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Kanthawang T, Wudhikulprapan W, Phinyo P, Settakorn J, Pruksakorn D, Link TM, Pattamapaspong N. Can conventional magnetic resonance imaging at presentation predict chemoresistance in osteosarcoma? Br J Radiol 2024; 97:451-461. [PMID: 38308035 DOI: 10.1093/bjr/tqad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/03/2023] [Accepted: 11/25/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES Histological tumour necrosis is the current indicator for the response of osteosarcoma after neoadjuvant chemotherapy. Chemoresistant tumours require close monitoring and adjustment of treatment. Characteristics of tumours on baseline MRI may be able to predict response to chemotherapy. The aim is to identify which baseline MRI findings can help predict chemoresistant osteosarcoma. METHODS Baseline MRI before giving neoadjuvant chemotherapy of 95 patients during 2008-2021 was reviewed by 2 musculoskeletal radiologists. Histological necrosis from surgical specimens was the reference standard. MRIs were reviewed for tumour characteristics (tumour volume, maximum axial diameter, central necrosis, haemorrhage, fluid-fluid level), peritumoural bone and soft tissue oedema, and other parameters including intra-articular extension, epiphyseal involvement, neurovascular involvement, pathologic fracture, and skip metastasis. The cut-off thresholds were generated by receiver operating characteristic curves which then tested for diagnostic accuracy. RESULTS Two-third of patients were chemoresistance (histological necrosis <90%). Tumour volume >150 mL, maximum axial diameter >7.0 cm, area of necrosis >50%, presence of intra-articular extension, and peritumoural soft tissue oedema >6.5 cm significantly predicted chemoresistance, particularly when found in combination. Tumour volume >150 mL and maximum axial diameter >7.0 cm could be used as an independent predictor (multivariable analysis, P-value = .025, .045). CONCLUSIONS Findings on baseline MRI could help predicting chemoresistant osteosarcoma with tumour size being the strongest predictor. ADVANCES IN KNOWLEDGE Osteosarcomas with large size, large cross-sectional diameter, large area of necrosis, presence of intra-articular extension, and extensive peritumoural soft tissue oedema were most likely to have a poor response to neoadjuvant chemotherapy.
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Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wanat Wudhikulprapan
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jongkolnee Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Dumnoensun Pruksakorn
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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2
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Kalisvaart GM, Van Den Berghe T, Grootjans W, Lejoly M, Huysse WCJ, Bovée JVMG, Creytens D, Gelderblom H, Speetjens FM, Lapeire L, van de Sande MAJ, Sys G, de Geus-Oei LF, Verstraete KL, Bloem JL. Evaluation of response to neoadjuvant chemotherapy in osteosarcoma using dynamic contrast-enhanced MRI: development and external validation of a model. Skeletal Radiol 2024; 53:319-328. [PMID: 37464020 PMCID: PMC10730632 DOI: 10.1007/s00256-023-04402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To identify which dynamic contrast-enhanced (DCE-)MRI features best predict histological response to neoadjuvant chemotherapy in patients with an osteosarcoma. METHODS Patients with osteosarcoma who underwent DCE-MRI before and after neoadjuvant chemotherapy prior to resection were retrospectively included at two different centers. Data from the center with the larger cohort (training cohort) was used to identify which method for region-of-interest selection (whole slab or focal area method) and which change in DCE-MRI features (time to enhancement, wash-in rate, maximum relative enhancement and area under the curve) gave the most accurate prediction of histological response. Models were created using logistic regression and cross-validated. The most accurate model was then externally validated using data from the other center (test cohort). RESULTS Fifty-five (27 poor response) and 30 (19 poor response) patients were included in training and test cohorts, respectively. Intraclass correlation coefficient of relative DCE-MRI features ranged 0.81-0.97 with the whole slab and 0.57-0.85 with the focal area segmentation method. Poor histological response was best predicted with the whole slab segmentation method using a single feature threshold, relative wash-in rate <2.3. Mean accuracy was 0.85 (95%CI: 0.75-0.95), and area under the receiver operating characteristic curve (AUC-index) was 0.93 (95%CI: 0.86-1.00). In external validation, accuracy and AUC-index were 0.80 and 0.80. CONCLUSION In this study, a relative wash-in rate of <2.3 determined with the whole slab segmentation method predicted histological response to neoadjuvant chemotherapy in osteosarcoma. Consistent performance was observed in an external test cohort.
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Affiliation(s)
- Gijsbert M Kalisvaart
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
| | - Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Willem Grootjans
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Maryse Lejoly
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Wouter C J Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Frank M Speetjens
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Michiel A J van de Sande
- Department of Orthopedics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Gwen Sys
- Department of Orthopedics, Ghent University Hospital, Ghent, Belgium
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Koenraad L Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Johan L Bloem
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
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3
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Luo Z, Li J, Liao Y, Huang W, Li Y, Shen X. Prediction of response to preoperative neoadjuvant chemotherapy in extremity high-grade osteosarcoma using X-ray and multiparametric MRI radiomics. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023; 31:611-626. [PMID: 37005907 DOI: 10.3233/xst-221352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE This study aims to evaluate the value of applying X-ray and magnetic resonance imaging (MRI) models based on radiomics feature to predict response of extremity high-grade osteosarcoma to neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS A retrospective dataset was assembled involving 102 consecutive patients (training dataset, n = 72; validation dataset, n = 30) diagnosed with extremity high-grade osteosarcoma. The clinical features of age, gender, pathological type, lesion location, bone destruction type, size, alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were evaluated. Imaging features were extracted from X-ray and multi-parametric MRI (T1-weighted, T2-weighted, and contrast-enhanced T1-weighted) data. Features were selected using a two-stage process comprising minimal-redundancy-maximum-relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) regression. Logistic regression (LR) modelling was then applied to establish models based on clinical, X-ray, and multi-parametric MRI data, as well as combinations of these datasets. Each model was evaluated using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI). RESULTS AUCs of 5 models using clinical, X-ray radiomics, MRI radiomics, X-ray plus MRI radiomics, and combination of all were 0.760 (95% CI: 0.583-0.937), 0.706 (95% CI: 0.506-0.905), 0.751 (95% CI: 0.572-0.930), 0.796 (95% CI: 0.629-0.963), 0.828 (95% CI: 0.676-0.980), respectively. The DeLong test showed no significant difference between any pair of models (p > 0.05). The combined model yielded higher performance than the clinical and radiomics models as demonstrated by net reclassification improvement (NRI) and integrated difference improvement (IDI) values, respectively. This combined model was also found to be clinically useful in the decision curve analysis (DCA). CONCLUSION Modelling based on combination of clinical and radiomics data improves the ability to predict pathological responses to NAC in extremity high-grade osteosarcoma compared to the models based on either clinical or radiomics data.
