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ROLE OF FDG PET/CT IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY

ROLE OF FDG PET/CT IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY. Emanuela Palmerini Chemotherapy, Musculoskeletal Oncology Department Istituto Ortopedico Rizzoli, Bologna, Italy. Bone Tumors and PET Clinical Trial –Preliminary data.

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ROLE OF FDG PET/CT IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY

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  1. ROLE OF FDG PET/CT IN PATIENTS TREATED WITH NEOADJUVANT CHEMOTHERAPY Emanuela PalmeriniChemotherapy, Musculoskeletal Oncology Department Istituto Ortopedico Rizzoli, Bologna, Italy

  2. Bone Tumors and PETClinical Trial –Preliminary data E. Palmerini, C. Nanni, A. Paioli, E. Staals, S. Fanti, M. Alberghini, P. Picci, P. Ruggieri, S. Ferrari ISTITUTO ORTOPEDICO RIZZOLI Musculoskeletal Oncology Department OSPEDALE SANT’ ORSOLA Nuclear Medecine

  3. Possible Benefits of PET/CT in Bone Sarcoma Management • Staging: Detect metastatic disease at diagnosis • Detect local and distant relapses • Determine tumor responsiveness to neo-adjuvant chemotherapy

  4. Bone Tumors and PET Patients and methods • Prospective analysis • Histology: Ewing’s Sarcoma Osteosarcoma • Stage: localized disease • Age <40 (All pts in protocol) • Study period: April 2010-Mar 2012

  5. Study Design Induction Consolidation PET/CT PET/CT Same Drugs C S C C C C Poor Responders Different Drugs d Good Responders = 1 cycle of chemotherapy C

  6. Study Design Induction Consolidation PET/CT PET/CT SUV1 SUV2 Same Drugs C S C C C C Poor Responders Different Drugs d Good Responders = 1 cycle of chemotherapy C

  7. Bone Tumors and PET Histologic Response Ewing’s Sarcoma Osteosarcoma Chemoinduced necrosis Chemoinduced necrosis Grade I Grade II Grade III 0% 90% 100% POOR GOOD = MACRO FOCI = MICRO FOCI = NO VIABLE CELLS POOR GOOD

  8. 10-1991 12-1991 Ewing sarcoma. In case of no surgery: radiological evaluation Poor response

  9. Bone Tumors and PET 50 patients 50 Patients Histology • Osteosarcoma n = 22 • Ewing Sarcoma n = 28 All with localized disease

  10. Bone Tumors and PET 50 Patients Median age: 17 yrs (3-37) No. pts Age

  11. 76% Histologic Response 24% Radiologic Response Bone Tumors and PET Surgery

  12. Bone Tumors and PET Radiologic and Histologic Responses

  13. Bone Tumors and PET Metabolic Responses Median SUV1 = 6.3 Median SUV2 = 2.9 P = 0.0002

  14. Bone Tumors and PET OSTEO VS EWING • Osteosarcoma: 22 cases • Median SUV1: 6.5 (range 0-20) • Ewing Sarcoma: 28 cases • Median SUV1: 6.2 (range 0-17) P = 0.70

  15. SUV1 * Males with higher SUV1

  16. Bone Tumors and PET Response and SUV SUV1 SUV2 P = 0.02 P = 0.21 Cut-off 5 Cut-off 3

  17. Bone Tumors and PET SUV2 P = 0.70

  18. Bone Tumors and PET Response and SUV 1 EWING OSTEO P = 0.056 P = 0.21 Cut-off 5 Cut-off 3

  19. Bone Tumors and PET Response and SUV2 EWING OSTEO P = 0.27 P = 0.96 Cut-off 5 Cut-off 3

  20. Osteosarcoma 95% necrosis Female, 16 yo, tibia

  21. Ewing Male, 19 yo, femur November 2011 February 2012

  22. Ewing POOR necrosis Male, 19 yo, femur November 2011 February 2012

  23. Bone Tumors and PET Preliminary Indications 1 – No differences in SUV1 between OS and EW 2 – Pre-op chemo greatly decreases the metabolic activity of OS and EW 3 – Pts with high SUV1 seem to have lower probability to achieve a good response 4 – SUV2 in this series do not correlate with response 5 – The correlation seems to be stronger in EW than in OS (different extracellular matrix, and reparative processes)

  24. Bone Tumors and PET Further studies 1 – Explore the differences between OS and EW 2 – Investigate correlations with other prognostic factors (i.e. size, site, age, molecular markers, etc.) 3 – Correlations with disease free survival Final aim PET basal activity surrogate biomarker for tumor resistance To use PET to stratify patients and anticipate treatment modifications before surgery

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