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Yadgarov M, Berikashvili L, Rakova E, Likar Y. 18F-FDG PET Metabolic Parameters for the Prediction of Histological Response to Induction Chemotherapy in Osteosarcoma and Ewing Sarcoma: A Systematic Review and Network Meta-analysis. Clin Nucl Med 2024:00003072-990000000-01277. [PMID: 39325490 DOI: 10.1097/rlu.0000000000005412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
PURPOSE This study aimed to evaluate the ability of 18F-FDG PET/CT metabolic parameters to predict the histological response to neoadjuvant chemotherapy in patients with osteosarcoma and Ewing sarcoma. PATIENTS AND METHODS This systematic review and network meta-analysis adhered to the PRISMA-NMA and Cochrane guidelines. Electronic databases were searched from January 2008 to January 2024; this search was supplemented by snowballing methods. The risk of bias was evaluated with QUADAS-2, and evidence certainty was assessed using the GRADE approach. The prognostic value of 18F-FDG PET/CT parameters, including pretreatment and posttreatment SUVs (SUV1, SUV2 and the SUV2/SUV1 ratio), metabolic tumor volume (MTV1, MTV2, ΔMTV), and total lesion glycolysis (TLG1, TLG2, ΔTLG), was examined. RESULTS The meta-analysis of 18 studies (714 patients) identified the ΔTLG, ΔMTV, and SUVratio as superior predictors of histological response. The changes in metabolic activity, as indicated by these parameters, provided a robust indication of treatment effectiveness. Baseline parameters showed limited predictive value compared with posttreatment assessments. The study's robustness was confirmed through meta-regression, which revealed that the predictive value of the SUV2 and SUVratio was consistent across various cutoff thresholds. CONCLUSIONS 18F-FDG PET/CT metabolic parameters, particularly those measuring changes posttherapy, are effective in predicting the histological response in patients with osteosarcoma and Ewing sarcoma. These findings underscore the potential of 18F-FDG PET/CT in guiding early treatment decisions, thereby enhancing personalized therapeutic approaches.
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Affiliation(s)
| | - Levan Berikashvili
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | | | - Yury Likar
- From the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
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Fukushima R, Harimoto N, Kawai S, Ishii N, Tsukagoshi M, Igarashi T, Araki K, Tomonaga H, Higuchi T, Shirabe K. Total lesion glycolysis by 18F-fluorodeoxyglucose positron emission tomography predicts tumor aggressiveness in patients with extrahepatic bile duct carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:339-350. [PMID: 38465467 DOI: 10.1002/jhbp.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) parameters are prognostic factors in multiple malignancies. However, the prognostic value in bile duct carcinoma is unclear. We evaluated the impact of metabolic parameters of 18F-FDG-PET/CT in resectable extrahepatic bile duct carcinoma. METHODS We retrospectively reviewed the records of 100 patients with extrahepatic bile duct carcinoma who had undergone 18F-FDG-PET/CT and subsequent surgical resection between January 2017 and January 2023. We calculated maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) and investigated their prognostic significance. RESULTS The optimal cutoff values of SUVmax, MTV, and TLG for predicting overall survival (OS) after surgery were 3.88, 3.55 and 7.55, respectively. In multivariate analysis, each metabolic parameter influenced both OS and recurrence-free survival (RFS). TLG showed the lowest Akaike information criteria statistic value, indicating that it had the best ability to predict OS and RFS. High TLG was significantly associated with the number of lymph node metastases and poorly differentiated type. Patients with high TLG showed poorer RFS and OS, which were significantly worse than in those with low TLG. CONCLUSIONS Tumor TLG predicted tumor malignancy potential and could be a useful prognostic predictor for extrahepatic bile duct carcinoma.
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Affiliation(s)
- Ryosuke Fukushima
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Shunsuke Kawai
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takamichi Igarashi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyasu Tomonaga
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Wu X, Wang J, He D. Establishment and validation of a competitive risk model for predicting cancer-specific survival in patients with osteosarcoma: a population-based study. J Cancer Res Clin Oncol 2023; 149:15383-15394. [PMID: 37639006 DOI: 10.1007/s00432-023-05320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Osteosarcoma is the most common primary bone tumor with a poor prognosis. The aim of this study was to establish a competitive risk model nomogram to predict cancer-specific survival in patients with osteosarcoma. METHODS Patient data was obtained from the Surveillance, Epidemiology, and End Results database in the United States. A sub-distribution proportional hazards model was used to analyze independent risk factors affecting cancer-specific mortality (CSM) in osteosarcoma patients. Based on these risk factors, a competitive risk model was constructed to predict 1-year, 3-year, and 5-year cancer-specific survival (CSS) in osteosarcoma patients. The reliability and accuracy of the nomogram were evaluated using the concordance index (C-index), the area under the receiver operating characteristic curve (AUC), and calibration curves. RESULTS A total of 2900 osteosarcoma patients were included. The analysis showed that age, primary tumor site, M stage, surgery, chemotherapy, and median household income were independent risk factors influencing CSM in patients. The competitive risk model was constructed to predict CSS in osteosarcoma patients. In the training and validation sets, the C-index of the model was 0.756 (95% CI 0.725-0.787) and 0.737 (95% CI 0.717-0.757), respectively, and the AUC was greater than 0.7 for both. The calibration curves also demonstrated a high consistency between the predicted survival rates and the actual survival rates, confirming the accuracy and reliability of the model. CONCLUSION We established a competitive risk model to predict 1-year, 3-year, and 5-year CSS in osteosarcoma patients. The model demonstrated good predictive performance and can assist clinicians and patients in making clinical decisions and formulating follow-up strategies.