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Affiliation(s)
- Zhendong Luo
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jing Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | | | - Wenxiao Huang
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yulin Li
- Department of Radiology, Peking Universtiy Shenzhen Hospital, Shenzhen, China
| | - Xinping Shen
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Li Y, Fu Y, Zhang Z, Wang Z, Yin J, Shen J. Mediating effect assessment of ifosfamide on limb salvage rate in osteosarcoma: A study from a single center in China. Front Oncol 2022; 12:1046199. [DOI: 10.3389/fonc.2022.1046199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Osteosarcoma is one of the most prevalent primary bone malignancies in children and adolescents. Surgery and chemotherapy are the standard treatment methods of osteosarcoma. Methotrexate, adriamycin, and cisplatin, and methotrexate, adriamycin, cisplatin, and ifosfamide regimens are both first-line neoadjuvant chemotherapy regimens for osteosarcoma. Moreover, the use of ifosfamide is highly controversial. Most studies of ifosfamide focused on the overall survival rate and event-free survival rate; few studies concentrated on surgical options. We conducted this retrospective study to compare the baseline characteristic of amputation and limb salvage osteosarcoma patients. Furthermore, we analyzed the direct and indirect roles in surgical decision-making and found that ifosfamide may play a partial mediating role in the surgery option choice by mediating tumor mass volume change, tumor response, and the shortest distance from the center of main blood vessels to the margin of the tumor lesion.
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Xi Y, Ge X, Ji H, Wang L, Duan S, Chen H, Wang M, Hu H, Jiang F, Ding Z. Prediction of Response to Induction Chemotherapy Plus Concurrent Chemoradiotherapy for Nasopharyngeal Carcinoma Based on MRI Radiomics and Delta Radiomics: A Two-Center Retrospective Study. Front Oncol 2022; 12:824509. [PMID: 35530350 PMCID: PMC9074388 DOI: 10.3389/fonc.2022.824509] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective We aimed to establish an MRI radiomics model and a Delta radiomics model to predict tumor retraction after induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) for primary nasopharyngeal carcinoma (NPC) in non-endemic areas and to validate its efficacy. Methods A total of 272 patients (155 in the training set, 66 in the internal validation set, and 51 in the external validation set) with biopsy pathologically confirmed primary NPC who were screened for pretreatment MRI were retrospectively collected. The NPC tumor was delineated as a region of interest in the two sequenced images of MRI before treatment and after IC, followed by radiomics feature extraction. With the use of maximum relevance minimum redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) algorithms, logistic regression was performed to establish pretreatment MRI radiomics and pre- and post-IC Delta radiomics models. The optimal Youden’s index was taken; the receiver operating characteristic (ROC) curve, calibration curve, and decision curve were drawn to evaluate the predictive efficacy of different models. Results Seven optimal feature subsets were selected from the pretreatment MRI radiomics model, and twelve optimal subsets were selected from the Delta radiomics model. The area under the ROC curve, accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the MRI radiomics model were 0.865, 0.827, 0.837, 0.813, 0.776, and 0.865, respectively; the corresponding indicators of the Delta radiomics model were 0.941, 0.883, 0.793, 0.968, 0.833, and 0.958, respectively. Conclusion The pretreatment MRI radiomics model and pre- and post-IC Delta radiomics models could predict the IC-CCRT response of NPC in non-epidemic areas.
