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Guja KE, Ganjoo KN, Iagaru A. Molecular Imaging in Soft-tissue Sarcoma: Evolving Role of FDG PET. Semin Nucl Med 2024; 54:332-339. [PMID: 38433024 DOI: 10.1053/j.semnuclmed.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
Soft tissue sarcomas are a rare and heterogenous group of tumors that account for 2% of all cancer-related deaths. Molecular imaging with FDG PET can offer valuable metabolic information to help inform clinical management of soft tissue sarcomas that is unique and complementary to conventional diagnostic imaging techniques. FDG PET imaging often correlates with tumor grade, can help guide biopsy, and frequently detects additional sites of disease compared to conventional imaging in patients being considered for definitive or salvage therapy. Traditional size-based evaluation of treatment response is often inadequate in soft tissue sarcoma and changes in metabolic activity can add significant value to interim and end of treatment imaging for high-grade sarcomas. FDG PET can be used for detection of recurrence or malignant transformation and thus play a vital role in surveillance. This article reviews the evolving role of FDG PET in initial diagnosis, staging, treatment response assessment, and restaging. Further studies on the use of FDG PET in soft sarcoma are needed, particularly for rare histopathologic subtypes.
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Affiliation(s)
- Kip E Guja
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA
| | - Kristen N Ganjoo
- Division of Oncology, Department of Medicine, Stanford University, 900 Blake Wilbur Drive, Stanford CA
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA.
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2
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Broski SM. Positron Emission Tomography/Computed Tomography Transformation of Oncology: Musculoskeletal Cancers. PET Clin 2024; 19:217-229. [PMID: 38184453 DOI: 10.1016/j.cpet.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
The past 25 years have seen significant growth in the role of positron emission tomography/computed tomography (PET/CT) in musculoskeletal oncology. Substantiative advances in technical capability and image quality have been paralleled by increasingly widespread clinical adoption and implementation. It is now recognized that PET/CT is useful in diagnosis, staging, prognostication, response assessment, and surveillance of bone and soft tissue sarcomas, often providing critical information in addition to conventional imaging assessment. As individualized, precision medicine continues to evolve for patients with sarcoma, PET/CT is uniquely positioned to offer additional insight into the biology and management of these tumors.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Mayo Building, 2nd Floor, 200 First Street SW, Rochester, MN 55905, USA.
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3
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Castillo-Flores S, Gonzalez MR, Bryce-Alberti M, de Souza F, Subhawong TK, Kuker R, Pretell-Mazzini J. PET-CT in the Evaluation of Neoadjuvant/Adjuvant Treatment Response of Soft-tissue Sarcomas: A Comprehensive Review of the Literature. JBJS Rev 2022; 10:01874474-202212000-00003. [PMID: 36639875 DOI: 10.2106/jbjs.rvw.22.00131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
➢ In soft-tissue sarcomas (STSs), the use of positron emission tomography-computed tomography (PET-CT) through a standardized uptake value reduction rate correlates well with histopathological response to neoadjuvant treatment and survival. ➢ PET-CT has shown a better sensitivity to diagnose systemic involvement compared with magnetic resonance imaging and CT; therefore, it has an important role in detecting recurrent systemic disease. However, delaying the use of PET-CT scan, to differentiate tumor recurrence from benign fluorodeoxyglucose uptake changes after surgical treatment and radiotherapy, is essential. ➢ PET-CT limitations such as difficult differentiation between benign inflammatory and malignant processes, inefficient discrimination between benign soft-tissue tumors and STSs, and low sensitivity when evaluating small pulmonary metastases must be of special consideration.
