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Abstract
Purpose
Various diagnostic imaging modalities have been used to evaluate the effect of neoadjuvant chemotherapy for osteosarcoma early and noninvasively. We evaluated the effectiveness of imaging studies of plain radiographs and positron-emission tomography/computed tomography (PET/CT) in predicting neoadjuvant chemotherapy effect for osteosarcoma and tried to establish a general principle in interpretation of PET/CT parameters.
Materials and Methods
Eighteen patients who underwent two cycles of neoadjuvant chemotherapy and surgical excision for osteosarcoma were enrolled. There were 13 males and 5 females, with a median age of 19 (11−63) years. Fifteen patients of 18 had the American Joint Committe on Cancer (AJCC) stage IIB. They had plain radiographs and PET/CT before and after neoadjuvant chemotherapy. The resected tumor specimens were pathologically examined to determine histological response grade using a conventional mapping method. Statistical analysis was performed to evaluate the correlation between histopathological necrosis rate, and radiographic finding category, post-chemotherapy maximum standardized uptake value (SUVmax), average standardized uptake value and metabolic tumor volume (MTV) as well as reduction rates of them.
Results
Eight patients were good responders to neoadjuvant chemotherapy based on histological evaluation. Median SUVmax reduction rate was 73 (23−77) % in good responders and 42 (−32−76) % in poor responders. Median MTV reduction rate was 93.5 (62−99) % in good responders and 46 (−81−100) % in poor responders. While radiographic finding category was not different according to histological response (p=1.0), SUVmax reduction rate was significantly different (p=0.041). Difference in MTV reduction rates approached statistical significance as well (p=0.071).
Conclusion
While radiographic finding category was not reliable to assess neoadjuvant chemotherapy effect for osteosarcoma, reduction rate of SUVmax was a useful indicator in this study. As parameters of PET/CT can be influenced by various factors of settings, different centers have to make an effort to establish their own standard of judgement with reference of previous studies.
References
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Figure 1.
A 13 year-old male patient. While (D) a plain radiograph and (E) an magnetic resonance imaging (MRI) after chemotherapy show marked increase in tumor size compared to (A) a plain radiograph and (B) an MRI after chemotherapy, (F) a post-chemotherapy 18F-Fluoro-2-deoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) image damonstrated decrease in 18F-FDG uptake compared to (C) a pre-chemotherapy PET/CT image. Maximum standardized uptake value decreased from 11.8 to 3.0 by 75% and the patient was identified as a good responder based on histological examination.
Table 1.
Patient Characteristics, Histological Response, Radiographic Finding Category, and Values of PET/CT
Table 2.
Correlation between Histological Response and Evaluation Parameters
| GR | PR | p-value | |
|---|---|---|---|
| Radiographic finding category G: NG | 4: 3 | 5: 6 | 1.0 |
| Post-chemotherapy SUVmax Median (range) | 4.1 (3−6.6) | 5 (2.5−9.8) | 0.375 |
| SUVmax reduction (%) Median (range) | 74 (23−77) | 42 (−32−76) | 0.041* |
| Post-chemotherapy SUVavg Median (range) | 2.95 (2.7−3.1) | 3.1 (2.5−3.7) | 0.216 |
| SUVavg reduction (%) Median (range) | 30 (24−47) | 28 (−9−50) | 0.286 |
| Post-chemotherapy MTV (cm3) Median (range) | 9.8 (1.1−20.3) | 27.8 (0−177.0) | 0.098 |
| MTV reduction (%) Median (range) | 93.5 (62−99) | 46 (−81−100) | 0.071 |
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