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Affiliation(s)
- Yuzhen Xi
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, China
- Department of Radiology, 903rd Hospital of PLA, Hangzhou, China
| | - Xiuhong Ge
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiming Ji
- Department of Radiology, Liangzhu Hospital, Hangzhou, China
| | - Luoyu Wang
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaofeng Duan
- GE Healthcare, Precision Health Institution, Shanghai, China
| | - Haonan Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Mengze Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital Affiliated to Medical College Zhejiang University, Hangzhou, China
| | - Feng Jiang
- Department of Head and Neck Radiotherapy, Zhejiang Cancer Hospital/Zhejiang Province Key Laboratory of Radiation Oncology, Hangzhou, China
- *Correspondence: Feng Jiang, ; Zhongxiang Ding,
| | - Zhongxiang Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Feng Jiang, ; Zhongxiang Ding,
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Nazon C, Pierrevelcin M, Willaume T, Lhermitte B, Weingertner N, Marco AD, Bund L, Vincent F, Bierry G, Gomez-Brouchet A, Redini F, Gaspar N, Dontenwill M, Entz-Werle N. Together Intra-Tumor Hypoxia and Macrophagic Immunity Are Driven Worst Outcome in Pediatric High-Grade Osteosarcomas. Cancers (Basel) 2022; 14:cancers14061482. [PMID: 35326631 PMCID: PMC8945994 DOI: 10.3390/cancers14061482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Radiological and immunohistochemical data were correlated with the outcome in a retrospective monocentric cohort of 30 pediatric osteosarcomas (OTS). A necrotic volume of more than 50 cm3 at diagnosis was significantly linked to a worse overall survival (OS). Regarding immunohistochemical analyses, an overexpression of hypoxic markers, such as HIF-1α and anhydrase carbonic IX (CAIX), was significantly linked to a worse OS, while pS6-RP hyperexpression was correlated with a better survival. We also featured that CD68 positive cells, representative of macrophagic M1 polarization, were mostly associated with HIF-1α and CAIX hyperexpressions and that M2-like polarization, mostly related to CD163 positivity, was correlated to mTor activation. These findings, involving clinical, radiological and biology data, allowed us to hypothesize a dual signature association ready to use routinely in future protocols. Abstract Background: Osteosarcomas (OTS) represent the most common primary bone cancer diagnosed in adolescents and young adults. Despite remarkable advances, there are no objective molecular or imaging markers able to predict an OTS outcome at diagnosis. Focusing on biomarkers contributing broadly to treatment resistance, we examine the interplay between the tumor-associated macrophages and intra-tumor hypoxia. Methods: Radiological and immunohistochemical (IHC) data were correlated with the outcome in a retrospective and monocentric cohort of 30 pediatric OTS. We studied hypoxic (pS6, phospho-mTor, HIF-1α and carbonic anhydrase IX (CAIX)) and macrophagic (CD68 and CD163) biomarkers. Results: The imaging analyses were based on MRI manual volumetric measures on axial post-contrast T1 weighted images, where, for each tumor, we determined the necrotic volume and its ratio to the entire tumor volume. When they were above 50 cm3 and 20%, respectively, they correlated with a worse overall survival (p = 0.0072 and p = 0.0136, respectively) and event-free survival (p = 0.0059 and p = 0.0143, respectively). IHC assessments enable a significant statistical link between HIF-1α/CAIX hyper-expressions, CD68+ cells and a worse outcome, whereas activation of mTor pathway was linked to a better survival rate and CD163+ cells. Conclusions: This study evidenced the links between hypoxia and immunity in OTS, as their poor outcome may be related to a larger necrotic volume on diagnostic MRI and, in biopsies, to a specific IHC profile.
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Affiliation(s)
- Charlotte Nazon
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (C.N.); (F.V.)
| | - Marina Pierrevelcin
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
| | - Thibault Willaume
- Radiology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (T.W.); (G.B.)
| | - Benoît Lhermitte
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
- Pathology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Noelle Weingertner
- Pathology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Antonio Di Marco
- Department of Orthopedic Surgery and Traumatology, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Laurent Bund
- Department of Pediatric Surgery, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Florence Vincent
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (C.N.); (F.V.)
| | - Guillaume Bierry
- Radiology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (T.W.); (G.B.)
| | - Anne Gomez-Brouchet
- Department of Pathology, University Hospital of Toulouse, 1 Avenue Irène Joliot Curie, 31100 Toulouse, France;
| | - Françoise Redini
- INSERM UMR1238, PHY-OS, Bone Sarcomas and Remodeling of Calcified Tissues, Nantes University, 44000 Nantes, France;
| | - Nathalie Gaspar
- Department of Oncology for Children and Adolescents, Gustave Roussy, 94805 Villejuif, France;
- INSERM U1015, Gustave Roussy, University of Paris-Saclay, 94805 Villejuif, France
- University of Paris-Saclay, 91400 Orsay, France
| | - Monique Dontenwill
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
| | - Natacha Entz-Werle
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (C.N.); (F.V.)
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
- Correspondence: ; Tel.: +33-3-88-12-83-96; Fax: +33-3-88-12-80-92
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Lin P, Yang PF, Chen S, Shao YY, Xu L, Wu Y, Teng W, Zhou XZ, Li BH, Luo C, Xu LM, Huang M, Niu TY, Ye ZM. A Delta-radiomics model for preoperative evaluation of Neoadjuvant chemotherapy response in high-grade osteosarcoma. Cancer Imaging 2020; 20:7. [PMID: 31937372 PMCID: PMC6958668 DOI: 10.1186/s40644-019-0283-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background The difficulty of assessment of neoadjuvant chemotherapeutic response preoperatively may hinder personalized-medicine strategies that depend on the results from pathological examination. Methods A total of 191 patients with high-grade osteosarcoma (HOS) were enrolled retrospectively from November 2013 to November 2017 and received neoadjuvant chemotherapy (NCT). A cutoff time of November 2016 was used to divide the training set and validation set. All patients underwent diagnostic CTs before and after chemotherapy. By quantifying the tumor regions on the CT images before and after NCT, 540 delta-radiomic features were calculated. The interclass correlation coefficients for segmentations of inter/intra-observers and feature pair-wise correlation coefficients (Pearson) were used for robust feature selection. A delta-radiomics signature was constructed using the lasso algorithm based on the training set. Radiomics signatures built from single-phase CT were constructed for comparison purpose. A radiomics nomogram was then developed from the multivariate logistic regression model by combining independent clinical factors and the delta-radiomics signature. The prediction performance was assessed using area under the ROC curve (AUC), calibration curves and decision curve analysis (DCA). Results The delta-radiomics signature showed higher AUC than single-CT based radiomics signatures in both training and validation cohorts. The delta-radiomics signature, consisting of 8 selected features, showed significant differences between the pathologic good response (pGR) (necrosis fraction ≥90%) group and the non-pGR (necrosis fraction < 90%) group (P < 0.0001, in both training and validation sets). The delta-radiomics nomogram, which consisted of the delta-radiomics signature and new pulmonary metastasis during chemotherapy showed good calibration and great discrimination capacity with AUC 0.871 (95% CI, 0.804 to 0.923) in the training cohort, and 0.843 (95% CI, 0.718 to 0.927) in the validation cohort. The DCA confirmed the clinical utility of the radiomics model. Conclusion The delta-radiomics nomogram incorporating the radiomics signature and clinical factors in this study could be used for individualized pathologic response evaluation after chemotherapy preoperatively and help tailor appropriate chemotherapy and further treatment plans.