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Affiliation(s)
- Xin Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, Chongqing, 400013, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jinkui Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, Chongqing, 400013, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, Chongqing, 400013, Chongqing, China.
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Oh C, Bishop MW, Cho SY, Im HJ, Shulkin BL. 18F-FDG PET/CT in the Management of Osteosarcoma. J Nucl Med 2023:jnumed.123.265592. [PMID: 37201958 DOI: 10.2967/jnumed.123.265592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/26/2023] [Indexed: 05/20/2023] Open
Abstract
Osteosarcoma is the most common type of primary malignant bone tumor. 18F-FDG PET/CT is useful for staging, detecting recurrence, monitoring response to neoadjuvant chemotherapy, and predicting prognosis. Here, we review the clinical aspects of osteosarcoma management and assess the role of 18F-FDG PET/CT, in particular with regard to pediatric and young adult patients.
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Affiliation(s)
- Chiwoo Oh
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Steve Y Cho
- Nuclear Medicine and Molecular Imaging Section, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hyung-Jun Im
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea;
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea; and
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
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Pedersen MA, Baad-Hansen T, Gormsen LC, Bærentzen S, Sandfeld-Paulsen B, Aggerholm-Pedersen N, Vendelbo MH. Inclusion of Metabolic Tumor Volume in Prognostic Models of Bone and Soft Tissue Sarcoma Increases the Prognostic Value. Cancers (Basel) 2023; 15:cancers15030816. [PMID: 36765774 PMCID: PMC9913525 DOI: 10.3390/cancers15030816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
Sarcomas are rare and have a high mortality rate. Further prognostic classification, with readily available parameters, is warranted, and several studies have examined circulating biomarkers and PET parameters separately. This single-site, retrospective study aimed to examine the prognostic values of several scoring systems in combination with PET parameters. We included 148 patients with sarcoma, who were treated and scanned at Aarhus University Hospital from 1 January 2016 to 31 December 2019. The Akaike information criterion and Harrell's concordance index were used to evaluate whether the PET parameters added prognostic information to existing prognostic models using circulating biomarkers. Of the PET parameters, metabolic tumor volume (MTV) performed best, and when combined with the existing prognostic models, the prognostic value improved in all models. Backward stepwise selection was used to create a new model, SBSpib, which included albumin, lymphocytes, and one PET parameter, MTV. It has scores ranging from zero to three and increasing hazard ratios; HR = 4.83 (1.02-22.75) for group one, HR = 7.40 (1.6-33.42) for group two, and HR = 17.32 (3.45-86.93) for group three. Consequently, implementing PET parameters in prognostic models improved the prognostic value. SBSpib is a new prognostic model that includes both circulating biomarkers and PET parameters; however, validation in another sarcoma cohort is warranted.
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Affiliation(s)
- Mette Abildgaard Pedersen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Institute of Biomedicine, Aarhus University, 8200 Aarhus N, Denmark
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Thomas Baad-Hansen
- Department of Orthopedics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Lars C. Gormsen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Steen Bærentzen
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Birgitte Sandfeld-Paulsen
- Department of Clinical Biochemistry, Viborg Regional Hospital, 8800 Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | | | - Mikkel Holm Vendelbo
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Institute of Biomedicine, Aarhus University, 8200 Aarhus N, Denmark
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Correspondence:
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Erol M, Önner H, Küçükosmanoğlu İ. Association of Fluorodeoxyglucose Positron Emission Tomography Radiomics Features with Clinicopathological Factors and Prognosis in Lung Squamous Cell Cancer. Nucl Med Mol Imaging 2022; 56:306-312. [PMID: 36425277 PMCID: PMC9679117 DOI: 10.1007/s13139-022-00774-2] [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: 05/30/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022] Open
Abstract
Aim To evaluate the role of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) radiomics features (RFs) for predicting clinicopathological factors (CPFs) and prognosis in patients with resected lung squamous cell cancer (LSCC). Material and Methods Patients with early-stage (stage I-III) LSCC who underwent 18F-FDG PET/CT before surgical resection between August 2012 and February 2020 were analyzed. Patients who received neoadjuvant chemotherapy or radiotherapy were excluded from the study. The maximum standard uptake value (SUVmax) and RFs were extracted from PET images for primary tumors. The diagnostic performances of PET parameters in groups of tumor differentiation, stage, and mediastinal lymph node metastasis (MLNM) status were evaluated. The study endpoints were overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analyses were performed with RFs, SUVmax, and CPFs to find independent predictors of PFS and OS. Results A total of 77 patients (5 female, 72 male) were included in the study. SUVmax and GLCM entropy were independently associated with tumor differentiation. The only parameter with significant diagnostic performance for MLNM was GLZLM-SLZGE. Tumor diameter and NGLDM busyness were independently associated with the stage. MLNM and tumor differentiation were found to be independent predictors of PFS. NGLDM contrast and MLNM were independently associated with OS. Conclusion Using radiomic features in addition to CPFs to predict disease recurrence and shorter overall survival can guide precision medicine in patients with LSCC.