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Affiliation(s)
- Samy Castillo-Flores
- Medical Student at Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcos R Gonzalez
- Medical Student at Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mayte Bryce-Alberti
- Medical Student at Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Felipe de Souza
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ty K Subhawong
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Russ Kuker
- Division of Musculoskeletal Radiology, Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan Pretell-Mazzini
- Division of Orthopedic Oncology, Miami Cancer Institute, Baptist Health System South Florida, Plantation, Florida
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Gennaro N, Reijers S, Bruining A, Messiou C, Haas R, Colombo P, Bodalal Z, Beets-Tan R, van Houdt W, van der Graaf WTA. Imaging response evaluation after neoadjuvant treatment in soft tissue sarcomas: Where do we stand? Crit Rev Oncol Hematol 2021; 160:103309. [PMID: 33757836 DOI: 10.1016/j.critrevonc.2021.103309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Soft tissue sarcomas (STS) represent a broad family of rare tumours for which surgery with radiotherapy represents first-line treatment. Recently, neoadjuvant chemo-radiotherapy has been increasingly used in high-risk patients in an effort to reduce surgical morbidity and improve clinical outcomes. An adequate understanding of the efficacy of neoadjuvant therapies would optimise patient care, allowing a tailored approach. Although response evaluation criteria in solid tumours (RECIST) is the most common imaging method to assess tumour response, Choi criteria and functional and molecular imaging (DWI, DCE-MRI and 18F-FDG-PET) seem to outperform it in the discrimination between responders and non-responders. Moreover, the radiologic-pathology correlation of treatment-related changes remains poorly understood. In this review, we provide an overview of the imaging assessment of tumour response in STS undergoing neoadjuvant treatment, including conventional imaging (CT, MRI, PET) and advanced imaging analysis. Future directions will be presented to shed light on potential advances in pre-surgical imaging assessments that have clinical implications for sarcoma patients.
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Affiliation(s)
- Nicolò Gennaro
- Humanitas Research and Cancer Center, Dept. of Radiology, Rozzano, Italy; Humanitas University, Dept. of Biomedical Sciences, Pieve Emanuele, Italy; The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands.
| | - Sophie Reijers
- The Netherlands Cancer Institute, Dept. of Surgical Oncology, Amsterdam, the Netherlands
| | - Annemarie Bruining
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands
| | - Christina Messiou
- The Royal Marsden NHS Foundation Trust, Dept. Of Radiology Sarcoma Unit, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom
| | - Rick Haas
- The Netherlands Cancer Institute, Dept. of Radiation Oncology, Amsterdam, the Netherlands; Leiden University Medical Center, Dept. of Radiation Oncology, the Netherlands
| | | | - Zuhir Bodalal
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Regina Beets-Tan
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Danish Colorectal Cancer Center South, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Winan van Houdt
- The Netherlands Cancer Institute, Dept. of Surgical Oncology, Amsterdam, the Netherlands
| | - Winette T A van der Graaf
- The Netherlands Cancer Institute, Dept. of Medical Oncology, Amsterdam, the Netherlands; Erasmus MC Cancer Institute, Dept. of Medical Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands
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5
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Tsukamoto S, Mavrogenis AF, Tanaka Y, Errani C. Imaging of Soft Tissue Tumors. Curr Med Imaging 2021; 17:197-216. [PMID: 32660406 DOI: 10.2174/1573405616666200713183400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/08/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
Differentiation of malignant from benign soft tissue tumors is challenging with imaging alone, including that by magnetic resonance imaging and computed tomography. However, the accuracy of this differentiation has increased owing to the development of novel imaging technology. Detailed patient history and physical examination remain essential for differentiation between benign and malignant soft tissue tumors. Moreover, measurement only of tumor size based on Response Evaluation Criteria In Solid Tumors criteria is insufficient for the evaluation of response to chemotherapy or radiotherapy. Change in metabolic activity measured by 18F-fluorodeoxyglucose positron emission tomography or dynamic contrast enhanced-derived quantitative endpoints can more accurately evaluate treatment response compared to change in tumor size. Magnetic resonance imaging can accurately evaluate essential factors in surgical planning such as vascular or bone invasion and "tail sign". Thus, imaging plays a critical role in the diagnosis and treatment of soft tissue tumors.