the completion of the preoperative chemotherapy.
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Kimura H, Tsuchiya H, Shirai T, Nishida H, Hayashi K, Takeuchi A, Ohnari I, Tomita K. Caffeine-potentiated chemotherapy for metastatic osteosarcoma. J Orthop Sci 2009; 14:556-65. [PMID: 19802667 DOI: 10.1007/s00776-009-1372-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prognosis for patients with metastatic osteosarcoma is still poor despite the development of effective adjuvant and neoadjuvant chemotherapy regimens. We have developed caffeine-potentiated chemotherapy for treatment of high-grade bone and soft tissue sarcomas based on the ability of caffeine to enhance the cytocidal effects of anticancer drugs. We report results of caffeine-potentiated chemotherapy for patients with osteosarcoma with pulmonary metastases. METHODS We analyzed retrospectively overall survival and some prognostic factors for 41 patients with osteosarcoma/pulmonary metastases who were treated with caffeine-potentiated chemotherapy between 1990 and 2006. RESULTS The mean follow-up of all patients was 32.7 months. At the time of the final follow-up, 11 patients were alive and 30 had died of disease. Overall survival rates at 2 and 5 years were 38% and 28%, respectively. We identified the primary tumor site, the histological response to preoperative chemotherapy, the number of pulmonary nodules at initial identification, the timing of pulmonary metastasis identification, and the existence of extrapulmonary metastasis as prognostic factors. Especially, the number of pulmonary nodules at initial identification and the timing of pulmonary metastasis identification were independent, strong prognostic factors. Patients with solitary pulmonary metastasis had good prognoses, and their overall 5-year survival rate was 60%; in contrast, survival was 28% in patients with two to five pulmonary nodules, and no patients with more than six nodules survived 5 years. Patients with pulmonary metastasis identified after completion of treatment had the best prognosis, whereas patients with pulmonary metastases identified during treatment had the worst prognosis. CONCLUSIONS Caffeine-potentiated chemotherapy prolonged survival of patients who had osteosarcoma with pulmonary metastasis. Especially, patients with pulmonary metastasis identified after completion of treatment or with a solitary pulmonary nodule had good prognoses.
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Affiliation(s)
- Hiroaki Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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