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Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential 18 F-FDG PET/CT and MRI

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We evaluated the potential of sequential fluorine-18 fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET)/computed tomography (CT) and MRI (PET/MRI) after one cycle of neoadjuvant chemotherapy to predict a poor histologic response in osteosarcoma.

Methods

A prospective study was conducted on 30 patients with osteosarcoma treated with two cycles of neoadjuvant chemotherapy and surgery. All patients underwent PET/MRI before, after one cycle, and after the completion of neoadjuvant chemotherapy, respectively. Imaging parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor volume based on magnetic resonance (MR) images (MRV)] and their % changes were calculated on each PET/MRI data set, and histological responses were evaluated on the postsurgical specimen.

Results

A total of 17 patients (57 %) exhibited a poor histologic response after two cycles of chemotherapy. Unlike the little volumetric change in MRI, PET parameters significantly decreased after one and two cycles of chemotherapy, respectively. After one cycle of chemotherapy, SUVmax, MTV, and TLG predicted the poor responders. Among these parameters, either MTV ≥ 47 mL or TLG ≥ 190 g after one cycle of chemotherapy was significantly associated with a poor histologic response on multivariate logistic regression analysis (OR 8.98, p = 0.039). The sensitivity, specificity, and accuracy of these parameters were 71 %, 85 % and 77 %; and 71 %, 85 % and 77 %, respectively.

Conclusion

The histologic response to neoadjuvant chemotherapy in osteosarcoma can be predicted accurately by FDG PET after one course of chemotherapy. Among PET parameters, MTV and TLG were independent predictors of the histologic response.

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Acknowledgments

This work was supported by Establishment of Center for PET Application Technology Development, Korea Institute of Radiological and Medical Sciences (KIRAMS), and by grants from the Ministry of Education, Science and Technology (50441-2014).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Departments of Nuclear Medicine, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea

    Byung Hyun Byun, Ilhan Lim, Byung Il Kim, Chang Woon Choi & Sang Moo Lim

  2. Orthopedic Surgery, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea

    Chang-Bae Kong, Won Seok Song, Wan Hyeong Cho, Dae-Geun Jeon & Soo-Yong Lee

  3. Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea

    Jae-Soo Koh

  4. Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul, 139-706, Korea

    Sang Moo Lim

  5. Department of Orthopedic Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul, 139-706, Korea

    Chang-Bae Kong

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  1. Byung Hyun Byun
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  2. Chang-Bae Kong
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  3. Ilhan Lim
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  4. Byung Il Kim
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  6. Won Seok Song
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  9. Jae-Soo Koh
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  10. Soo-Yong Lee
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Correspondence to Chang-Bae Kong or Sang Moo Lim.

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Byun, B.H., Kong, CB., Lim, I. et al. Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential 18 F-FDG PET/CT and MRI. Eur J Nucl Med Mol Imaging 41, 1553–1562 (2014). https://doi.org/10.1007/s00259-014-2746-2

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  • DOI: https://doi.org/10.1007/s00259-014-2746-2

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