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PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005

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  1. PET after Chemotherapy in RhabdomyosarcomaConnective Tissue Oncology SocietyNovember 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko Schoder, Paul A. Meyers, Suzanne L. Wolden Memorial Sloan-Kettering Cancer Center

  2. Background • Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood. • Staging system is clinical and radiographic. • PET for initial staging • Identify involved LN, distant metastases • Determine involvement of CT/MRI equivocal sites

  3. PET at Diagnosis Chest wall embryonal RMS (SUV 5.1) Supraclavicular LN (SUV 2.8)

  4. Hypothesis • Initial treatment will result in a decreased SUV at the primary site of disease • Study design- retrospective review of RMS patients who had PET scans at diagnosis and after receiving initial therapy

  5. Methods • PET scans performed on • Biograph PET/CT scanner (Siemens) • Discovery LS PET/CT scanner (General Electric) • GE ADVANCE PET scanner (General Electric) • SUV at primary, regional, distant sites, and areas of clinical suspicion • Scans obtained 1 hour after iv 18F-FDG

  6. Patient Characteristics • All patients with RMS treated at MSKCC from 2/02 till 12/04 were reviewed • 20 had PET at the time of diagnosis and after receiving chemotherapy • 11 patients had PET prior to any chemo • 9 patients within first cycle of chemotherapy (13 days)

  7. Patient Characteristics • 13 females, 7 males • Median age 12.3 years (range 2-38 years) • 10 embryonal, 10 alveolar • Stage • Stage II: 1 • Stage III: 14 • Stage IV: 5 • Group • Group 3: 15 • Group 4: 5

  8. Primary Site

  9. Treatment Prior to PET • All patients received 2-8 cycles of chemotherapy prior to follow up PET • 5 patients completed radiation prior to PET

  10. Rapid Response of PET to Chemotherapy

  11. Rapid Response of PET to Chemotherapy

  12. Initial SUV *p=0.006

  13. Results • First follow up PET • median of 2.8 months after chemotherapy (1.3-7.3m) • median of 4 cycles of chemotherapy • 18 patients had a decrease in SUV • Median decrease 3.7, range (0.2-11.7)

  14. Results • 12 patients with normal PET by first follow up • 3 had completed radiation • 18 had eventual normalization of PET • No correlation of early normalization of PET with • primary site of disease, histology, stage, group • gender, age at diagnosis • SUV at diagnosis

  15. Time to Normalization

  16. Pathologic correlation

  17. Response on PET 3 year old boy with alveolar RMS in the gluteal and pelvic regions

  18. Response on PET Irinotecan/ Carboplatin 3 year old boy with alveolar RMS in the gluteal and pelvic regions

  19. Response on PET 14 year old female with an alveolar paranasal RMS

  20. Response on PET Irinotecan/ Carboplatin 14 year old female with an alveolar paranasal RMS

  21. Conclusions • PET has potential utility in monitoring response to treatment. • SUV at primary site is higher when initial PET is prior to therapy. PET should be performed prior to chemotherapy when possible. • A decrease in SUV was seen with therapy. • Most patients had normalization by first follow up PET. • Normalization of PET correlated with pathologic response to therapy. • Further work is needed to assess if response on PET can be used to guide therapy and predict response in RMS.

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