Potential Role of FDG PET Imaging in Predicting Metastatic Potential and Assessment of Therapeutic Response to Neoadjuvant Chemotherapy in Ewing Sarcoma Family of Tumors

Gupta, Khushboo; Pawaskar, Alok; Basu, Sandip; Rajan, M. G. R.; Asopa, Ramesh; Arora, Brijesh; Nair, Narendra; Banavali, Shripad

doi:10.1097/rlu.0b013e31822f684b

Cited by 49 publications

(21 citation statements)

References 22 publications

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“…Functional imaging such as positron emission tomography (PET) was studied with more promising results. In a series of 36 patients, absolute value of standard uptake value (SUV) of PET tracer after neoadjuvant chemotherapy was predictive of PFS[21], and a study of 14 patients demonstrated a correlation between the relative change in SUV and histologic response[22]. In our study, there was no correlation between radiologic response and histologic response, but different radiologic measures were associated with disease outcomes.…”

Section: Discussionmentioning

confidence: 50%

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

Pan

Morani

Wang

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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PURPOSE/OBJECTIVE(S) To identify prognostic factors and patterns of relapse for patients with Ewing sarcoma (ES) who underwent chemotherapy and R0 resection without radiation therapy (RT). METHODS AND MATERIALS We reviewed the medical records of patients who underwent surgical resection at our institution between 2000 and 2013 for an initial diagnosis of ES. The associations of demographic and clinical factors with local control (LC) and patient outcome were determined by Cox regression. Time to events was measured from the time of surgery. Survival curves were estimated by the Kaplan-Meier method and compared by the log rank test. RESULTS A total of 66 patients (median age 19 years, range: 4–55) met the study criteria. The median follow-up was 5.6 years for living patients. In 43 patients (65%) for whom imaging studies were available, the median tumor volume reduction was 73% and at least partial response (PR) by RECIST was achieved in 17 patients (40%). At 5 years, LC was 78%, progression-free survival (PFS) was 59%, and overall survival (OS) was 65%. Poor histologic response (necrosis ≤ 95%) was an independent predictor of LC (HR=6.8, P=0.004), PFS (HR=5.2, P=0.008), and OS (HR=5.0, P=0.008). Metastasis on presentation was also an independent predictor of LC (HR=6.3, P=0.011), PFS (HR=6.8, P=0.002) and OS (HR=6.7, P=0.002). Radiologic PR was a predictor of PFS (HR=0.26, P=0.012) and post-chemotherapy tumor volume was associated with OS (HR=1.06, P=0.015). All deaths were preceded by distant relapse. Of the 8 initial local-only relapses, 5 (63%) were soon followed by distant relapse. Predictors of poor post-recurrence survival were time to recurrence <1 year (HR=11.5, P=0.002) and simultaneous local and distant relapse (HR=16.8, P=0.001). CONCLUSIONS Histologic and radiologic response to chemotherapy were independent predictors of outcome. Additional study is needed to determine the role of adjuvant RT for patients who have poor histologic response after R0 resection.

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Section: Discussionmentioning

confidence: 50%

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

Pan

Morani

Wang

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…FDG uptake has also been correlated with the expression of HIF-1α [9] and was found significantly increased in the primary Ewing sarcoma family of tumors with distant metastasis [10]. On the other hand, it has been also reported that it remains challenging for 18 F-FDG PET to reliably differentiate chronically hypoxic from normoxic tumors [11] or malignant lesions from benign inflammatory processes [12].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Aggressiveness of Breast Cancer Using Simultaneous 18F-FDG-PET and DCE-MRI

Margolis

Moy

Sigmund

et al. 2016

Clinical Nuclear Medicine

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Purpose To investigate the feasibility of using simultaneous breast MRI and PET to assess the synergy of MR pharmacokinetic and fluorine-18 fluorodeoxyglucose (18F-FDG) uptake data to characterize tumor aggressiveness in terms of metastatic burden and Ki67 status. Methods Twelve consecutive patients underwent breast and whole body PET/MRI. During the MR scan, PET events were simultaneously accumulated. MR contrast kinetic model parametric maps were computed using the extended Tofts model, including the volume transfer constant between blood plasma and the interstitial space (Ktrans), the transfer constant from the interstitial space to the blood plasma (kep), and the plasmatic volume fraction (Vp). Results Patients with systemic metastases had a significantly lower kep compared to those with local disease (0.45 vs 0.99 min−1, p=0.011). Metastatic burden correlated positively with Ktrans and standardized uptake value (SUV), and negatively with kep. Ki67 positive tumors had a significantly greater Ktrans compared to Ki67 negative tumors (0.29 vs 0.45 min−1, p=0.03). A negative correlation was found between metabolic tumor volume and transfer constant (Ktrans or Kep). Conclusion These preliminary results suggest that MR pharmacokinetic parameters and FDG-PET may aid in the assessment of tumor aggressiveness and metastatic potential. Future studies are warranted with a larger cohort to further assess the role of pharmacokinetic modeling in simultaneous PET/MRI imaging.

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“…The metabolic information from 18 F-FDG-PET scans may improve therapy response assessment, especially for tumors with small extraosseous soft tissue components [87, 88]. Due to its high soft tissue contrast, 18 F-FDG PET/MR can accurately diagnose hypermetabolic brown fat and hypermetabolic reconverted hematopoietic marrow after chemotherapy [89–91].…”

Section: Improve the Accuracy For The Diagnosis Of Treatment Responsementioning

confidence: 99%

How PET/MR Can Add Value for Children with Cancer

Daldrup-Link

2017

Curr Radiol Rep

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Purpose To review how PET/MR technology could add value for pediatric cancer patients. Recent Findings Since many primary tumors in children are evaluated with MRI and metastases are detected with PET/CT, integrated PET/MR can be a time-efficient and convenient solution for pediatric cancer staging. 18F-FDG PET/MR can assess primary tumors and the whole body in one imaging session, avoid repetitive anesthesia and reduce radiation exposure compared to 18F-FDG PET/CT. This article lists 10 action points, which might improve the clinical value of PET/MR for children with cancer. However, even if PET/MR proves valuable, it cannot enter mainstream applications if it is not accessible to the majority of pediatric cancer patients. Therefore, innovations are needed to make PET/MR scanners affordable and increase patient throughput. Summary PET/MR offers opportunities for more efficient, accurate and safe diagnoses of pediatric cancer patients. The impact on patient management and outcomes has to be substantiated by large-scale prospective clinical trials.

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Potential Role of FDG PET Imaging in Predicting Metastatic Potential and Assessment of Therapeutic Response to Neoadjuvant Chemotherapy in Ewing Sarcoma Family of Tumors

Cited by 49 publications

References 22 publications

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

Assessment of Aggressiveness of Breast Cancer Using Simultaneous 18F-FDG-PET and DCE-MRI

How PET/MR Can Add Value for Children with Cancer

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