Imaging of pediatric bone tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Abstract

Malignant primary bone tumors are uncommon in the pediatric population, accounting for 3%-5% of all pediatric malignancies. Osteosarcoma and Ewing sarcoma comprise 90% of malignant primary bone tumors in children and adolescents. This paper provides consensus-based recommendations for imaging in children with osteosarcoma and Ewing sarcoma at diagnosis, during therapy, and after therapy.

Consensus recommendations in the management of Ewing sarcoma from the National Ewing Sarcoma Tumor Board

“…With respect to dose and fractionation, cumulative radiation doses of 12-20 Gy in 1.25-1.5 Gy fractions, administered once or twice daily have been reported. 1,12 One group found improved outcomes with 15 Gy versus 12-13 Gy. 61 Stereotactic body radiation therapy (SBRT) for oligometastatic lung metastases has been shown to be a feasible local treatment option with excellent outcomes and low toxicity, but it has not yet been used in the upfront setting on prospective trials.…”

“…The initial evaluation of ES includes cross‐sectional imaging of the primary tumor by computerized tomography (CT) or magnetic resonance imaging (MRI) in addition to staging evaluation to assess for metastatic disease 1 . CT of the chest has replaced chest radiograph as the standard of care to assess for pulmonary involvement.…”

“…Of note, IMRT WLI is not yet allowed on ES COG studies. With respect to dose and fractionation, cumulative radiation doses of 12–20 Gy in 1.25–1.5 Gy fractions, administered once or twice daily have been reported 1,12 . One group found improved outcomes with 15 Gy versus 12–13 Gy 61 .…”