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Butler E, Schwettmann B, Geboers S, Hao G, Kim J, Nham K, Sun X, Laetsch TW, Xu L, Williams NS, Skapek SX. Functional imaging of RAS pathway targeting in malignant peripheral nerve sheath tumor cells and xenografts. Pediatr Blood Cancer 2020; 67:e28639. [PMID: 32975370 DOI: 10.1002/pbc.28639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumor (MPNST) is an aggressive form of soft-tissue sarcoma (STS) in children. Despite intensive therapy, relatively few children with metastatic and unresectable disease survive beyond three years. RAS pathway activation is common in MPNST, suggesting MEK pathway inhibition as a targeted therapy, but the impact on clinical outcome has been small to date. PROCEDURE We conducted preclinical pharmacokinetic (PK) and pharmacodynamic studies of two MEK inhibitors, trametinib and selumetinib, in two MPNST models and analyzed tumors for intratumor drug levels. We then investigated 3'-deoxy-3'-[18 F]fluorothymidine (18 F-FLT) PET imaging followed by 18 F-FDG PET/CT imaging of MPNST xenografts coupled to short-term or longer-term treatment with selumetinib focusing on PET-based imaging as a biomarker of MEK inhibition. RESULTS Trametinib decreased pERK expression in MPNST xenografts but did not prolong survival or decrease Ki67 expression. In contrast, selumetinib prolonged survival of animals bearing MPNST xenografts, and this correlated with decreased pERK and Ki67 staining. PK studies revealed a significantly higher fraction of unbound selumetinib within a responsive MPNST xenograft model. Thymidine uptake, assessed by 18 F-FLT PET/CT, positively correlated with Ki67 expression in different xenograft models and in response to selumetinib. CONCLUSION The ability of MEK inhibitors to control MPNST growth cannot simply be predicted by serum drug levels or drug-induced changes in pERK expression. Tumor cell proliferation assessed by 18 F-FLT PET imaging might be useful as an early response marker to targeted therapies, including MEK inhibition, where a primary effect is cell-cycle arrest.
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Affiliation(s)
- Erin Butler
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Blake Schwettmann
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sophie Geboers
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Guiyang Hao
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jiwoong Kim
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kien Nham
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xiankai Sun
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,The Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Theodore W Laetsch
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,The Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lin Xu
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,The Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noelle S Williams
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen X Skapek
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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7
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional imaging in soft tissue sarcomas: Update of the indications for 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional image in soft tissue sarcomas: An update of the indications of 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020; 39:233-243. [PMID: 32616457 DOI: 10.1016/j.remn.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.
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Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Madrid, España.
| | - M Simó-Perdigó
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Orcajo Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España; Miembro del Grupo Español de Investigación en Sarcomas (GEIS)
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Lim HJ, Johnny Ong CA, Tan JWS, Ching Teo MC. Utility of positron emission tomography/computed tomography (PET/CT) imaging in the evaluation of sarcomas: A systematic review. Crit Rev Oncol Hematol 2019; 143:1-13. [DOI: 10.1016/j.critrevonc.2019.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
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Abstract
Soft tissue sarcomas (STSs) account for less than 1% of adult solid tumors and about 7% of pediatric malignancies, causing 2% of cancer-related deaths. With the advent of PET-computed tomography (CT), the value of (18) fluorine-2-fluoro-2-deoxy-d-glucose (FDG) PET imaging to improve the management of STSs has been explored. FDG PET imaging has been found useful in restaging and treatment response assessment. This article reviews current knowledge and application of FDG PET-CT in initial diagnosis, staging, restaging, treatment response monitoring, and prognosis, with a brief overview of the most common histologic subtypes of STS.
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11
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Advantages of 18F FDG-PET/CT over Conventional Staging for Sarcoma Patients. Pathol Oncol Res 2017; 25:131-136. [DOI: 10.1007/s12253-017-0325-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
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13
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Pasquali S, Gronchi A. Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications. Ther Adv Med Oncol 2017; 9:415-429. [PMID: 28607580 PMCID: PMC5455882 DOI: 10.1177/1758834017705588] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 12/20/2022] Open
Abstract
Soft tissue sarcomas are a rare and multifaceted group of solid tumours. Neoadjuvant chemotherapy is increasingly used to limit loss of function after wide surgical excision with the ultimate aim of improving patient survival. Recently, advances in the identification of effective treatment strategies and improvements in patient risk stratification have been reached. A randomized trial demonstrated that neoadjuvant epirubicin and ifosfamide improves survival of patients affected by five high-risk soft tissue sarcoma histologies of trunk and extremities, including undifferentiated pleomorphic sarcoma, myxoid liposarcoma, synovial sarcoma, malignant peripheral nerve sheath tumours, and leiomyosarcoma. Selection of patients for these treatments is expected to be improved by the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system, as it tailors T-stage categories on primary tumour site and considers a prognostic nomogram for retroperitoneal sarcoma, which also includes soft tissue sarcoma histology and other patient and tumour features not directly included in the TNM staging. Within this framework, this article will present neoadjuvant treatment strategies for high-risk soft tissue sarcoma, emphasizing the most recent advances and discussing the need for further research to improve the effectiveness of neoadjuvant treatments.