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Affiliation(s)
- Peng Lin
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Peng-Fei Yang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China.,College of Biomedical Engineering &Instrument Science, Zhejiang University, Zhejiang, Hangzhou, China
| | - Shi Chen
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Department of Orthopaedics, Ninghai First Hospital, Ningbo, Zhejiang, 315600, China
| | - You-You Shao
- Department of Pediatrics, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China
| | - Lei Xu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China
| | - Yan Wu
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Wangsiyuan Teng
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Xing-Zhi Zhou
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Bing-Hao Li
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China.,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China
| | - Chen Luo
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China
| | - Lei-Ming Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China
| | - Mi Huang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, 27708, USA
| | - Tian-Ye Niu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Institute of Translational Medicine, Zhejiang University, Zhejiang, Hangzhou, China. .,Nuclear & Radiological Engineering and Medical Physics Programs, Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 770 State Street, Boggs 385, Atlanta, GA, 30332-0745, USA.
| | - Zhao-Ming Ye
- Musculoskeletal Tumor Center, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China. .,Institute of Orthopaedics Research, No.88 Jiefang Road, Hangzhou City, Zhejiang Province, 310009, China.
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Saifuddin A, Sharif B, Gerrand C, Whelan J. The current status of MRI in the pre-operative assessment of intramedullary conventional appendicular osteosarcoma. Skeletal Radiol 2019; 48:503-516. [PMID: 30288560 DOI: 10.1007/s00256-018-3079-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/08/2018] [Accepted: 09/16/2018] [Indexed: 02/08/2023]
Abstract
Osteosarcoma is the commonest primary malignant bone tumour in children and adolescents, the majority of cases being conventional intra-medullary high-grade tumours affecting the appendicular skeleton. Treatment is typically with a combination of neo-adjuvant chemotherapy, tumour resection with limb reconstruction and post-operative chemotherapy. The current article reviews the role of magnetic resonance imaging (MRI) in the pre-operative assessment of high-grade central conventional osteosarcoma.
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Affiliation(s)
- Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ban Sharif
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Craig Gerrand
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Jeremy Whelan
- Medical Oncology, University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK
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9
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Pierce TT, Shailam R, Lozano-Calderon S, Sagar P. Inter-rater Variability in the Interpretation of Pre and Post Contrast MRI for Pre-Surgical Evaluation of Osteosarcoma in Long Bones in Pediatric Patients and Young Adults. Surg Oncol 2019; 28:135-139. [PMID: 30851887 DOI: 10.1016/j.suronc.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/15/2018] [Accepted: 11/24/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES The value of gadolinium enhanced magnetic resonance imaging (MRI) sequences for extremity osteosarcoma resection planning is unverified. We evaluate the performance of intravenous gadolinium enhanced MRI for identification of neurovascular bundle involvement (NBI) and intraarticular extension (IAE) in patients with osteosarcoma. METHODS Two pediatric radiologists independently analyzed MRI examinations of patients with pathology proven extremity osteosarcoma for NBI and IAE. Initial evaluation utilized only non-contrast MRI images (PRE) and, after 2 weeks, subsequent evaluation included both the pre and post contrast images (POST). Cohen's Kappa and McNemar's test were calculated to assess agreement between PRE and POST image interpretations of NBI and IAE. RESULTS 56 patients with 90 preoperative MRI examinations were analyzed. PRE and POST interpretations were rarely discordant; 4/90 cases for NBI (Kappa 0.91) and 2/90 cases for IAE (Kappa 0.95). McNemar's test did not show a difference between PRE and POST imaging (NBI p=0.62; IAE p=0.48). CONCLUSION No significant difference between PRE and POST image interpretation was found. A high level of agreement between PRE and POST image interpretation suggests that pre-contrast MRI may be sufficient for pre-surgical planning for pediatric patients with long bone osteosarcoma.
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Affiliation(s)
- T T Pierce
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street Founders 216, Boston, MA, 02114, USA.
| | - R Shailam
- Massachusetts General Hospital, Department of Radiology, Division of Pediatric Radiology, 34 Fruit Street Ellison 237, Boston, MA, 02114, USA.
| | - S Lozano-Calderon
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street Yawkey Center for Outpatient Care, Suit 3B, Boston, MA, 02114, USA.
| | - P Sagar
- Massachusetts General Hospital, Department of Radiology, Division of Pediatric Radiology, 34 Fruit Street Ellison 237, Boston, MA, 02114, USA.