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Affiliation(s)
- Mustafa Erol
- Department of Nuclear Medicine, Konya City Hospital, University of Health Sciences Turkey, Konya, Turkey
| | - Hasan Önner
- Department of Nuclear Medicine, Medical Faculty, Selcuk University, Konya, Turkey
| | - İlknur Küçükosmanoğlu
- Department of Pathology, Konya City Hospital, University of Health Sciences Turkey, Konya, Turkey
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Choi S, Kim YI, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI, Ryu JS. Diagnostic value of 18F-FDG PET/CT in discriminating between benign and malignant lesions of the ribs. Medicine (Baltimore) 2022; 101:e29867. [PMID: 35801734 PMCID: PMC9259158 DOI: 10.1097/md.0000000000029867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Imaging biomarkers for rib mass are needed to optimize treatment plan. We investigated the diagnostic value of metabolic and volumetric parameters from 18F-fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) in discriminating between benign and malignant lesions of the ribs. PATIENTS AND METHODS Fifty-seven patients with pathologically proven diagnosis of rib lesions were retrospectively enrolled. The size of rib lesions, the maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, SUVpeak), tumor-to-background ratio (TBR), metabolic tumor volume (MTV), and total lesions glycolysis (TLG) were measured. The FDG uptake patterns (segmental and discrete) and CT findings (soft tissue involvement and fracture) were also reviewed. RESULTS Among the multiple parameters extracted from PET/CT, the MTV of malignant lesions was significantly higher than that of benign lesions (median; 4.7 vs 0.2, respectively, P = .041). In receiver operating characteristics curve analysis, MTV had the largest area under curve of 0.672 for differentiating malignant from benign lesions. For identifying malignant lesions, an MTV threshold of 0.5 had a sensitivity of 85.0%, specificity of 47.1%, positive predictive value of 79.1%, negative predictive value of 57.1%, and accuracy of 73.7%. The presence of adjacent soft tissue involvement around rib lesions showed a significant association with malignancy (odds ratio = 6.750; 95% CI, 1.837-24.802, P = .003). CONCLUSIONS The MTV is a useful PET/CT parameter for assisting in the differential diagnosis of suspected malignant lesions of the ribs. CT finding of adjacent soft tissue involvement around rib was significantly associated with malignant lesions of the ribs.
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Affiliation(s)
- Sunju Choi
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
- Department of Nuclear Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Yong-il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
- *Correspondence: Yong-il Kim, Department of Nuclear Medicine, Asan Medical Center, University of Ulsan college of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea (e-mail: )
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
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Aydos U, Sever T, Vural Ö, Topuz Türkcan B, Okur A, Akdemir ÜÖ, Poyraz A, Pinarli FG, Atay LÖ, Karadeniz C. Prognostic value of fluorodeoxyglucose positron emission tomography derived metabolic parameters and textural features in pediatric sarcoma. Nucl Med Commun 2022; 43:778-786. [PMID: 35506271 DOI: 10.1097/mnm.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prognostic value of PET-derived metabolic features and textural parameters of primary tumors in pediatric sarcoma patients. METHODS The imaging findings of 43 patients (14 girls and 29 boys; age 11.4 ± 4.4 years) who underwent 18-fluorodeoxyglucose positron emission tomography (PET)/computed tomography for primary staging prior to therapy between 2005 and 2020 were retrospectively evaluated. The diagnoses were osteosarcoma in 10, rhabdomyosarcoma in 10, and Ewing sarcoma in 23 patients. PET metabolic data and textural features of primary tumors were obtained. Cox proportional hazards regression models were used to identify predictors for progression-free survival and overall survival. Survival curves were estimated by using the Kaplan-Meier method. RESULTS Distant metastases were detected in primary staging in 13 patients (30.2%). The median follow-up duration after diagnosis was 28 months (range: 10-171 months). In multivariate Cox regression analysis, the presence of distant metastasis and neighborhood grey-level difference matrix_Contrast (ngldm_Contrast) were found as independent predictors for both progression-free survival and overall survival. Grey-level zone length matrix_Zone-length nonuniformity (glzlm_ZLNU) was also found as an independent predictor for overall survival. The Kaplan-Meier survival analysis showed that higher ngldm_Contrast and glzlm_ZLNU values of primary tumors were significantly associated with shorter progression-free survival and overall survival. CONCLUSION In addition to the presence of distant metastasis at initial diagnosis, textural features of primary tumors may be used as prognostic biomarkers to identify patients with worse prognosis in pediatric sarcoma. Higher tumor heterogeneity is significantly associated with shorter progression-free survival and OS.
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Affiliation(s)
| | | | | | | | | | | | - Aylar Poyraz
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Beşevler/Ankara, Turkey
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Nguyen JC, Baghdadi S, Pogoriler J, Guariento A, Rajapakse CS, Arkader A. Pediatric Osteosarcoma: Correlation of Imaging Findings with Histopathologic Features, Treatment, and Outcome. Radiographics 2022; 42:1196-1213. [PMID: 35594197 DOI: 10.1148/rg.210171] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteosarcoma is the most common primary bone sarcoma in children. Imaging plays a pivotal role in diagnostic workup, surgical planning, and follow-up monitoring for possible disease relapse. Survival depends on multiple factors, including presence or absence of metastatic disease, chemotherapy response, and surgical margins. At diagnosis, radiography and anatomic MRI are used to characterize the primary site of disease, whereas chest CT and whole-body bone scintigraphy and/or PET are used to identify additional sites of disease. Treatment starts with neoadjuvant chemotherapy, followed by en bloc tumor resection and limb reconstruction, and finally, adjuvant chemotherapy. Preoperative planning requires precise tumor delineation, which traditionally has been based on high-spatial-resolution anatomic MRI to identify tumor margins (medullary and extraosseous), skip lesions, neurovascular involvement, and joint invasion. These findings direct the surgical approach and affect the options for reconstruction. For skeletally immature children, the risk of cumulative limb-length discrepancy and need for superior longevity of the reconstruction have led to the advent and preferential use of several pediatric-specific surgical techniques, including rotationplasty, joint preservation surgery, autograft or allograft reconstruction, and extendible endoprostheses. A better understanding of the clinically impactful imaging features can directly and positively influence patient care. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Jie C Nguyen
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Soroush Baghdadi
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Jennifer Pogoriler
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Andressa Guariento
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Chamith S Rajapakse
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
| | - Alexandre Arkader
- From the Department of Radiology (J.C.N., A.G.), Division of Orthopaedic Surgery (S.B., A.A.), and Department of Pathology and Laboratory Medicine (J.P.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104; and Department of Radiology (C.S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (J.C.N., J.P., A.A.)
