Diffusion-weighted imaging in differentiating mid-course responders to chemotherapy for long-bone osteosarcoma compared to the histologic response: an update

Abstract

Background Diffusion-weighted imaging (DWI) has been described to correlate with tumoural necrosis in response to preoperative chemotherapy for osteosarcoma. Objective To assess the accuracy of DWI in evaluating the response to neoadjuvant chemotherapy at the mid-course treatment of long-bone osteosarcoma and in predicting survival. Materials and methods We conducted a prospective single-centre study over a continuous period of 11 years. Consecutive patients younger than 20 years treated with a neoadjuvant regimen for peripheral conventional osteosarcoma were eligible for inclusion. Magnetic resonance imaging (MRI) with DWI was performed at diagnosis, and mid- and end-course chemotherapy with mean apparent diffusion coefficients (ADC) calculated at each time point. A percentage less than or equal to 10% of the viable residual tissue at the histological analysis of the surgical specimen was defined as a good responder to chemotherapy. Survival comparisons were calculated using the Kaplan-Meier method. Uni- and multivariate analyses with ADC change were performed by Cox modelling. This is an expansion and update of our previous work. Results Twenty-six patients between the ages of 4.8 and 19.6 years were included, of whom 14 were good responders. At mid-course chemotherapy, good responders had significantly higher mean ADC values (P=0.046) and a higher increase in ADC (P=0.015) than poor responders. The ADC change from diagnosis to mid-course MRI did not appear to be a prognosticator of survival and did not impact survival rates of both groups. Conclusion DWI at mid-course preoperative chemotherapy for osteosarcoma should be considered to evaluate the degree of histological necrosis and to predict survival. The anticipation of a response to neoadjuvant treatment by DWI may have potential implications on preoperative management.

Effect of Paclitaxel Combined with Doxorubicin Hydrochloride Liposome Injection in the Treatment of Osteosarcoma and MRI Changes before and after Treatment

“…In this retrospective study, all enrolled patients met the treatment indications of chemotherapy. The evaluation of postoperative clinical efficacy showed that the DCR of the STG (94.44%) was markedly higher than that of the COG (81.48%, P < 0.05), which was consistent with previous reports [ 9 , 20 , 21 ], demonstrating that paclitaxel combined with DHLI improves the chemotherapeutic effect of osteosarcoma patients and lays a good foundation for subsequent treatment and prognosis. In order to further analyze drug safety, the incidence of adverse events during chemotherapy was statistically analyzed.…”

Evaluation of response to neoadjuvant chemotherapy in osteosarcoma using dynamic contrast-enhanced MRI: development and external validation of a model

“…However, due to limited cohort sizes, cohort heterogeneity and absence of external validation, studies on DCE-MRI or other imaging modalities have not yet resulted in a widely accepted method for response assessment. Reported accuracies generally range between 0.60 and 0.77 [ 3 , 5 , 6 , 23 ]. The determined threshold for prediction of poor response of rWIR <2.3, corresponding to a <57% decrease in WIR over time, is of the same order of magnitude as the threshold of <60% decrease in the WIR studied in the meta-analysis by Kubo et al, with a reported pooled sensitivity, specificity and AUC-index of 0.73, 0.83 and 0.89, affirming the robustness of the current results [ 10 ].…”

Imaging Assessment of the Efficacy of Chemotherapy in Primary Malignant Bone Tumors: Recent Advances in Qualitative and Quantitative Magnetic Resonance Imaging and Radiomics

“…However, the authors reported no differences in the imaging parameters and tumor volume between the two groups. In contrast, Habre et al 54 prospectively investigated changes in ADC in the middle of chemotherapy treatment of 26 pediatric OS patients treated with high‐dose MTX and ifosfamide/etoposide, and found that the ADC values at middle of chemotherapy were significantly higher in the good response group than in the poor response group. Wang et al 55 prospectively studied the relationship between ADC values and tumor necrosis rates after chemotherapy in 35 OS patients treated mainly with cisplatin, methopterin, epirubicin, and iphosphamide.…”