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10
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He F, Qin L, Bao Q, Zang S, He Q, Qiu S, Shen Y, Zhang W. Pre-Operative chemotherapy response assessed by contrast-enhanced MRI can predict the prognosis of Enneking surgical margins in patients with osteosarcoma. J Orthop Res 2019; 37:258-264. [PMID: 30255519 DOI: 10.1002/jor.24143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/04/2018] [Indexed: 02/04/2023]
Abstract
The method used to evaluate the response of osteosarcoma to preoperative chemotherapy before specimen resection is still unclear. The purpose of this study was to identify factors that contribute to overall survival (OS) and to discuss their roles in making a decision regarding Enneking surgical margins. Patients (109) with pathologically confirmed Enneking stage IIB osteosarcoma were retrospectively analyzed. Univariate and multivariate survival analyses were performed. Patient characteristics and chemotherapy-induced contrast-enhanced MRI changes were considered as potential factors. Changes in the tumor volume and the relative necrosis ratio measured by MRI were independent risk factors predicting the OS of patients who underwent limb-salvage surgery. For those in whom the tumor volume had decreased (VolRatio <1) or the relative necrosis ratio had increased by at least 10% (NecRatioInc ≥0.1), there was no significant difference in OS between Enneking wide and marginal margins. Variables measured by contrast-enhanced MRI could be used to evaluate chemotherapy response and increase the limb-salvage rate. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Fangzhou He
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiyuan Bao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shizhao Zang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin He
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shijing Qiu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan
| | - Yuhui Shen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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11
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Guenther LM, Rowe RG, Acharya PT, Swenson DW, Meyer SC, Clinton CM, Guo D, Sridharan M, London WB, Grier HE, Ecklund K, Janeway KA. Response Evaluation Criteria in Solid Tumors (RECIST) following neoadjuvant chemotherapy in osteosarcoma. Pediatr Blood Cancer 2018; 65. [PMID: 29251406 DOI: 10.1002/pbc.26896] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/28/2017] [Accepted: 10/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND In osteosarcoma, patient survival has not changed in over 30 years. Multiple phase II trials have been conducted in osteosarcoma using the Response Evaluation Criteria in Solid Tumors (RECIST) as a primary endpoint; however, none of these have revealed new treatment strategies. We investigated RECIST in newly diagnosed patients who received neoadjuvant chemotherapy proven to be beneficial. METHODS Patients treated from 1986 to 2011 for newly diagnosed osteosarcoma with paired tumor imaging before and after adequate neoadjuvant chemotherapy were included in this retrospective study. Two radiologists performed independent, blinded (to image timing) RECIST measurements of primary tumor and lung metastases at diagnosis and post-neoadjuvant chemotherapy. Association between RECIST and histological necrosis and outcome were assessed. RESULTS Seventy-four patients met inclusion criteria. Five-year overall survival and progression-free survival (PFS) were 77 ± 7% and 61 ± 8%, respectively. No patients had RECIST partial or complete response in the primary tumor. Sixty-four patients (86%) had stable disease, and 10 (14%) had progressive disease (PD). PD in the primary tumor was associated with significantly worse PFS in localized disease patients (P = 0.02). There was no association between RECIST in the primary tumor and necrosis. There were an insufficient number of patients with lung nodules ≥1 cm at diagnosis to evaluate RECIST in pulmonary metastases. CONCLUSIONS PD by RECIST predicts poor outcome in localized disease patients. In bone lesions, chemotherapy proven to improve overall survival does not result in radiographic responses as measured by RECIST. Further investigation of RECIST in pulmonary metastatic disease in osteosarcoma is needed.
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Affiliation(s)
- Lillian M Guenther
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - R Grant Rowe
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Patricia T Acharya
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Stephanie C Meyer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Catherine M Clinton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Dongjing Guo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Madhumitha Sridharan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Holcombe E Grier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Kirsten Ecklund
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Katherine A Janeway
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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12
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Navid F, Santana VM, Neel M, McCarville MB, Shulkin BL, Wu J, Billups CA, Mao S, Daryani VM, Stewart CF, Kunkel M, Smith W, Ward D, Pappo AS, Bahrami A, Loeb DM, Reikes Willert J, Rao BN, Daw NC. A phase II trial evaluating the feasibility of adding bevacizumab to standard osteosarcoma therapy. Int J Cancer 2017. [PMID: 28631382 DOI: 10.1002/ijc.30841] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Increased vascular endothelial growth factor (VEGF) expression in osteosarcoma correlates with a poor outcome. We conducted a phase II trial to evaluate the feasibility and efficacy of combining bevacizumab, a monoclonal antibody against VEGF, with methotrexate, doxorubicin and cisplatin (MAP) in patients with localized osteosarcoma. Eligible patients received two courses of MAP chemotherapy before definitive surgery at week 10. Bevacizumab (15 mg/kg) was administered 3 days before starting chemotherapy then on day 1 of weeks 3 and 5 of chemotherapy. After surgery, patients received MAP for a total of 29 weeks; bevacizumab was added every 2 or 3 weeks on day 1 of chemotherapy at least 5 weeks after surgery. Group sequential monitoring rules were used to monitor for unacceptable bevacizumab-related targeted toxicity (grade 4 hypertension, proteinuria or bleeding, grade 3 or 4 thrombosis/embolism, and grade 2-4 major wound complications). Thirty-one patients (median age 12.8 years) with localized osteosarcoma were enrolled. No unacceptable targeted toxicities were observed except for wound complications (9 minor and 6 major), which occurred in 15 patients; none required removal of prosthetic hardware or amputation. The estimated 4-year event-free survival (EFS) rate and overall survival rate were 57.5 ± 10.0% and 83.4 ± 7.8%, respectively. Eight (28%) of 29 evaluable patients had good histologic response (<5% viable tumor) to preoperative chemotherapy. The addition of bevacizumab to MAP for localized osteosarcoma is feasible but frequent wound complications are encountered. The observed histologic response and EFS do not support further evaluation of bevacizumab in osteosarcoma.
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Affiliation(s)
- Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Victor M Santana
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Michael Neel
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN.,Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN.,Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Catherine A Billups
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Vinay M Daryani
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kunkel
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wendene Smith
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Deborah Ward
- Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, TN
| | - Alberto S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - David M Loeb
- Department of Oncology, Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Jennifer Reikes Willert
- Pediatric Hematology/Oncology/Blood and Marrow Transplant, Rady Children's Hospital, San Diego, CA
| | - Bhaskar N Rao
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.,Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Najat C Daw
- Division of Pediatrics, MD Anderson Cancer Center, Houston, TX
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13
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Wakabayashi H, Saito J, Taki J, Hashimoto N, Tsuchiya H, Gabata T, Kinuya S. Triple-phase contrast-enhanced MRI for the prediction of preoperative chemotherapeutic effect in patients with osteosarcoma: comparison with (99m)Tc-MIBI scintigraphy. Skeletal Radiol 2016; 45:87-95. [PMID: 26385785 DOI: 10.1007/s00256-015-2250-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to determine whether (99m)Tc-MIBI scintigraphy and triple-phase contrast-enhanced magnetic resonance imaging (TCE-MRI) performed during and after preoperative chemotherapy have the power to predict final chemotherapeutic effects in patients with osteosarcoma (OS). MATERIALS AND METHODS Seventeen patients underwent (99m)Tc-MIBI scintigraphy and TCE-MRI before and after the middle and last courses of preoperative chemotherapy. As for (99m)Tc-MIBI scintigraphy, an uptake ratio (UR) and a reduction rate of UR (ΔUR(MIBI)) were calculated. As for TCE-MRI, a ratio of contrast to background (CTB) was calculated in the whole tumor area (WA) at each phase on dynamic T1-weighted fat suppression images. Then a ratio of signal (R(WA)) was calculated by dividing CTB at triple-phase by CTB at pre-phase. RESULTS Nine and eight patients showed good and poor response in histopathologic evaluation. The sensitivity, specificity, and accuracy for the prediction of histopathological chemotherapeutic effect was 44, 100, 69% in R(WA) at the first phase, 100, 75, 88% in ΔUR(MIBI) after the middle course, 88, 100, 94% in R(WA) at the first phase, and 100, 75, 88% in ΔUR(MIBI) after the last course of the preoperative chemotherapy, respectively. CONCLUSION Both (99m)Tc-MIBI scintigrapy and TCE-MRI can predict the tumor response in patients with OS after the completion of the preoperative chemotherapy.