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Automated prediction of the neoadjuvant chemotherapy response in osteosarcoma with deep learning and an MRI-based radiomics nomogram. Eur Radiol 2022; 32:6196-6206. [PMID: 35364712 DOI: 10.1007/s00330-022-08735-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To implement a pipeline to automatically segment the ROI and to use a nomogram integrating the MRI-based radiomics score and clinical variables to predict responses to neoadjuvant chemotherapy (NAC) in osteosarcoma patients. METHODS A total of 144 osteosarcoma patients treated with NAC were separated into training (n = 101) and test (n = 43) groups. After normalisation, ROIs for the preoperative MRI were segmented by a deep learning segmentation model trained with nnU-Net by using two independent manual segmentations as labels. Radiomics features were extracted using automatically segmented ROIs. Feature selection was performed in the training dataset by five-fold cross-validation. The clinical, radiomics, and clinical-radiomics models were built using multiple machine learning methods with the same training dataset and validated with the same test dataset. The segmentation model was evaluated by the Dice coefficient. AUC and decision curve analysis (DCA) were employed to illustrate the model performance and clinical utility. RESULTS 36/144 (25.0%) patients were pathological good responders (pGRs) to NAC, while 108/144 (75.0%) were non-pGRs. The segmentation model achieved a Dice coefficient of 0.869 on the test dataset. The clinical and radiomics models reached AUCs of 0.636 with a 95% confidence interval (CI) of 0.427-0.860 and 0.759 (95% CI, 0.589-0.937), respectively, in the test dataset. The clinical-radiomics nomogram demonstrated good discrimination, with an AUC of 0.793 (95% CI, 0.610-0.975), and accuracy of 79.1%. The DCA suggested the clinical utility of the nomogram. CONCLUSION The automatic nomogram could be applied to aid radiologists in identifying pGRs to NAC. KEY POINTS • The nnU-Net trained by manual labels enables the use of an automatic segmentation tool for ROI delineation of osteosarcoma. • A pipeline using automatic lesion segmentation and followed by a radiomics classifier could aid the evaluation of NAC response of osteosarcoma. • A predictive nomogram composed of clinical variables and MRI-based radiomics score provides support for individualised treatment planning.
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Clinical Perspectives for 18F-FDG PET Imaging in Pediatric Oncology: Μetabolic Tumor Volume and Radiomics. Metabolites 2022; 12:metabo12030217. [PMID: 35323660 PMCID: PMC8956064 DOI: 10.3390/metabo12030217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Pediatric cancer, although rare, requires the most optimized treatment approach to obtain high survival rates and minimize serious long-term side effects in early adulthood. 18F-FDG PET/CT is most helpful and widely used in staging, recurrence detection, and response assessment in pediatric oncology. The well-known 18F-FDG PET metabolic indices of metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG) have already revealed an independent significant prognostic value for survival in oncologic patients, although the corresponding cut-off values remain study-dependent and not validated for use in clinical practice. Advanced tumor “radiomic” analysis sheds new light into these indices. Numerous patterns of texture 18F-FDG uptake features can be extracted from segmented PET tumor images due to new powerful computational systems supporting complex “deep learning” algorithms. This high number of “quantitative” tumor imaging data, although not decrypted in their majority and once standardized for the different imaging systems and segmentation methods, could be used for the development of new “clinical” models for specific cancer types and, more interestingly, for specific age groups. In addition, data from novel techniques of tumor genome analysis could reveal new genes as biomarkers for prognosis and/or targeted therapies in childhood malignancies. Therefore, this ever-growing information of “radiogenomics”, in which the underlying tumor “genetic profile” could be expressed in the tumor-imaging signature of “radiomics”, possibly represents the next model for precision medicine in pediatric cancer management. This paper reviews 18F-FDG PET image segmentation methods as applied to pediatric sarcomas and lymphomas and summarizes reported findings on the values of metabolic and radiomic features in the assessment of these pediatric tumors.
