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[F-18]-fluorodeoxy-D-glucose–positron emission tomography response is associated with outcome for extremity osteosarcoma in children and young adults

  1. Douglas S. Hawkins MD1,†,*,
  2. Ernest U. Conrad III MD2,
  3. James E. Butrynski MD3,
  4. Scott M. Schuetze MD, PhD4,
  5. Janet F. Eary MD2

Article first published online: 10 JUN 2009

DOI: 10.1002/cncr.24421

Issue

Cancer

Cancer

Volume 115, Issue 15, pages 3519–3525, 1 August 2009

Additional Information

How to Cite

Hawkins, D. S., Conrad, E. U., Butrynski, J. E., Schuetze, S. M. and Eary, J. F. (2009), [F-18]-fluorodeoxy-D-glucose–positron emission tomography response is associated with outcome for extremity osteosarcoma in children and young adults. Cancer, 115: 3519–3525. doi: 10.1002/cncr.24421

Author Information

  1. 1

    Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington

  2. 2

    Departments of Orthopedics and Radiology, University of Washington Medical Center, Seattle, Washington

  3. 3

    Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

  4. 4

    Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan

  1. †

    Fax: (206) 987-3946

*Seattle Children's Hospital, 4800 Sandpoint Way, Mailstop: B-6553, Seattle, WA 98105-0371

Publication History

  1. Issue published online: 20 JUL 2009
  2. Article first published online: 10 JUN 2009
  3. Manuscript Accepted: 16 JAN 2009
  4. Manuscript Revised: 18 DEC 2008
  5. Manuscript Received: 27 OCT 2008

Funded by

  • National Institutes of Health/National Cancer Institute. Grant Numbers: CA87721, CA65537

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Keywords:

  • osteosarcoma;
  • fluorodeoxyglucose positron emission tomography;
  • outcome

Forty patients with extremity osteosarcoma underwent [F-18]-fluorodeoxy-D-glucose–positron emission tomography (FDG-PET) imaging before and after neoadjuvant chemotherapy. The FDG-PET standard uptake value after chemotherapy was associated with progression-free survival.

Abstract

BACKGROUND:

Response to neoadjuvant chemotherapy is 1 of the most powerful prognostic factors for extremity osteosarcoma. [F-18]-fluorodeoxy-D-glucose–positron emission tomography (FDG-PET) is a noninvasive imaging modality that is used to predict histopathologic response. To determine the prognostic value of FDG-PET response for progression-free survival (PFS) in osteosarcoma, the authors of this report reviewed the University of Washington Medical Center experience.

METHODS:

Forty patients with extremity osteosarcoma were evaluated by FDG-PET. All patients received neoadjuvant and adjuvant chemotherapy. FDG-PET standard uptake values (SUVs) before neoadjuvant chemotherapy (SUV1) and after neoadjuvant chemotherapy (SUV2) were analyzed and correlated with histopathologic response.

RESULTS:

The median SUV1 was 6.8 (range, 3.0-24.1), the median SUV2 was 2.3 (range, 1.2-12.8), and the median SUV2 to SUV1 ratio (SUV2:1), was 0.36 (range, 0.12-1.10). A good FDG-PET response was defined as anSUV2 <2.5 or an SUV2:1 ≤0.5. FDG-PET responses according to SUV2 and SUV2:1 were concordant with histologic response in 58% and 68% of patients, respectively. SUV2 was associated with outcome (4-year PFS, 73% for SUV2 <2.5 vs 39% for SUV2 ≥2.5; P = .021). Both the initial disease stage and the histologic response were associated with outcome.

CONCLUSIONS:

FDG-PET imaging of extremity osteosarcoma was correlated only partially with a histologic response to neoadjuvant chemotherapy. An SUV2 <2.5 was associated with improved PFS. Future prospective studies are warranted to determine whether FDG-PET imaging may be used as a predictor of outcome independent of initial disease stage. Cancer 2009. © 2009 American Cancer Society.

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