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Affiliation(s)
- Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Junko Saito
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Nanako Hashimoto
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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14
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Amit P, Malhotra A, Kumar R, Kumar L, Patro DK, Elangovan S. Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis. Indian J Radiol Imaging 2015; 25:269-75. [PMID: 26288521 PMCID: PMC4531451 DOI: 10.4103/0971-3026.161452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI) for assessing response preoperatively. MATERIALS AND METHODS Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas) with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test. RESULTS The change in dynamic MRI slope was significant (P = 0.001). Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV) =80%]. Change in tumor volume failed to show significant correlation (P = 0.071). Although it showed high negative predictive value (NPV = 85.7%), PPV was too low (PPV = 57.14%). CONCLUSIONS Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.
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Affiliation(s)
- Priyadarshi Amit
- Department of Orthopaedics, Max Super Speciality Hospital, New Delhi, India
| | - Atul Malhotra
- Department of Orthopaedics, Sport Injury Centre, Safdarjung Hospital, New Delhi, India
| | - Rahul Kumar
- Department of Orthopaedics, Sport Injury Centre, Safdarjung Hospital, New Delhi, India
| | - Lokesh Kumar
- Department of Radiodiagnosis, Sport Injury Centre, Safdarjung Hospital, New Delhi, India
| | - Dilip Kumar Patro
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Sundar Elangovan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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15
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Tumour response of osteosarcoma to neoadjuvant chemotherapy evaluated by magnetic resonance imaging as prognostic factor for outcome. INTERNATIONAL ORTHOPAEDICS 2014; 39:97-104. [PMID: 25432323 DOI: 10.1007/s00264-014-2606-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluated the feasibility of computed magnetic resonance imaging (MRI) volumetry in conventional osteosarcomas. Secondly, we investigated whether computed volumetry provides new prognostic indicators for histological response of osteosarcomas after neoadjuvant chemotherapy. METHODS In a retrospective cohort study, data from the Vienna Bone Tumour Registry was used. MR images from 14 patients (male:female = 1.8, mean age 19 years) were analysed prior to and after neoadjuvant chemotherapy according to current therapy regimens. Histological response to chemotherapy was graded according to the Salzer-Kuntschik classification. Computed volumetry was performed for the intraosseous part, as well as the soft-tissue component and the tumour as a whole. RESULTS In a setting of appropriate radiological equipment, the method has been considered to be well implementable into clinical routine. The mean tumour volume prior to chemotherapy was 321 (±351) ml. In good responders (n = 6), overall tumour volume decreased by 47% (p = 0.345), whereas poor responders (n = 8) showed a 19% decrease (p = 0.128). Neoadjuvant multidrug therapy remarkably changed the tumour composition. This is seen in a decrease of the mean ratio of soft-tissue to intraosseous tumour volume from 8.67 in poor responders and 1.15 in good responders to 1.26 and 0.45 (p = 0.065), respectively. Interestingly, the bony compartment of good responders showed a volume increase during neoadjuvant chemotherapy (p = 0.073). However, we did not find prognostic markers for histological tumour response to pre-operative chemotherapy. CONCLUSIONS Separated volumetry of tumour segments revealed interesting insights into therapy-induced growth patterns. If verified in a larger study population, these results should be taken into account when planning ablative surgery.
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16
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Silva FD, Pinheiro L, Cristofano C, de Oliveira Schiavon JL, Lederman HM. Magnetic Resonance Imaging in Pediatric Bone Tumors. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0077-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Byun BH, Kong CB, Lim I, Kim BI, Choi CW, Song WS, Cho WH, Jeon DG, Koh JS, Lee SY, Lim SM. Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential ¹⁸F-FDG PET/CT and MRI. Eur J Nucl Med Mol Imaging 2014; 41:1553-62. [PMID: 24652233 DOI: 10.1007/s00259-014-2746-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/21/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE We evaluated the potential of sequential fluorine-18 fluorodeoxyglucose ((18) F-FDG) positron emission tomography (PET)/computed tomography (CT) and MRI (PET/MRI) after one cycle of neoadjuvant chemotherapy to predict a poor histologic response in osteosarcoma. METHODS A prospective study was conducted on 30 patients with osteosarcoma treated with two cycles of neoadjuvant chemotherapy and surgery. All patients underwent PET/MRI before, after one cycle, and after the completion of neoadjuvant chemotherapy, respectively. Imaging parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor volume based on magnetic resonance (MR) images (MRV)] and their % changes were calculated on each PET/MRI data set, and histological responses were evaluated on the postsurgical specimen. RESULTS A total of 17 patients (57%) exhibited a poor histologic response after two cycles of chemotherapy. Unlike the little volumetric change in MRI, PET parameters significantly decreased after one and two cycles of chemotherapy, respectively. After one cycle of chemotherapy, SUVmax, MTV, and TLG predicted the poor responders. Among these parameters, either MTV ≥ 47 mL or TLG ≥ 190 g after one cycle of chemotherapy was significantly associated with a poor histologic response on multivariate logistic regression analysis (OR 8.98, p = 0.039). The sensitivity, specificity, and accuracy of these parameters were 71%, 85% and 77%; and 71%, 85% and 77 %, respectively. CONCLUSION The histologic response to neoadjuvant chemotherapy in osteosarcoma can be predicted accurately by FDG PET after one course of chemotherapy. Among PET parameters, MTV and TLG were independent predictors of the histologic response.