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Affiliation(s)
- Sandro Pasquali
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G Venezian 1, 20013 Milano, Italy
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Nathenson MJ, Sausville E. Looking for answers: the current status of neoadjuvant treatment in localized soft tissue sarcomas. Cancer Chemother Pharmacol 2016; 78:895-919. [PMID: 27206640 PMCID: PMC7577379 DOI: 10.1007/s00280-016-3055-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Sarcomas are a rare and heterogeneous variant of cancer. The standard of care treatment involves surgical resection with radiation in high-risk patients. Despite appropriate treatment approximately 50 % of patients will suffer and die from recurrent disease. The purpose of this article is to review the current evidence concerning the use of neoadjuvant chemotherapy with or without radiation in soft tissue sarcomas. METHODS An in-depth literature search was conducted using Ovid Medline and PubMed. RESULTS The most active chemotherapeutic agents in sarcoma are anthracyclines and ifosfamide. Adjuvant chemotherapy trials show only minimal benefit. Neoadjuvant chemotherapy offers the potential advantage of reducing the extent of surgery, increasing the limb salvage rate, early exposure of micrometastatic disease to chemotherapy, and assessment of tumor response to chemotherapy. Some retrospective and phase II trials suggest a benefit to neoadjuvant chemotherapy. Unfortunately, no clearly positive phase III prospectively randomized trials exist for neoadjuvant therapy in soft tissue sarcomas. CONCLUSIONS The current neoadjuvant chemotherapy trials that do exist are heterogeneous resulting in conflicting results. However, neoadjuvant chemotherapy with or without radiation can be considered in patients with high-risk disease in an attempt to improve long-term outcomes.
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Affiliation(s)
- Michael J Nathenson
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA.
| | - Edward Sausville
- Department of Medicine, University of Maryland Medical Center, 22 South Greene Street Suite 9d10, Baltimore, MD, 21201, USA
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Li YJ, Dai YL, Cheng YS, Zhang WB, Tu CQ. Positron emission tomography (18)F-fluorodeoxyglucose uptake and prognosis in patients with bone and soft tissue sarcoma: A meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1103-14. [PMID: 27189833 DOI: 10.1016/j.ejso.2016.04.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the prognostic significance of (18)F-FDG PET imaging in patients with bone and soft tissue sarcoma, a meta-analysis was conducted. METHODS Comprehensive literature searches were performed in PubMed, Embase, Web of Science and Cochrane Library. Pooled hazard ratio (HR) values were calculated to assess the correlations of pre-chemotherapy SUV (SUV1), post-chemotherapy SUV (SUV2), SUV Ratio, total lesion glycolysis (TLG) and metabolic tumor volume (MTV) with event-free survival (EFS) and overall survival (OS). RESULTS Twenty-three studies with 1261 patients were identified. The combined HRs for EFS were 1.84 (95% CI: 1.54-2.20) for SUV1, 2.92 (95% CI: 2.15-3.97) for SUV2, 1.90 (95% CI: 1.43-2.52) for SUV Ratio, 3.01 (95% CI: 1.36-6.67) for TLG and 2.32 (95% CI: 1.44-3.75) for MTV. The pooled HRs for OS were 1.85 (95% CI: 1.49-2.30) for SUV1, 2.00 (95% CI: 1.39-2.88) for SUV2, 2.20 (95% CI: 1.18-4.10) for SUV Ratio, 6.19 (95% CI: 2.17-17.66) for TLG and 2.67 (95% CI: 1.52-4.68) for MTV. Besides, high SUV1 was found to be significantly associated with higher rate of metastasis (RR 5.55, 95% CI: 2.75-11.18) and local recurrence (RR 1.87 95% CI: 1.28-2.72). CONCLUSION (18)F-FDG PET parameters of SUV1, SUV2, SUV Ratio, TLG and MTV may have effective prognostic significance for patients with bone and soft tissue sarcoma. (18)F-FDG PET imaging may be a promising tool to help predict survival outcomes of these patients.
