Prediction of tumour necrosis fractions using metabolic and volumetric F-18-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma

Department of Nuclear Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Korea.
European Journal of Nuclear Medicine (Impact Factor: 5.38). 09/2011; 39(1):39-49. DOI: 10.1007/s00259-011-1936-4
Source: PubMed


The utility of combined metabolic and volumetric (18)F-FDG PET/CT indices for predicting tumour necrosis fractions following neoadjuvant chemotherapy has not been extensively studied in osteosarcoma. Furthermore, little is known of the early PET/CT responses after only one chemotherapy course.
Enrolled in the study were 20 children and young adults with resectable osteosarcoma who had undergone (18)F-FDG PET/CT scans before and after neoadjuvant chemotherapy. Maximum standardized uptake value (mSUV), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were measured. From among the 20 patients, 14 were prospectively recruited and underwent an additional PET/CT scan after one chemotherapy course. Histopathological necrosis fractions were compared with the above-mentioned PET/CT indices and their ratios.
MTV at the SUV threshold of 2 g/ml was closely correlated with the magnetic resonance image volumes before therapy (r = 0.91). In the prospective cohort, five patients were classified as good responders and nine as poor responders. All the metabolic indices (mSUV and its ratio) and combined metabolic/volumetric indices (MTV, TLG, and their ratios) except the mSUV ratio determined after therapy showed significant differences between good and poor responders (P <0.05). Differences were also noted for all of these indices determined after one chemotherapy course. Furthermore, most of these indices determined after therapy as well as after one chemotherapy course had good sensitivity, specificity, positive predictive value and negative predictive value with respect to predicting histological response to chemotherapy.
In our osteosarcoma patient population, (18)F-FDG PET/CT indices (either combined metabolic/volumetric or metabolic indices) determined after neoadjuvant chemotherapy were useful in predicting tumour responses. This held true after only one chemotherapy course.

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Available from: Jong Hyung Yoon, Aug 21, 2014
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    • "In a prospective study of osteosarcoma patients, MTV and TLG were significantly different after therapy between good and poor responders. These parameters had good sensitivity, specificity, positive predictive value, and negative predictive value for predicting histological responses to chemotherapy (49). In another study comparing response evaluation using volume-based PET parameters to a clinical response evaluation based on RECIST and WHO clinical criteria in patients with esophageal cancer, a decrease in MTV and TLG between baseline and post-treatment scans was the better predictor of histopathologic response and survival than a decrease in clinical response (50). "
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