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Affiliation(s)
- Byung Hyun Byun
- Departments of Nuclear Medicine, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea
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18
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De Coninck T, Jans L, Sys G, Huysse W, Verstraeten T, Forsyth R, Poffyn B, Verstraete K. Dynamic contrast-enhanced MR imaging for differentiation between enchondroma and chondrosarcoma. Eur Radiol 2013; 23:3140-52. [DOI: 10.1007/s00330-013-2913-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
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19
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Song WS, Jeon DG, Kong CB, Cho WH, Koh JS, Lee JA, Yoo JY, Jung ST, Shin DS, Lee SY. Tumor volume increase during preoperative chemotherapy as a novel predictor of local recurrence in extremity osteosarcoma. Ann Surg Oncol 2011; 18:1710-6. [PMID: 21222166 DOI: 10.1245/s10434-010-1536-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Known risk factors (surgical margin, tumor necrosis) of local recurrence (LR) in osteosarcoma are determined by results available after surgery. However, relations between preoperative characteristics and LR have not been clearly defined. METHODS We compared the clinicopathologic characteristics of 36 osteosarcoma patients with LR and 394 patients without LR after surgery. In addition, prognostic variables were evaluated to establish factors could influence LR. RESULTS Compared to the non-LR group, the LR group showed an increase in tumor volume ratio (TVR) during preoperative chemotherapy (P < 0.01), inadequate surgical margin (P < 0.01), and poor histologic response (P < 0.01). Univariate analysis of data from 430 patients revealed that an increased TVR (P < 0.01), inadequate surgical margin (P < 0.01), poor histologic response (P < 0.01), and nonosteoblastic pathologic subtype (P = 0.04) were negatively related to LR-free survival. In multivariate analysis, an elevated TVR (P < 0.01, relative risk = 10.26) and inadequate surgical margin (P < 0.01, relative risk = 5.91) emerged as the key prognostic factors for LR. CONCLUSIONS A TVR increase during preoperative chemotherapy could be used to predict patients at high risk of LR. This finding might be useful when considering surgical options to decrease the risk of LR.
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Affiliation(s)
- Won Seok Song
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
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20
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Grimer R, Athanasou N, Gerrand C, Judson I, Lewis I, Morland B, Peake D, Seddon B, Whelan J. UK Guidelines for the Management of Bone Sarcomas. Sarcoma 2010; 2010:317462. [PMID: 21253474 PMCID: PMC3022187 DOI: 10.1155/2010/317462] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/20/2010] [Indexed: 12/29/2022] Open
Abstract
These guidelines have been developed in order to provide an overview and a set of broad-based key recommendations for the management of patients with bone sarcomas in the UK. They have taken into consideration the most up-to-date scientific literature along with the recent recommendations by the European Society of Medical Oncology. The principles of the NICE guidance on both "improving outcomes for patients with sarcomas" and "improving outcomes with children and young people with cancer" have been incorporated. As care evolves, it is acknowledged that these guidelines will need updating. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and patients with clinicoradiological findings suggestive of a primary bone tumour should be sent to a reference centre. Patients should then have their care managed at such a specialist centre by a fully accredited multidisciplinary team.
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21
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Miki Y, Ngan S, Clark JCM, Akiyama T, Choong PFM. The significance of size change of soft tissue sarcoma during preoperative radiotherapy. Eur J Surg Oncol 2010; 36:678-83. [PMID: 20547446 DOI: 10.1016/j.ejso.2010.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/30/2010] [Accepted: 05/17/2010] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the significance of change in tumour size during preoperative radiotherapy in patients with soft tissue sarcoma (STS). METHODS A retrospective review of 91 cases with STS was performed. Inclusion criteria were localised extremity and truncal STS with measurable disease, older than 18 years, treated with preoperative radiotherapy and wide local excision, in the period between January 1966 and December 2005. Patients with head and neck STS, or who received neoadjuvant chemotherapy were excluded. A difference in excess of 10% of the greatest tumour diameter of the pre-radiotherapy and the post-radiotherapy MRI scans was considered as change in tumour size. RESULTS Increase in tumour size was noted in 28 patients (31%) (Group 1). No change or decrease in size was observed in 63 patients (Group 2). There were no significance differences in local control or overall survival rates between the 2 groups. The estimated overall actuarial local recurrence free, event-free and overall survival rates were 90.5%, 64.4%, 62.9% in Group 1, and 85.7%, 60.8%, 68.9% in Group 2 respectively. CONCLUSION Increase in tumour size during preoperative radiotherapy for soft tissue sarcoma does not seem to associate with inferior local tumour control or compromise survival. Lack of reduction in tumour size is not necessarily a sign of lack of response to preoperative radiotherapy.
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Affiliation(s)
- Y Miki
- Department of Orthopaedics, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy 3065, Victoria, Melbourne, Australia.