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12
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Griffin LR, Brody A, Lee BI. The prognostic significance of metabolic tumour volume and total lesion glycolysis for dogs staged for appendicular osteosarcoma with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. Vet Comp Oncol 2021; 20:59-68. [PMID: 33988286 DOI: 10.1111/vco.12706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/10/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
Metabolic tumour volumes (MTV) and total lesion glycolysis (TLG) are metabolic parameters that are becoming more commonly reported in human medicine to quantify tumours detected on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT). In this retrospective study dogs afflicted with appendicular osteosarcoma that were staged with 18 F-FDG PET/CT had MTV and TLG at a variety of set and fixed thresholds calculated by two observers. These values, along with SUVmax , were evaluated for prognostic significance in this population of dogs. There was excellent correlation between two observers for all values. Multiple volumetric parameters were significantly associated with survival. SUVmax had the highest sensitivity for survival and TLG at 2.5 SUV*cm3 had the highest specificity for prediction of survival based on ROC calculations. The SUVmax , MTV at 2.5 SUV and TLG at 2.5 SUV*cm3 were significantly different between dogs that survived more than or less than 1 year. This study is the first of its kind in veterinary medicine that retrospectively evaluated volumetric tumour values for prognostic significance and may provide a basis for standardized method of reporting 18 F-FDG PET/CT results.
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Affiliation(s)
- Lynn R Griffin
- Environmental Health and Radiological Sciences Department, Colorado State University, Veterinary Teaching Hospital, Fort Collins, Colorado, USA
| | - Ariel Brody
- Environmental Health and Radiological Sciences Department, Colorado State University, Veterinary Teaching Hospital, Fort Collins, Colorado, USA
| | - Ber-In Lee
- Environmental Health and Radiological Sciences Department, Colorado State University, Veterinary Teaching Hospital, Fort Collins, Colorado, USA
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13
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Harrison DJ, Parisi MT, Khalatbari H, Shulkin BL. PET with 18F-Fluorodeoxyglucose/Computed Tomography in the Management of Pediatric Sarcoma. PET Clin 2021; 15:333-347. [PMID: 32498989 DOI: 10.1016/j.cpet.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The role for PET with fludeoxyglucose F 18 (18F-FDG PET)/computed tomography (CT) in the management of pediatric sarcomas continues to be controversial. The literature supports a role for PET/CT in the staging and surveillance of certain specific pediatric sarcoma subtypes; however, the data are less clear regarding whether PET/CT can be used as a biomarker for prognostication. Despite the interest in using this imaging modality in the management of pediatric sarcomas, most studies are limited by retrospective design and small sample size. Additional data are necessary to fully understand how best to use 18F-FDG PET/CT in pediatric sarcoma management.
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Affiliation(s)
- Douglas J Harrison
- Division of Pediatrics, MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Barry L Shulkin
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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14
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Koa B, Borja AJ, Aly M, Padmanabhan S, Tran J, Zhang V, Rojulpote C, Pierson SK, Tamakloe MA, Khor JS, Werner TJ, Fajgenbaum DC, Alavi A, Revheim ME. Emerging role of 18F-FDG PET/CT in Castleman disease: a review. Insights Imaging 2021; 12:35. [PMID: 33709329 PMCID: PMC7952491 DOI: 10.1186/s13244-021-00963-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Castleman disease (CD) describes a group of rare hematologic conditions involving lymphadenopathy with characteristic histopathology and a spectrum of clinical abnormalities. CD is divided into localized or unicentric CD (UCD) and multicentric CD (MCD) by imaging. MCD is further divided based on etiological driver into human herpesvirus-8-associated MCD, POEMS-associated MCD, and idiopathic MCD. There is notable heterogeneity across MCD, but increased level of pro-inflammatory cytokines, particularly interleukin-6, is an established disease driver in a portion of patients. FDG-PET/CT can help determine UCD versus MCD, evaluate for neoplastic conditions that can mimic MCD clinico-pathologically, and monitor therapy responses. CD requires more robust characterization, earlier diagnosis, and an accurate tool for both monitoring and treatment response evaluation; FDG-PET/CT is particularly suited for this. Moving forward, future prospective studies should further characterize the use of FDG-PET/CT in CD and specifically explore the utility of global disease assessment and dual time point imaging. Trial registration ClinicalTrials.gov, NCT02817997, Registered 29 June 2016, https://clinicaltrials.gov/ct2/show/NCT02817997
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Affiliation(s)
- Benjamin Koa
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mahmoud Aly
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanabhan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Tran
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Zhang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sheila K Pierson
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark-Avery Tamakloe
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Johnson S Khor
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, 0316, Oslo, Norway.
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15
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Seidensaal K, Mattke M, Haufe S, Rathke H, Haberkorn U, Bougatf N, Kudak A, Blattmann C, Oertel S, Kirchner M, Buesch C, Kieser M, Herfarth K, Kulozik A, Debus J, Uhl M, Harrabi SB. The role of combined ion-beam radiotherapy (CIBRT) with protons and carbon ions in a multimodal treatment strategy of inoperable osteosarcoma. Radiother Oncol 2021; 159:8-16. [PMID: 33549644 DOI: 10.1016/j.radonc.2021.01.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND To investigate the role of combined ion-beam radiotherapy (CIBRT) with protons and carbon ions in a multimodal treatment strategy of inoperable osteosarcoma; final analysis of a one-armed, single center phase I/II trial. METHODS Between August 2011 until September 2018, 20 patients with primary (N = 18), metastatic (N = 3), or recurrent (N = 2) inoperable pelvic (70%) or craniofacial (30%) osteosarcoma were treated with protons up to 54 Gy (RBE) and a carbon ion boost of 18 Gy (RBE) and followed until May 2019. A Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was performed before CIBRT in search for a prognostic factor. The primary endpoint was toxicity. Secondary endpoints included treatment response, global, local and distant progression free survival (PFS, LPFS and DPFS) and overall (OS), among others. RESULTS The median age was 20; all patients finished treatment per protocol. LPFS, DPFS, PFS and OS were 73%, 74%, 60% and 75% after one year and 55%, 65% 65.3%, 45% and 68% after two years, respectively. The median clinical target volume (CTV) was 1042 cc and 415 cc for the primary and boost plan, respectively. Craniofacial localization, lower uptake of FDG in PET/CT and boost plan CTV ≤ median were associated with improved overall survival (p = 0.039, p = 0.016 and p = 0.0043, respectively). No acute toxicities > grade III were observed. We observed one case of secondary acute myeloid leukemia (AML) seven months after CIBRT for recurrent disease and one case of hearing loss. CONCLUSION CIBRT shows a favorable toxicity profile and promising results particularly for patients with inoperable craniofacial osteosarcoma.
