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[18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial
Jeremie Calais
University of California Los Angeles
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8839-4379
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at EJNMMI Research.
Introduction: This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [18F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX).
Methods: Bone or soft tissue sarcoma patients with i) baseline [18F]FDG PET/CT within four weeks prior to the start of neo-CTX (PET1), ii) early interim [18F]FDG PET/CT (six weeks after the start of neo-CTX (PET2), iii) evaluation of neo-CTX response by histology or MRI, and iv) definitive therapy after neo-CTX (surgery or radiation) were included. Semi-quantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [18F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a sub-population of patients with bone involvement only.
Results: Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had Osteosarcoma, 13/34 (38%) Ewing Sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16-84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p <0.02). ΔMTV was associated with tissue response to neo-CTX (p=0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS.
Conclusion: [18F]FDG PET/CT performed six weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.
Keywords
[18F]FDG; PET/CT, sarcoma, neoadjuvant chemotherapy, therapy response, pediatrics
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On 15 Oct, 2020
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On 23 Sep, 2020
Editor assigned
On 22 Sep, 2020
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Reviewer #1 agreed
On 22 Sep, 2020
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On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
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Editorial decision: Major Revision
On 17 Aug, 2020
Review #2 received
Received 16 Aug, 2020
Review #1 received
Received 02 Aug, 2020
Reviewer #2 agreed
On 27 Jul, 2020
Reviewer #1 agreed
On 23 Jul, 2020
Reviewers invited
Invitations sent on 11 Jul, 2020
Editor assigned
On 10 Jul, 2020
Editor invited
On 09 Jul, 2020
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On 23 Jun, 2020
First submitted
On 22 Jun, 2020
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Subject Areas
Clinical Pharmacology
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This preprint is under consideration at EJNMMI Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original research
[18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial
Jeremie Calais
University of California Los Angeles
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8839-4379
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 23 Sep, 2020
Published
On 15 Oct, 2020
No community comments so far
Reviewer #2 agreed
On 23 Sep, 2020
Review #2 received
Received 23 Sep, 2020
Review #1 received
Received 23 Sep, 2020
Editorial decision: Accept
On 23 Sep, 2020
Editor assigned
On 22 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
Reviewer #1 agreed
On 22 Sep, 2020
Submission checks complete
On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
No comments provided
Editorial decision: Major Revision
On 17 Aug, 2020
Review #2 received
Received 16 Aug, 2020
Review #1 received
Received 02 Aug, 2020
Reviewer #2 agreed
On 27 Jul, 2020
Reviewer #1 agreed
On 23 Jul, 2020
Reviewers invited
Invitations sent on 11 Jul, 2020
Editor assigned
On 10 Jul, 2020
Editor invited
On 09 Jul, 2020
Submission checks complete
On 23 Jun, 2020
First submitted
On 22 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Clinical Pharmacology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at EJNMMI Research.
Introduction: This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [18F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX).
Methods: Bone or soft tissue sarcoma patients with i) baseline [18F]FDG PET/CT within four weeks prior to the start of neo-CTX (PET1), ii) early interim [18F]FDG PET/CT (six weeks after the start of neo-CTX (PET2), iii) evaluation of neo-CTX response by histology or MRI, and iv) definitive therapy after neo-CTX (surgery or radiation) were included. Semi-quantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [18F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a sub-population of patients with bone involvement only.
Results: Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had Osteosarcoma, 13/34 (38%) Ewing Sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16-84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p <0.02). ΔMTV was associated with tissue response to neo-CTX (p=0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS.
Conclusion: [18F]FDG PET/CT performed six weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.
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Figure 2
Figure 3
Figure 4
Figure 5
Figure 6