Abstract
AimThe aim of this retrospective study was to determine whether glucose metabolism assessed by using Fluorine-18 (F-18) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) provides prognostic information independent of established prognostic factors in patients with Ewing sarcoma.MethodsWe retrospectively reviewed the medical records of 34 patients (men, 19; women, 15; mean age, 14.5 ± 9.7 years) with pathologically proven Ewing sarcoma. They had undergone F-18 FDG PET/CT as part of a pretreatment workup between September 2006 and April 2012. In this analysis, patients were classified by age, sex, initial location, size, and maximum standardized uptake value (SUVmax). The relationship between FDG uptake and survival was analyzed using the Kaplan-Meier method with the log-rank test and Cox’s proportional hazards regression model.ResultsThe median survival time for all 34 subjects was 999 days and the median SUV by using PET/CT was 5.8 (range, 2–18.1). Patients with a SUVmax ≤ 5.8 survived significantly longer than those with a SUVmax > 5.8 (median survival time, 1265 vs. 656 days; p = 0.002). Survival was also found to be significantly related to age (p = 0.024), size (p = 0.03), and initial tumor location (p = 0.036). Multivariate analysis revealed that a higher SUVmax (p = 0.003; confidence interval [CI], 3.63–508.26; hazard ratio [HR], 42.98), older age (p = 0.023; CI, 1.34–54.80; HR, 8.59), and higher stage (p = 0.03; CI, 1.21–43.95; HR, 7.3) were associated with worse overall survival.ConclusionsSUVmax measured by pretreatment F-18-FDG PET/CT can predict overall survival in patients with Ewing sarcoma.
Highlights
IntroductionOwing to the use of multimodal therapy in the form of chemotherapy and surgery, with or without radiotherapy, survival has improved to 60–70% [2]
Ewing sarcoma is the second most common primary bone tumor [1]
We retrospectively reviewed the medical records of 34 patients with pathologically proven Ewing sarcoma
Summary
Owing to the use of multimodal therapy in the form of chemotherapy and surgery, with or without radiotherapy, survival has improved to 60–70% [2]. 30–40% of patients will develop local and/or distant recurrent disease typically between 2 and 10 years after diagnosis [3]. Survival of patients with this malignancy is related to the presence of metastatic disease, tumor size and histologic response after chemotherapy [4,5]. Because Ewing sarcoma is an aggressive bone or soft tissue malignancy which usually metastasizes to the lungs or bone marrow [6,7], an extensive workup is important to define the tumor stage accurately including lymph node involvement and the presence of distant metastases. Subgroups of patients that may benefit from aggressive therapy (surgery, chemotherapy, and radiotherapy) should be accurately identified. Prognostic factors that permit the identification of patients likely to benefit from treatment are clinically relevant
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