Abstract
BackgroundTo propose a personalized therapeutic approach in osteosarcoma treatment, we assessed whether sequential [18F]FDG PET/CT (PET/CT) could predict the outcome of patients with osteosarcoma of the extremities after one cycle and two cycles of neoadjuvant chemotherapy.MethodsA total of 73 patients with AJCC stage II extremity osteosarcoma treated with 2 cycles of neoadjuvant chemotherapy, surgery, and adjuvant chemotherapy were retrospectively analyzed in this study. All patients underwent PET/CT before (PET0), after 1 cycle (PET1), and after the completion of neoadjuvant chemotherapy (PET2), respectively. Maximum standardized uptake value (SUVmax) (corrected for body weight) and the % changes of SUVmax were calculated, and histological responses were evaluated after surgery. Receiver-operating characteristic (ROC) curve analyses and the Cox proportional hazards models were used to analyze whether imaging and clinicopathologic parameters could predict event-free survival (EFS).ResultsA total of 36 patients (49.3%) exhibited a poor histologic response and 17 patients (23.3%) showed events (metastasis in 15 and local recurrence in 2). SUVmax on PET2 (SUV2), the percentage change of SUVmax between PET0 and PET1 (Δ%SUV01), and between PET0 and PET2 (Δ%SUV02) most accurately predicted events using the ROC curve analysis. SUV2 (relative risk, 8.86; 95% CI, 2.25–34.93), Δ%SUV01 (relative risk, 5.97; 95% CI, 1.47–24.25), and Δ%SUV02 (relative risk, 6.00; 95% CI, 1.16–30.91) were independent predicting factors for EFS with multivariate analysis. Patients with SUV2 over 5.9 or Δ%SUV01 over − 39.8% or Δ%SUV02 over − 54.1% showed worse EFS rates than others (p < 0.05).ConclusionsPET evaluation after 1 cycle of presurgical chemotherapy can predict the clinical outcome of extremity osteosarcoma. [18F]FDG PET, which shows a potential role in the early evaluation of the modification of timing of local control, can be a useful modality for early response monitoring of neoadjuvant chemotherapy.
Highlights
To propose a personalized therapeutic approach in osteosarcoma treatment, we assessed whether sequential [Fluorine 18-fluorodeoxyglucose (18F]FDG) positron emission tomography/computed tomography (PET/CT) (PET/CT) could predict the outcome of patients with osteosarcoma of the extremities after one cycle and two cycles of neoadjuvant chemotherapy
Many groups reported that baseline and post-chemotherapy PET could predict the prognosis of osteosarcoma [5]
The results showed that Maximum standardized uptake value (SUVmax) on PET2 (SUV2), Δ%SUV01, and Δ%SUV02 were independent predicting factors for event-free survival (EFS) (Table 4)
Summary
To propose a personalized therapeutic approach in osteosarcoma treatment, we assessed whether sequential [18F]FDG PET/CT (PET/CT) could predict the outcome of patients with osteosarcoma of the extremities after one cycle and two cycles of neoadjuvant chemotherapy. The survival rate of osteosarcoma remained at around 20% before the 1980s, but the 5year event-free survival (EFS) rate increased to 55–75% after neoadjuvant chemotherapy (NAC), and surgical resection became the standard therapy [1]. According to the National Comprehensive Cancer Network (NCCN) guidelines for bone cancers, all osteosarcoma patients should undergo NAC even in the era of precision medicine [3]. Many groups reported that baseline and post-chemotherapy PET could predict the prognosis of osteosarcoma [5]. It is important to determine at which time point during treatment should [18F]FDG PET be used for the best optimal prognosis
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