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Affiliation(s)
- Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Matthias Mattke
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Sabine Haufe
- Department of Nuclear Medicine, Heidelberg University Hospital, Germany
| | - Hendrik Rathke
- Department of Nuclear Medicine, Heidelberg University Hospital, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Germany; Clinical Cooperation Unit Nuclear Medicine, DKFZ, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Germany
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany
| | - Andreas Kudak
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Blattmann
- Department of Pediatric Hematology and Oncology, Olgahospital, Stuttgart, Germany; Department of Pediatric Hematology and Oncology, Hopp Children's Cancer Center, Heidelberg University Hospital, Germany
| | | | | | | | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany
| | - Andreas Kulozik
- Department of Pediatric Hematology and Oncology, Hopp Children's Cancer Center, Heidelberg University Hospital, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany; German Cancer Consortium (DKTK), partner site Heidelberg, Germany
| | - Matthias Uhl
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany
| | - Semi B Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany.
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16
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Harrison DJ, Chi YY, Tian J, Hingorani P, Mascarenhas L, McCowage GB, Weigel BJ, Venkatramani R, Wolden SL, Yock TI, Rodeberg DA, Hayes-Jordan AA, Teot LA, Spunt SL, Meyer WH, Hawkins DS, Shulkin BL, Parisi MT. Metabolic response as assessed by 18 F-fluorodeoxyglucose positron emission tomography-computed tomography does not predict outcome in patients with intermediate- or high-risk rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee. Cancer Med 2020; 10:857-866. [PMID: 33340280 PMCID: PMC7897958 DOI: 10.1002/cam4.3667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Strategies to optimize management in rhabdomyosarcoma (RMS) include risk stratification to assign therapy aiming to minimize treatment morbidity yet improve outcomes. This analysis evaluated the relationship between complete metabolic response (CMR) as assessed by 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET) imaging and event-free survival (EFS) in intermediate-risk (IR) and high-risk (HR) RMS patients. METHODS FDG-PET imaging characteristics, including assessment of CMR and maximum standard uptake values (SUVmax) of the primary tumor, were evaluated by central review. Institutional reports of SUVmax were used when SUVmax values could not be determined by central review. One hundred and thirty IR and 105 HR patients had FDG-PET scans submitted for central review or had SUVmax data available from institutional report at any time point. A Cox proportional hazards regression model was used to evaluate the relationship between these parameters and EFS. RESULTS SUVmax at study entry did not correlate with EFS for IR (p = 0.32) or HR (p = 0.86) patients. Compared to patients who did not achieve a CMR, EFS was not superior for IR patients who achieved a CMR at weeks 4 (p = 0.66) or 15 (p = 0.46), nor for HR patients who achieved CMR at week 6 (p = 0.75) or 19 (p = 0.28). Change in SUVmax at week 4 (p = 0.21) or 15 (p = 0.91) for IR patients or at week 6 (p = 0.75) or 19 (p = 0.61) for HR patients did not correlate with EFS. CONCLUSION Based on these data, FDG-PET does not appear to predict EFS in IR or HR-RMS. It remains to be determined whether FDG-PET has a role in predicting survival outcomes in other RMS subpopulations.
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Affiliation(s)
| | | | - Jing Tian
- University of Florida, Gainesville, FL, USA
| | - Pooja Hingorani
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Brenda J Weigel
- University of Minnesota/Masonic Cancer Center, Minneapolis, MN, USA
| | - Rajkumar Venkatramani
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, TX, USA
| | | | - Torunn I Yock
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | | | - Sheri L Spunt
- Lucile Packard Children's Hospital Stanford University, Palo Alto, CA, USA
| | - William H Meyer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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17
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Froelich JW, Salavati A. Artificial Intelligence in PET/CT Is about to Make Whole-Body Tumor Burden Measurements a Clinical Reality. Radiology 2020; 294:453-454. [DOI: 10.1148/radiol.2019192425] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jerry W. Froelich
- From the Department of Radiology, University of Minnesota, 420 Delaware St SE, Mayo Bldg, MMC 292, Minneapolis, MN 55455
| | - Ali Salavati
- From the Department of Radiology, University of Minnesota, 420 Delaware St SE, Mayo Bldg, MMC 292, Minneapolis, MN 55455
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18
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Lin P, Yang PF, Chen S, Shao YY, Xu L, Wu Y, Teng W, Zhou XZ, Li BH, Luo C, Xu LM, Huang M, Niu TY, Ye ZM. A Delta-radiomics model for preoperative evaluation of Neoadjuvant chemotherapy response in high-grade osteosarcoma. Cancer Imaging 2020; 20:7. [PMID: 31937372 PMCID: PMC6958668 DOI: 10.1186/s40644-019-0283-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background The difficulty of assessment of neoadjuvant chemotherapeutic response preoperatively may hinder personalized-medicine strategies that depend on the results from pathological examination. Methods A total of 191 patients with high-grade osteosarcoma (HOS) were enrolled retrospectively from November 2013 to November 2017 and received neoadjuvant chemotherapy (NCT). A cutoff time of November 2016 was used to divide the training set and validation set. All patients underwent