[F-18]-fluorodeoxy-D-glucose-positron Emission Tomography Response is Associated with Outcome for Extremity Osteosarcoma in Children and Young Adults

Overview

Journal Cancer

Publisher Wiley

Specialty Oncology

Date 2009 Jun 12

PMID 19517457

Citations 43

Authors

Douglas S Hawkins

Ernest U Conrad 3rd

James E Butrynski

Scott M Schuetze

Janet F Eary

Affiliations

Soon will be listed here.

Abstract

Background: Response to neoadjuvant chemotherapy is 1 of the most powerful prognostic factors for extremity osteosarcoma. [F-18]-fluorodeoxy-D-glucose-positron emission tomography (FDG-PET) is a noninvasive imaging modality that is used to predict histopathologic response. To determine the prognostic value of FDG-PET response for progression-free survival (PFS) in osteosarcoma, the authors of this report reviewed the University of Washington Medical Center experience.

Methods: Forty patients with extremity osteosarcoma were evaluated by FDG-PET. All patients received neoadjuvant and adjuvant chemotherapy. FDG-PET standard uptake values (SUVs) before neoadjuvant chemotherapy (SUV1) and after neoadjuvant chemotherapy (SUV2) were analyzed and correlated with histopathologic response.

Results: The median SUV1 was 6.8 (range, 3.0-24.1), the median SUV2 was 2.3 (range, 1.2-12.8), and the median SUV2 to SUV1 ratio (SUV2:1), was 0.36 (range, 0.12-1.10). A good FDG-PET response was defined as an SUV2<2.5 or an SUV2:1<or=0.5. FDG-PET responses according to SUV2 and SUV2:1 were concordant with histologic response in 58% and 68% of patients, respectively. SUV2 was associated with outcome (4-year PFS, 73% for SUV2<2.5 vs 39% for SUV2>or=2.5; P=.021). Both the initial disease stage and the histologic response were associated with outcome.

Conclusions: FDG-PET imaging of extremity osteosarcoma was correlated only partially with a histologic response to neoadjuvant chemotherapy. An SUV2<2.5 was associated with improved PFS. Future prospective studies are warranted to determine whether FDG-PET imaging may be used as a predictor of outcome independent of initial disease stage.

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References

Picci P, Sangiorgi L, Rougraff B, Neff J, Casadei R, Campanacci M . Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma. J Clin Oncol. 1994; 12(12):2699-705. DOI: 10.1200/JCO.1994.12.12.2699. View

Provisor A, Ettinger L, Nachman J, Krailo M, Makley J, Yunis E . Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children's Cancer Group. J Clin Oncol. 1997; 15(1):76-84. DOI: 10.1200/JCO.1997.15.1.76. View

Hawkins D, Rajendran J, Conrad 3rd E, Bruckner J, Eary J . Evaluation of chemotherapy response in pediatric bone sarcomas by [F-18]-fluorodeoxy-D-glucose positron emission tomography. Cancer. 2002; 94(12):3277-84. DOI: 10.1002/cncr.10599. View

Zalupski M, Rankin C, Ryan J, Lucas D, Muler J, Lanier K . Adjuvant therapy of osteosarcoma--A Phase II trial: Southwest Oncology Group study 9139. Cancer. 2004; 100(4):818-25. DOI: 10.1002/cncr.20021. View

Eary J, Conrad E, Bruckner J, Folpe A, Hunt K, Mankoff D . Quantitative [F-18]fluorodeoxyglucose positron emission tomography in pretreatment and grading of sarcoma. Clin Cancer Res. 1998; 4(5):1215-20. View

Meyers P, Schwartz C, Krailo M, Kleinerman E, Betcher D, Bernstein M . Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate. J Clin Oncol. 2005; 23(9):2004-11. DOI: 10.1200/JCO.2005.06.031. View

SALZER-KUNTSCHIK M, Delling G, Beron G, Sigmund R . Morphological grades of regression in osteosarcoma after polychemotherapy - study COSS 80. J Cancer Res Clin Oncol. 1983; 106 Suppl:21-4. DOI: 10.1007/BF00625047. View

Hawkins D, Schuetze S, Butrynski J, Rajendran J, Vernon C, Conrad 3rd E . [18F]Fluorodeoxyglucose positron emission tomography predicts outcome for Ewing sarcoma family of tumors. J Clin Oncol. 2005; 23(34):8828-34. DOI: 10.1200/JCO.2005.01.7079. View

Davis A, Bell R, Goodwin P . Prognostic factors in osteosarcoma: a critical review. J Clin Oncol. 1994; 12(2):423-31. DOI: 10.1200/JCO.1994.12.2.423. View

10.

Huvos A, Rosen G, Marcove R . Primary osteogenic sarcoma: pathologic aspects in 20 patients after treatment with chemotherapy en bloc resection, and prosthetic bone replacement. Arch Pathol Lab Med. 1977; 101(1):14-8. View

11.

Marina N, Gebhardt M, Teot L, Gorlick R . Biology and therapeutic advances for pediatric osteosarcoma. Oncologist. 2004; 9(4):422-41. DOI: 10.1634/theoncologist.9-4-422. View

12.

Bielack S, Kempf-Bielack B, Delling G, Exner G, Flege S, Helmke K . Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002; 20(3):776-90. DOI: 10.1200/JCO.2002.20.3.776. View

13.

Peto R, Pike M, Armitage P, Breslow N, Cox D, Howard S . Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977; 35(1):1-39. PMC: 2025310. DOI: 10.1038/bjc.1977.1. View

14.

Meyers P, Gorlick R . Osteosarcoma. Pediatr Clin North Am. 1997; 44(4):973-89. DOI: 10.1016/s0031-3955(05)70540-x. View

15.

Murphy Jr W . Imaging bone tumors in the 1990s. Cancer. 1991; 67(4 Suppl):1169-76. DOI: 10.1002/1097-0142(19910215)67:4+<1169::aid-cncr2820671511>3.0.co;2-a. View

16.

Folpe A, Lyles R, Sprouse J, Conrad 3rd E, Eary J . (F-18) fluorodeoxyglucose positron emission tomography as a predictor of pathologic grade and other prognostic variables in bone and soft tissue sarcoma. Clin Cancer Res. 2000; 6(4):1279-87. View

17.

Eary J, OSullivan F, Powitan Y, Chandhury K, Vernon C, Bruckner J . Sarcoma tumor FDG uptake measured by PET and patient outcome: a retrospective analysis. Eur J Nucl Med Mol Imaging. 2002; 29(9):1149-54. DOI: 10.1007/s00259-002-0859-5. View

18.

Meyers P, Gorlick R, Heller G, Casper E, Lane J, Huvos A . Intensification of preoperative chemotherapy for osteogenic sarcoma: results of the Memorial Sloan-Kettering (T12) protocol. J Clin Oncol. 1998; 16(7):2452-8. DOI: 10.1200/JCO.1998.16.7.2452. View

19.

Bacci G, Picci P, Ferrari S, Ruggieri P, Casadei R, Tienghi A . Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 1993; 72(11):3227-38. DOI: 10.1002/1097-0142(19931201)72:11<3227::aid-cncr2820721116>3.0.co;2-c. View

20.

Rosen G, Marcove R, Caparros B, Nirenberg A, Kosloff C, Huvos A . Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer. 1979; 43(6):2163-77. DOI: 10.1002/1097-0142(197906)43:6<2163::aid-cncr2820430602>3.0.co;2-s. View