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[18F]FDG PET/CT quantitative parameters for the prediction of histological response to induction chemotherapy and clinical outcome in patients with localised bone and soft-tissue Ewing sarcoma

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

The application of [18F]FDG PET/CT in predicting histologic response to induction chemotherapy in patients with Ewing sarcoma (EWS) has been proposed using the values of pre-post treatment SUVmax as a referral parameter, although with heterogeneous results. The aim of this retrospective study was to evaluate the diagnostic accuracy of [18F]FDG PET/CT volumetric parameters (metabolic tumour volume (MTV) and total lesion glycolysis (TLG)) as compared to SUVmax to predict response to chemotherapy and clinical outcome in patients with localised EWS of bone and soft-tissue.

Methods

Twenty-eight patients with non-metastatic EWS of bone (n = 20) and soft tissues (n = 8) who underwent a [18F]FDG PET/CT scan before (PET1) and after induction chemotherapy (PET2) were enclosed in the analysis. Values of PET metrics (SUVmax, MTV, TLG) at diagnosis and after neoadjuvant chemotherapy as well as the percentage change between PET1 and PET2 (ΔSUV, ΔMTV and ΔTLG) were correlated to histological response and to progression-free survival (PFS).

Results

ΔTLG (cut-off: -60%) is the best predictor for histologic response with 100% sensitivity and 77.8% specificity. MTV1 > 33.4 cm3 and TLG1 > 112 were also associated with a favourable histologic response (sensitivity 80% and specificity 77.8% for both). On multivariate analysis, SUV2 (> 3.3) and ΔTLG (< -18%) were independent predictors of worse PFS.

Conclusions

[18F]FDG PET/CT could accurately predict histologic response to neoadjuvant chemotherapy in patients with EWS, also showing a possible prognostic value for future disease relapse.

Key Points

• The variation of the PET parameter tumour lesion glycolysis (TLG) can predict the histologic response to induction chemotherapy (sensitivity 100%, specificity 77.8%), in patients with Ewing sarcoma.

• The percentage variation of TLG and the value of the SUVmax at PET scan after chemotherapy show a prognostic role for future disease relapse. The combination of both the parameters identifies three prognostic classes of patients with low, intermediate and high risk of disease relapse.

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Abbreviations

[18F]FDG PET/CT:

[18F]Fluorodeoxyglucose positron emission/computed tomography

EWS:

Ewing sarcoma

FDG:

Fluorodeoxyglucose

MTV:

Metabolic tumour volume

TLG:

Total lesion glycolysis

ΔMTV:

Percentage variation of metabolic tumour volume

ΔTLG:

Percentage variation of total lesion glycolysis

ΔTV:

Percentage variation of tumour volume

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Acknowledgements

The authors wish to thank Miss Elisa Checcucci and Miss Wioletta Falthyn, respectively, Data Manager and Case Manager of the Disease Management Team (DMT) of bone and soft tissue sarcomas at our Institution, for their invaluable collaboration on patient management and data collection.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Nuclear Medicine Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy

    Alessio Annovazzi & Rosa Sciuto

  2. First Division of Medical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy

    Virginia Ferraresi & Sabrina Vari

  3. Sarcomas and Rare Tumors Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy

    Virginia Ferraresi

  4. Radiology and Diagnostic Imaging Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy

    Vincenzo Anelli

  5. Department of Pathology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy

    Renato Covello

  6. Oncological Orthopaedics Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy

    Carmine Zoccali & Roberto Biagini

Authors
  1. Alessio Annovazzi
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  2. Virginia Ferraresi
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  3. Vincenzo Anelli
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  4. Renato Covello
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  8. Rosa Sciuto
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Corresponding author

Correspondence to Alessio Annovazzi.

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Guarantor

The scientific guarantor of this publication is Dr Alessio Annovazzi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise.

Informed consent

Due to the retrospective design of the study, a formal consent was not required; however, all patients enclosed in the analysis gave permission to use their data in anonymous and aggregate form for research activities, at the time of [18F]FDG PET/CT scan

Ethical approval

The study has been approved by the local institutional ethics committee (prot. no. RS1362/20-2372) and it has been performed in accordance with the ethical standards.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Annovazzi, A., Ferraresi, V., Anelli, V. et al. [18F]FDG PET/CT quantitative parameters for the prediction of histological response to induction chemotherapy and clinical outcome in patients with localised bone and soft-tissue Ewing sarcoma. Eur Radiol 31, 7012–7021 (2021). https://doi.org/10.1007/s00330-021-07841-w

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