diagnostic CTs before and after chemotherapy. By quantifying the tumor regions on the CT images before and after NCT, 540 delta-radiomic features were calculated. The interclass correlation coefficients for segmentations of inter/intra-observers and feature pair-wise correlation coefficients (Pearson) were used for robust feature selection. A delta-radiomics signature was constructed using the lasso algorithm based on the training set. Radiomics signatures built from single-phase CT were constructed for comparison purpose. A radiomics nomogram was then developed from the multivariate logistic regression model by combining independent clinical factors and the delta-radiomics signature. The prediction performance was assessed using area under the ROC curve (AUC), calibration curves and decision curve analysis (DCA). Results The delta-radiomics signature showed higher AUC than single-CT based radiomics signatures in both training and validation cohorts. The delta-radiomics signature, consisting of 8 selected features, showed significant differences between the pathologic good response (pGR) (necrosis fraction ≥90%) group and the non-pGR (necrosis fraction < 90%) group (P < 0.0001, in both training and validation sets). The delta-radiomics nomogram, which consisted of the delta-radiomics signature and new pulmonary metastasis during chemotherapy showed good calibration and great discrimination capacity with AUC 0.871 (95% CI, 0.804 to 0.923) in the training cohort, and 0.843 (95% CI, 0.718 to 0.927) in the validation cohort. The DCA confirmed the clinical utility of the radiomics model. Conclusion The delta-radiomics nomogram incorporating the radiomics signature and clinical factors in this study could be used for individualized pathologic response evaluation after chemotherapy preoperatively and help tailor appropriate chemotherapy and further treatment plans.
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Affiliation(s)
- Peng Lin
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Peng-Fei Yang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China.,College of Biomedical Engineering &Instrument Science, Zhejiang University, Zhejiang, Hangzhou, China
| | - Shi Chen
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Department of Orthopaedics, Ninghai First Hospital, Ningbo, Zhejiang, 315600, China
| | - You-You Shao
- Department of Pediatrics, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China
| | - Lei Xu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China
| | - Yan Wu
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Wangsiyuan Teng
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Xing-Zhi Zhou
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Bing-Hao Li
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Chen Luo
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China
| | - Lei-Ming Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China
| | - Mi Huang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, 27708, USA
| | - Tian-Ye Niu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China. .,Nuclear & Radiological Engineering and Medical Physics Programs, Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 770 State Street, Boggs 385, Atlanta, GA, 30332-0745, USA.
| | - Zhao-Ming Ye
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China. .,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China.
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19
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Lee I, Byun BH, Lim I, Kim BI, Choi CW, Koh JS, Song WS, Cho WH, Kong CB, Lim SM. Early response monitoring of neoadjuvant chemotherapy using [ 18F]FDG PET can predict the clinical outcome of extremity osteosarcoma. EJNMMI Res 2020; 10:1. [PMID: 31900594 PMCID: PMC6942108 DOI: 10.1186/s13550-019-0588-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/23/2019] [Indexed: 01/27/2023] Open
Abstract
Background To propose a personalized therapeutic approach in osteosarcoma treatment, we assessed whether sequential [18F]FDG PET/CT (PET/CT) could predict the outcome of patients with osteosarcoma of the extremities after one cycle and two cycles of neoadjuvant chemotherapy. Methods A total of 73 patients with AJCC stage II extremity osteosarcoma treated with 2 cycles of neoadjuvant chemotherapy, surgery, and adjuvant chemotherapy were retrospectively analyzed in this study. All patients underwent PET/CT before (PET0), after 1 cycle (PET1), and after the completion of neoadjuvant chemotherapy (PET2), respectively. Maximum standardized uptake value (SUVmax) (corrected for body weight) and the % changes of SUVmax were calculated, and histological responses were evaluated after surgery. Receiver-operating characteristic (ROC) curve analyses and the Cox proportional hazards models were used to analyze whether imaging and clinicopathologic parameters could predict event-free survival (EFS). Results A total of 36 patients (49.3%) exhibited a poor histologic response and 17 patients (23.3%) showed events (metastasis in 15 and local recurrence in 2). SUVmax on PET2 (SUV2), the percentage change of SUVmax between PET0 and PET1 (Δ%SUV01), and between PET0 and PET2 (Δ%SUV02) most accurately predicted events using the ROC curve analysis. SUV2 (relative risk, 8.86; 95% CI, 2.25–34.93), Δ%SUV01 (relative risk, 5.97; 95% CI, 1.47–24.25), and Δ%SUV02 (relative risk, 6.00; 95% CI, 1.16–30.91) were independent predicting factors for EFS with multivariate analysis. Patients with SUV2 over 5.9 or Δ%SUV01 over − 39.8% or Δ%SUV02 over − 54.1% showed worse EFS rates than others (p < 0.05). Conclusions PET evaluation after 1 cycle of presurgical chemotherapy can predict the clinical outcome of extremity osteosarcoma. [18F]FDG PET, which shows a potential role in the early evaluation of the modification of timing of local control, can be a useful modality for early response monitoring of neoadjuvant chemotherapy.