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Affiliation(s)
- Y-J Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China; Department of Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Y-L Dai
- College of Computer Science, Sichuan Normal University, Chengdu, PR China
| | - Y-S Cheng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China
| | - W-B Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China
| | - C-Q Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China.
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17
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Khiewvan B, Macapinlac HA, Lev D, McCutcheon IE, Slopis JM, Al Sannaa G, Wei W, Chuang HH. The value of ¹⁸F-FDG PET/CT in the management of malignant peripheral nerve sheath tumors. Eur J Nucl Med Mol Imaging 2014; 41:1756-66. [PMID: 24699907 DOI: 10.1007/s00259-014-2756-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/04/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE Our objective was to determine how positron emission tomography (PET)/CT had been used in the clinical treatment of malignant peripheral nerve sheath tumor (MPNST) patients at The University of Texas MD Anderson Cancer Center. METHODS We reviewed a database of MPNST patients referred to MD Anderson Cancer Center during 1995-2011. We enrolled 47 patients who underwent PET/CT imaging. Disease stage was based on conventional imaging and PET/CT findings using National Comprehensive Cancer Network (NCCN) guidelines. Treatment strategies based on PET/CT and conventional imaging were determined by chart review. The maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), change in SUVmax, change in MTV, and change in TLG were calculated from the PET/CT studies before and after treatment. Response prediction was based on imaging studies performed before and after therapy and categorized as positive or negative for residual tumor. Clinical outcome was determined from chart review. RESULTS PET/CT was performed for staging in 16 patients, for restaging in 29 patients, and for surveillance in 2 patients. Of the patients, 88 % were correctly staged with PET/CT, whereas 75 % were correctly staged with conventional imaging. The sensitivity to detect local recurrence and distant metastasis at restaging was 100 and 100 % for PET/CT compared to 86 and 83 % for conventional imaging, respectively. PET/CT findings resulted in treatment changes in 31 % (5/16) and 14 % (4/29) of patients at staging and restaging, respectively. Recurrence, MTV, and TLG were prognostic factors for survival, whereas SUVmax and SUVmean were not predictive. For 21 patients who had imaging studies performed both before and after treatment, PET/CT was better at predicting outcome (overall survival, progression-free survival) than conventional imaging. A decreasing SUVmax ≥ 30 % and decrease in TLG and MTV were significant predictors for overall and progression-free survival. CONCLUSION PET/CT is valuable in MPNST management because of its high accuracy in staging and high sensitivity and accuracy in restaging as well as improvements in treatment planning. MTV from baseline staging studies is predictive of survival. Additionally, change in SUVmax, TLG, and MTV accurately predicted outcomes after treatment.
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Affiliation(s)
- Benjapa Khiewvan
- Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1483,1515 Holcombe Blvd., Houston, TX, 77230-1402, USA
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Hoshi M, Oebisu N, Takada J, Ieguchi M, Wakasa K, Nakamura H. Role of FDG-PET/CT for monitoring soft tissue tumors. Oncol Lett 2014; 7:1243-1248. [PMID: 24660036 PMCID: PMC3961202 DOI: 10.3892/ol.2014.1876] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/23/2014] [Indexed: 12/16/2022] Open
Abstract
The aim of the current study was to evaluate the limitations of 2-deoxy-2-F18-fluoro-D-glucose positron emission tomography combined with computed tomography (FDG-PET/CT) when monitoring soft tissue tumors. The diagnostic criteria of malignancy was defined as the tumor having a maximum standardized uptake value (SUVmax) ≥2.0 and a maximum diameter ≥5 cm as measured using FDG-PET/CT. One-hundred-and-thirteen patients, that were either included in the criteria or not, were compared. In addition, the values of SUVmax of the primary tumor and relapse in 12 patients were evaluated. The Kaplan-Meier analysis demonstrated that patients with tumors measuring ≥5 cm size and ≥2.0 SUVmax were associated with a worse survival rate. Among the 12 patients with relapse, statistical significances were detected in the tumor diameters, however, not in the SUVmax values. Thus, the criteria identified patients that were associated with a poor prognosis, and the SUVmax of distant metastases and local recurrences were identified to be significantly affected by tumor size.
