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Open Access 01-12-2020 | osteosarcoma | Original research

[¹⁸F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial

Authors: Giulia Polverari, Francesco Ceci, Roberto Passera, Jacquelyn Crane, Lin Du, Gang Li, Stefano Fanti, Nicholas Bernthal, Fritz C. Eilber, Martin Allen-Auerbach, Johannes Czernin, Jeremie Calais, Noah Federman

Published in: EJNMMI Research | Issue 1/2020

Abstract

Introduction

This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [¹⁸F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX).

Methods

Bone or soft tissue sarcoma patients with (1) baseline [¹⁸F]FDG PET/CT within 4 weeks prior to the start of neo-CTX (PET1), (2) early interim [¹⁸F]FDG PET/CT (6 weeks after the start of neo-CTX (PET2), (3) evaluation of neo-CTX response by histology or MRI, and (4) definitive therapy after neo-CTX (surgery or radiation) were included. Semiquantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [¹⁸F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a subpopulation of patients with bone involvement only.

Results

Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had osteosarcoma, 13/34 (38%) Ewing's sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16–84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease, and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p < 0.02). ΔMTV was associated with tissue response to neo-CTX (p = 0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS.

Conclusion

[¹⁸F]FDG PET/CT performed 6 weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.

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Title: [18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial
Authors: Giulia Polverari
Francesco Ceci
Roberto Passera
Jacquelyn Crane
Lin Du
Gang Li
Stefano Fanti
Nicholas Bernthal
Fritz C. Eilber
Martin Allen-Auerbach
Johannes Czernin
Jeremie Calais
Noah Federman
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: osteosarcoma
Ewing's Sarcoma
Ewing's sarcoma
Soft Tissue Sarcoma
Osteosarcoma
Sarcoma
Pediatrics
Cytostatic Therapy
Published in: EJNMMI Research / Issue 1/2020
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/s13550-020-00715-0

At a glance: The STEP trials

Springer Medicine

[¹⁸F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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