Cancer Res Treat.  2011 Sep;43(3):170-175.

Assessment of Chemotherapy Response Using FDG-PET in Pediatric Bone Tumors: A Single Institution Experience

• Kim DH
• Kim SY
• Lee HJ
• Song BS
• Kim DH
• Cho JB
• Lim JS
• Lee JA

Abstract

PURPOSE
Response to neo-adjuvant chemotherapy is an important prognostic factor for osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT). [F-18]-fluorodeoxy-D-glucose (FDG)-positron emission tomography (PET) is a non-invasive imaging modality that predicts histologic response to chemotherapy of various malignancies; however, limited data exist about the usefulness of FDG-PET in predicting the histologic response of pediatric bone tumors to chemotherapy. We analyzed the FDG-PET imaging characteristics of pediatric bone tumors and determined the association with response to chemotherapy.
MATERIALS AND METHODS
Pediatric patients with OS (n=19) or ESFT (n=17) were evaluated for FDG-PET standard uptake values before (SUV1) and after (SUV2) chemotherapy. The relationship to the chemotherapy response was assessed by histopathology in surgically-excised tumors. A complete data set (SUV1, SUV2, and histologic response) was available in 23 patients.
RESULTS
While the mean SUV1s were not different between patients with OSs and ESFTs (9.44 vs. 6.07, p=0.24), the SUV2s were greater in the patients with OSs than ESFTs (4.55 vs. 1.66, p=0.01). The ratios of SUV2-to-SUV1 (SUV2 : SUV1) were 0.65 and 0.35 for OS and ESFT, respectively (p=0.08). All of the patients with ESFTs and 47% of the patients with OS had a favorable histologic response to chemotherapy. The SUV2 : 1 [(SUV1-SUV2)/SUV1]> or =0.5 and SUV2< or =2.5 were related to favorable histologic responses to chemotherapy; the sensitivity and specificity of SUV2 : 1 at 0.5 and SUV2 at 2.5 were 93% and 88%, and 88% and 78%, respectively.
CONCLUSION
FDG-PET can be used as a non-invasive surrogate to predict response to chemotherapy in children with bone tumors.

Keyword

Pediatrics; Bone neoplasm; Positron-emission tomography; Chemotherapy

MeSH Terms

Bone Neoplasms
Child
Humans
Osteosarcoma
Pediatrics
Positron-Emission Tomography
Sarcoma, Ewing
Sensitivity and Specificity

Figure

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  Fig. 1 Magnetic resonance imaging (MRI) and [F-18]-fluorodeoxy-D-glucose-positron emission tomography (FDG-PET) findings before and after chemotherapy in children with bone tumors. (A) A 10-year-old boy with an osteosarcoma of the right proximal tibia. Standard uptake value (SUV) markedly decreased after chemotherapy (27.4 to 1.9) and the tumor showed a favorable histologic response (95% necrosis). (B) A 10-year-old girl with Ewing sarcoma family of tumors (ESFT) of the left proximal femur showed a complete histologic response (100% necrosis) to chemotherapy. SUV1 and SUV2 values were 5.9 and 1.6, respectively. CT, computed tomography.

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  Fig. 2 Histologic response and SUV2, SUV2 : 1, SUV2≤2.5, and SUV2:1≥0.5 were related to a favorable histologic response to chemotherapy. SUV, standard uptake value; SUV2 : 1, decreased SUV ratio, i.e., (SUV1-SUV2)/SUV1.

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