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Affiliation(s)
- Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kenichi Wakasa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Rodríguez-Alfonso B, Mucientes Rasilla J, Mitjavila Casanovas M, Cardona Arboniés J, Cubedo R. [18F-FDG-PET-CT in soft tissue sarcomas: when to image?]. Rev Esp Med Nucl Imagen Mol 2013; 33:43-9. [PMID: 24094372 DOI: 10.1016/j.remn.2013.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 12/24/2022]
Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - J Mucientes Rasilla
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - M Mitjavila Casanovas
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Cardona Arboniés
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - R Cubedo
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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PET/MRI Imaging in High-Risk Sarcoma: First Findings and Solving Clinical Problems. Case Rep Oncol Med 2013; 2013:793927. [PMID: 23936700 PMCID: PMC3713328 DOI: 10.1155/2013/793927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/12/2013] [Indexed: 12/23/2022] Open
Abstract
Simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) is a new whole-body hybrid PET/MR imaging technique that combines metabolic and cross-sectional diagnostic imaging. Since the use of MRI in imaging of soft-tissue sarcoma is extremely beneficial, investigation of the combined PET/MRI is of great interest. In this paper, we present three cases and first data. Combined PET/MRI technique can support the process of clinical decision-making and give answers to some meaningful questions when treating patients with STS. Therefore, the combined modality of simultaneous PET/MRI offers new pieces to the puzzle of sarcoma treatment.
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The Role of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography in Assessing the Response to Neoadjuvant Treatment in Patients with Osteosarcoma. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2012; 2012:870301. [PMID: 23008768 PMCID: PMC3449114 DOI: 10.1155/2012/870301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/25/2012] [Accepted: 08/17/2012] [Indexed: 11/18/2022]
Abstract
Aim. The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with fluorine-18-fluorodeoxyglucose (FDG) in assessing the response to neoadjuvant treatment in patients with osteosarcoma (OS). Methods. A comprehensive literature search of published studies through March 2012 in PubMed/MEDLINE, Embase, and Scopus databases regarding whole-body FDG-PET and FDG-PET/CT in patients with OS was performed. Results. Twenty-two studies have investigated the role of FDG-PET and FDG-PET/CT in the evaluation of response to neoadjuvant treatment with either chemotherapy or radiation therapy in patients with OS. The main findings of these studies are presented. Conclusion. FDG-PET or PET/CT seems to be sensitive and reliable diagnostic tools in the assessment of metabolic response to treatment in patients with OS, after baseline PET evaluation has been performed in advance. However, false positive findings due to inflammation in sites of tumoral response should be considered.
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Gámez Cenzano C, Sabaté Llobera A, Narváez García JA, Rodríguez Bel L, García del Muro FJ. [Positron emission tomography-computed tomography in tumors of the locomotor apparatus]. RADIOLOGIA 2012; 54 Suppl 1:3-13. [PMID: 22959330 DOI: 10.1016/j.rx.2012.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/26/2012] [Accepted: 07/09/2012] [Indexed: 12/23/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a hybrid imaging technique that combines the anatomic information from CT with the metabolic information acquired from PET after the administration of specific radiotracers, the most commonly used of which is F18-fluorodeoxyglucose (FDG). In oncology, this technique is based on the increased uptake of FDG by malignant lesions. In the locomotor apparatus, some uptake by bones and soft tissues is physiological or benign and this uptake must be differentiated from uptake by malignancies, whether primary or secondary. The most important limitations are active inflammatory or infectious processes, which are positive on PET images, and malignant lesions that are smaller than 1cm, cystic, necrotic, or low-grade, which are negative on PET images. PET/CT in the locomotor apparatus is especially useful for the detection of metastases from the most common tumors. It is also used for staging and monitoring the response to treatment of some hematological tumors like lymphoma, where it is fundamental to determine whether the bone marrow has been infiltrated, or myeloma. Lastly, although it is not yet an established indication, PET/CT is being increasingly used to study sarcomas, because it can provide additional information that can be useful for the characterization and grading of tumors, for guiding biopsies, for staging and re-staging, and for evaluating the response to neoadjuvant therapy as well as for evaluating new drugs in clinical trials.
