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PET Scan Markers for Survival in Patients with Soft Tissue Sarcomas . Joseph King, Eileen Crawford, Abass Alavi, Arthur Staddon, Lee Hartner, Richard Lackman and Christian Ogilvie. Background. Soft tissue sarcomas (STS) are a heterogeneous group of malignant tumors

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pet scan markers for survival in patients with soft tissue sarcomas
PET Scan Markers for Survival in Patients with Soft Tissue Sarcomas

Joseph King, Eileen Crawford, Abass Alavi,

Arthur Staddon, Lee Hartner, Richard Lackman

and Christian Ogilvie

University of Pennsylvania Department of Orthopaedic Surgery

background
Background
  • Soft tissue sarcomas (STS) are a heterogeneous group of malignant tumors
  • Prognosis determined by CT, MRI, and biopsy
  • Problems/challenges:
    • Local extent, metastasis, recurrence
    • Diagnosis, grading, monitoring treatment response

University of Pennsylvania Department of Orthopaedic Surgery

background3
Background
  • FDG uptake proportional to growth rate of neoplastic cells
  • PET SUVmax > 6 in sarcomas related to survival and progression1
  • PET has shown promise in predicting survival for lung and breast carcinomas2-4
  • Poor PET response to chemotherapy in STS (< 40% decline in FDG uptake) associated with increased rate of recurrence and death5

1) Eary et al 2002

2) Kramer et al. 2006

3) Chen et al. 2004

4) Schwartz et al. 2005

5) Sheutz et al. 2005

University of Pennsylvania Department of Orthopaedic Surgery

purpose
Purpose
  • Determine predictors of survival based on FDG-PET imaging for patients with soft tissue sarcomas
    • SUVmax
    • Response to chemotherapy
    • PET active lung nodules

University of Pennsylvania Department of Orthopaedic Surgery

hypothesis
Hypothesis
  • Predictors for decreased survival will include:
    • High maximum standard uptake value (SUV)
    • FDG-enhancing lung nodules
    • Poor SUV-based response to chemotherapy

University of Pennsylvania Department of Orthopaedic Surgery

materials and methods
Materials and Methods
  • Study Design: Retrospective review
  • Study Group:
    • Treated with chemotherapy +/- resection
      • High or intermediate grade sarcoma
      • Primary tumor > 5 cm, or metastatic disease
    • PET scans done between 2003-2006
    • 1st PET done before all disease resected
    • Minimum follow-up 6 months
    • 14 patients with pre- and post-chemo PET scans

University of Pennsylvania Department of Orthopaedic Surgery

materials and methods7
Materials and Methods
  • Study Group:
    • 32 patients with STS
    • 14 excluded
      • Bone sarcoma
      • Also had carcinoma
      • No gross disease at time of initial scan
      • Inadequate documented follow up

University of Pennsylvania Department of Orthopaedic Surgery

materials and methods8
Materials and Methods
  • Outcome Measures:

1. Maximum SUV (primary sarcoma or metastasis)

2. Number and location of PET detected metastatic lesions

3. SUV-based response to chemotherapy

      • Response: ≥ 40% decrease in SUV in over ½ of lesions
      • Stability: < 40% decrease in SUV in over ½ of lesions
      • Progression: SUV increase or new lesions

University of Pennsylvania Department of Orthopaedic Surgery

patient characteristics
Diagnosis N

Leiomyosarcoma 10

Synovial sarcoma 7

Liposarcoma 4

Malignant fibrous histiocytoma 4

Sarcoma NOS 2

Rhabdomyosarcoma 1

Myxofibrosarcoma 1

Atrial sarcoma 1

Desmoplastic round cell tumor 1

Extraosseous Ewing sarcoma 1

Mean age = 47 (range 20-74)

13 had mets on presentation

15 developed mets during f/u

Patient Characteristics

Location N

Lower extremity 11

Pelvis 6

Chest 5

Abdomen 5

Upper extremity 4

Back 1

University of Pennsylvania Department of Orthopaedic Surgery

results
Results
  • Mean follow-up = 49 months (range 7-172 months)
  • 10 alive at last f/u  6 with NED, 4 with metastatic disease
  • 5 patients had local recurrence after resection  mean time to LR was 2.4 years

University of Pennsylvania Department of Orthopaedic Surgery

slide11

p=0.76

University of Pennsylvania Department of Orthopaedic Surgery

slide12

p=0.01

p=0.01

University of Pennsylvania Department of Orthopaedic Surgery

slide13

p=0.001

University of Pennsylvania Department of Orthopaedic Surgery

conclusions
Conclusions
  • PET scan markers for decreased survival in patients with high grade STS include:
    • Presence of FDG-enchancing lung nodules
    • SUV-based disease progression during chemotherapy
  • SUVmax ≥ 6 was not a predictor for decreased survival

University of Pennsylvania Department of Orthopaedic Surgery

discussion
Discussion
  • Obtaining pre- and post-treatment PET scans to evaluate treatment response of localized or metastatic STS provides useful prognostic information
  • Maximum SUV was not found to have prognostic significance in this study
    • Lots of metastatic disease: selection bias with under representation of patients with lower histologic grade and better prognosis?

University of Pennsylvania Department of Orthopaedic Surgery

future directions
Future directions
  • Larger prospective studies of response to chemotherapy underway
  • Data on histologic subtypes
    • Liposarcoma: Brenner et al. 2006
    • Rhabdomyosarcoma: Klem et al. 2007
  • Probes other that glucose
    • Hypoxia
    • Apoptosis

University of Pennsylvania Department of Orthopaedic Surgery

thank you
Thank You!

University of Pennsylvania Department of Orthopaedic Surgery