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Affiliation(s)
- Inki Lee
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Byung Hyun Byun
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Ilhan Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Byung Il Kim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chang Woon Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Jae-Soo Koh
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Won Seok Song
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Wan Hyeong Cho
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chang-Bae Kong
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
| | - Sang Moo Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
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Blautzik J, Grelich L, Schramm N, Henkel R, Bartenstein P, Pfluger T. What and how should we measure in paediatric oncology FDG-PET/CT? Comparison of commonly used SUV metrics for differentiation between paediatric tumours. EJNMMI Res 2019; 9:115. [PMID: 31872312 PMCID: PMC6928180 DOI: 10.1186/s13550-019-0577-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background In clinical routine, SUVmax and SUVpeak are most often used to determine the glucose metabolism in tumours by 18F-FDG PET/CT. Both metrics can be further normalised to SUVs in reference regions resulting in a SUV ratio (SUVratio). The aim of the study was to directly compare several widely used SUVs/SUVratios with regard to differentiation between common tumours in paediatric patients; a special focus was put on characteristics of reference region SUVs. Methods The final study population consisted of 61 children and adolescents with diagnoses of non-Hodgkin lymphoma (NHL, n = 25), Hodgkin lymphoma (HL, n = 14), and sarcoma (n = 22). SUV metrics included SUVmax and SUVpeak as well as both parameters normalised to liver and mediastinal blood pool, respectively, yielding the SUVratios SUVmax/liver, SUVmax/mediastinum, SUVpeak/liver, and SUVpeak/mediastinum. Results The metrics SUVmax, SUVpeak, SUVmax/liver, and SUVpeak/liver all proved to be sensitive for tumour differentiation (p ≤ 0.008); in contrast, SUVmax/mediastinum and SUVpeak/mediastinum revealed to be non-sensitive approaches. Correlation analyses showed inverse associations between reference region SUVs and SUVratios (p < 0.05). Multiple regression analyses demonstrated significant effects of factors as bodyweight and uptake time on reference region SUVs (p < 0.01), and thus indirectly on the corresponding SUVratios. Conclusions In the paediatric population, the ability to differentiate between common tumours remarkably varies between SUV metrics. When using SUVratios, the choice of reference region is crucial. Factors potentially influencing reference region SUVs (and thus SUVratios) should be taken into account in order to avoid erroneous conclusions. When not possible, SUVmax and SUVpeak represent less complex, more robust alternatives.
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Affiliation(s)
- Janusch Blautzik
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany. .,Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Institute for Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
| | - Leonie Grelich
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Nicolai Schramm
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Nuclear Medicine, University Hospital, Würzburg, Germany
| | - Rebecca Henkel
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Pfluger
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
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Høilund-Carlsen PF, Edenbrandt L, Alavi A. Global disease score (GDS) is the name of the game! Eur J Nucl Med Mol Imaging 2019; 46:1768-1772. [PMID: 31183636 PMCID: PMC6647113 DOI: 10.1007/s00259-019-04383-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark.
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Lars Edenbrandt
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Can pretreatment 18F-FDG PET tumor texture features predict the outcomes of osteosarcoma treated by neoadjuvant chemotherapy? Eur Radiol 2019; 29:3945-3954. [DOI: 10.1007/s00330-019-06074-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/21/2019] [Accepted: 02/06/2019] [Indexed: 02/07/2023]
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Griffin LR, Thamm DH, Brody A, Selmic LE. Prognostic value of fluorine 18 flourodeoxyglucose positron emission tomography/computed tomography in dogs with appendicular osteosarcoma. J Vet Intern Med 2019; 33:820-826. [PMID: 30768736 PMCID: PMC6430893 DOI: 10.1111/jvim.15453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/30/2019] [Indexed: 12/22/2022] Open
Abstract
Background Factors indicative of a negative prognosis for appendicular osteosarcoma (OSA) in dogs are visible metastatic disease, location, and size of lesion. In human medicine maximum standard uptake value (SUVmax), as measured on a fluorine18 flourodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT), is prognostic for survival for several tumor types. Objective Determine if SUVmax is associated with progression‐free interval (PFI) and determination of survival in dogs with appendicular OSA. Animals Sixty‐two dogs with untreated appendicular OSA that had been staged with 18F‐FDG PET/CT. Methods Retrospective analysis of the 18F‐FDG PET/CT was performed. Dogs were excluded from the study if they did not receive definitive intent treatment for their primary OSA and adjuvant chemotherapy with carboplatin, or had visible metastatic disease on initial imaging. A region of interest (ROI) was created around the primary tumor to measure SUVmax. Univariable and multivariable Cox proportional hazards analysis was performed to evaluate for associations between variables including SUVmax and outcome of PFI and overall survival (OS). Results Maximum standard uptake value of the primary tumor was significantly associated with the OS (P = .04) with adjustment for treatment type and monocyte count. The overall median survival time (OST) was 284 days (range, 39‐1293 days) with the OST of dogs having an SUVmax of ≥7.4 of 254 days (range, 98‐428 days) and dogs with an SUVmax of <7.4 of 680 days (range, 108‐811 days, P = .01). Conclusions and Clinical Importance Maximum standard uptake value as measured via 18F‐FDG PET/CT is significantly associated with survival in dogs with appendicular OSA with a high SUVmax being an indicator of a negative prognosis.
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Affiliation(s)
- Lynn R Griffin
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado
| | - Douglas H Thamm
- Department of Clinical Sciences and Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado
| | - Ariel Brody
- North Carolina State University Veterinary Hospital, Raleigh, North Carolina
| | - Laura E Selmic
- Ohio State University Veterinary Medical Center, Columbus, Ohio
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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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