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Affiliation(s)
- C Gámez Cenzano
- Unidad PET-IDI, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
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Müller J, Schrader M, Schrader A, Höpfner M, Zengerling F. Stellenwert der Positronenemissionstomographie bei urologischen Tumoren. Urologe A 2012; 51:331-40. [DOI: 10.1007/s00120-012-2834-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Herrmann K, Benz MR, Czernin J, Allen-Auerbach MS, Tap WD, Dry SM, Schuster T, Eckardt JJ, Phelps ME, Weber WA, Eilber FC. 18F-FDG-PET/CT Imaging as an early survival predictor in patients with primary high-grade soft tissue sarcomas undergoing neoadjuvant therapy. Clin Cancer Res 2012; 18:2024-31. [PMID: 22338012 DOI: 10.1158/1078-0432.ccr-11-2139] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 2[18F]fluoro-2-deoxy-d-glucose ((18)F-FDG)-PET/computed tomographic (CT) imaging after the initial cycle of neoadjuvant therapy could predict overall survival in these patients. EXPERIMENTAL DESIGN Thirty-nine patients underwent (18)F-FDG-PET/CT before and after one cycle of neoadjuvant therapy. Fifty-six patients underwent end-of-treatment PET. Overall survival was, among others, correlated with changes of SUV(peak) and histopathology. RESULTS One-, two-, and five-year survival rates were 95% ± 3.0%, 86% ± 4.6%, and 68% ± 6.6%, respectively. Median time to death was 30.9 months (mean, 27.7; range, 6.9-50.1). Optimal cutoff values for early and late decreases in SUV(peak) (26% and 57%, respectively) were significant predictors of survival in univariate survival analysis [P = 0.041; HR, 0.27; 95% confidence interval (CI), 0.08-0.95 and P = 0.045; HR, 0.31; 95% CI, 0.10-0.98]. Seven of 15 early PET nonresponders but only four of 24 early PET responders died during follow-up (P = 0.068). The only other significant survival predictor was surgical margin positivity (P = 0.041; HR, 3.31; 95% CI, 1.05-10.42). By multivariable analysis, early metabolic response (P = 0.016) and positivity of surgical margins (P = 0.036) remained significant survival predictors. CONCLUSION (18)F-FDG-PET predicted survival after the initial cycle of neoadjuvant chemotherapy in patients with STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.
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Affiliation(s)
- Ken Herrmann
- Division of Surgical Oncology, University of California at Los Angeles, 10833 Le Conte Avenue, Rm 54-140 CHS, Los Angeles, CA 90095, USA
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Jones NB, Iwenofu H, Scharschmidt T, Kraybill W. Prognostic factors and staging for soft tissue sarcomas: an update. Surg Oncol Clin N Am 2012; 21:187-200. [PMID: 22365514 DOI: 10.1016/j.soc.2011.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Soft tissue sarcoma (STS) staging is a constantly evolving process. Grading is still of utmost importance and has been adapted into a three-tier system. The STS most difficult to categorize are those with uncertain malignant potential, such as solitary fibrous tumors, gastrointestinal stromal tumors, and glomus tumors, some of which have developed completely separate staging systems and may not even be considered sarcomas. Beyond the current TNM staging system, a multitude of prognostic factors for STS will continue to be discovered and ultimately incorporated into future revisions of the staging system.
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Affiliation(s)
- Natalie B Jones
- Department of Surgery, The Ohio State University, Columbus, OH 43210, USA
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