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22
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Pels H, Juergens A, Schirgens I, Glasmacher A, Schulz H, Engert A, Schackert G, Reichmann H, Kroschinsky F, Vogt-Schaden M, Egerer G, Bode U, Deckert M, Fimmers R, Urbach H, Schmidt-Wolf IGH, Schlegel U. Early complete response during chemotherapy predicts favorable outcome in patients with primary CNS lymphoma. Neuro Oncol 2010; 12:720-4. [PMID: 20159882 DOI: 10.1093/neuonc/noq010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In primary central nervous system lymphoma (PCNSL), 2 international prognostic scores have been developed to estimate the outcome according to certain "prognostic groups". However, these scores do not predict the individual course of a single patient under therapy. In this analysis, we addressed the question of whether early tumor remission in patients still under therapy, according to magnetic resonance imaging (MRI) criteria, helps to predict long-term outcome. Eighty-eight patients treated with 6 polychemotherapy cycles within a pilot/phase II trial underwent MRI scanning within 72 hours prior to initiation of therapy, after the second chemotherapy cycle, and after completion of chemotherapy. Response was assessed by contrast-enhanced MRI of the brain according to the Macdonald criteria. Median follow-up was 42 months (range, 0-124 months). Patients achieving a complete radiographic response after 2 courses of chemotherapy (n = 18) had a significantly longer median overall survival (OS) (not reached) and median time-to-treatment failure (TTF) (not reached) than patients with complete response (CR) after termination of treatment but with only a partial response after the second cycle (n = 24) (OS: 55 months; TTF: 32 months) (P < .01). Early complete tumor response assessed by MRI after the second of sixth scheduled chemotherapy cycles was highly predictive for both OS and TTF in patients with PCNSL treated in this series.
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Affiliation(s)
- Hendrik Pels
- Department of Neurology, Knappschaftskrankenhaus, University of Bochum, In der Schornau 23-25, D-44892 Bochum, Germany.
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23
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Cheon GJ, Kim MS, Lee JA, Lee SY, Cho WH, Song WS, Koh JS, Yoo JY, Oh DH, Shin DS, Jeon DG. Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med 2009; 50:1435-40. [PMID: 19690035 DOI: 10.2967/jnumed.109.063602] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Response to neoadjuvant chemotherapy is a significant prognostic factor for osteosarcoma; however, this information can be determined only after surgical resection. If we could predict histologic response before surgery, it might be helpful for the planning of surgeries and tailoring of treatment. We evaluated the usefulness of (18)F-FDG PET for this purpose. METHODS A total of 70 consecutive patients with a high-grade osteosarcoma treated at our institute were prospectively enrolled. All patients underwent (18)F-FDG PET and MRI before and after neoadjuvant chemotherapy. We analyzed the predictive values of 5 parameters, namely, maximum standardized uptake values (SUVs), before and after (SUV2) chemotherapy, SUV change ratio, tumor volume change ratio, and metabolic volume change ratio (MVCR) in terms of their abilities to discriminate responders from nonresponders. RESULTS Patients with an SUV2 of less than or equal to 2 showed a good histologic response, and patients with an SUV2 of greater than 5 showed a poor histologic response. The histologic response of a patient with an intermediate SUV2 (2 < SUV2 </= 5) was found to be predictable using MVCR. A patient with an MVCR of less than 0.65 is likely to be a good responder, whereas a patient with an MVCR of greater than or equal to 0.65 is likely to be a poor responder. According to our model, the predictive values for good responders and poor responders were 97% (31/32) and 95% (36/38), respectively. CONCLUSION We found that combined information on (18)F-FDG PET and MRI scans, acquired before and after chemotherapy, could be used to predict histologic response to neoadjuvant chemotherapy in osteosarcoma.
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Affiliation(s)
- Gi Jeong Cheon
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Korea
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24
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Bley TA, Wieben O, Uhl M. Diffusion-weighted MR imaging in musculoskeletal radiology: applications in trauma, tumors, and inflammation. Magn Reson Imaging Clin N Am 2009; 17:263-75. [PMID: 19406358 DOI: 10.1016/j.mric.2009.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Diffusion-weighted imaging is a noninvasive magnetic resonance technique that is capable of measuring icroscopic movement of water molecules (ie, random or Brownian motion) within biologic tissues. Diffusion weighting is achieved with a pulsed-field gradient that leaves "static" spins unaffected but causes dephasing of spin ensembles that experience different motion histories according to their diffusion paths, with respect to the direction of the gradient. This article focuses on the interesting opportunities of the use of diffusion weighted imaging in the diagnosis of musculoskeletal diseases, including trauma, tumor, and inflammation.
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Affiliation(s)
- Thorsten A Bley
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
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25
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Kim MS, Lee SY, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Jung ST, Jeon DG. Effect of increases in tumor volume after neoadjuvant chemotherapy on the outcome of stage II osteosarcoma regardless of histological response. J Orthop Sci 2009; 14:292-7. [PMID: 19499296 DOI: 10.1007/s00776-009-1334-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 02/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We assessed volume changes after neoadjuvant chemotherapy and evaluated relations between tumor size changes and clinical characteristics. In addition, we sought to determine whether tumor size change influences patient outcome. METHODS The records of 127 patients with stage II osteosarcoma who showed more than a 15% volume change after chemotherapy were retrospectively reviewed. Patients were divided into two groups depending on whether tumors increased or decreased in size. Fisher's exact test was performed to analyze correlations between tumor size changes and clinicopathological variables. Five-year metastasis-free survival and overall survival were evaluated using univariate and multivariate analyses. RESULTS A total of 71 patients (55.9%) showed a decrease in tumor volume, and 56 patients (44.1%) showed an increase. An increase in tumor volume after neoadjuvant chemotherapy was found to be positively correlated with a poor histological response and subsequent metastasis. Univariate analysis identified the following parameters as poor prognostic factors: age < or = 15 years (P = 0.03), American Joint Committee on Cancer (AJCC) stage IIB (P = 0.02), a subtype other than osteoblastic (P < 0.01), a poor histological response (P < 0.001), and increased tumor volume after preoperative chemotherapy (P < 0.0001). Multivariate analysis revealed that AJCC stage IIB (P = 0.006) and an increase in tumor volume after preoperative chemotherapy (P < 0.001) both independently shortened metastasis-free survival. However, a poor histological response lost its prognostic significance (P = 0.34). CONCLUSIONS Increased tumor volume after neoadjuvant chemotherapy independently shortened metastasis-free and overall survival in AJCC stage II osteosarcoma patients. Tumor volume changes may serve as a basis for risk-adapted therapy when used in combination with other prognostic factors.
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Affiliation(s)
- Min Suk Kim
- Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea
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26
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Kim MS, Lee SY, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Jeon DG. Tumor necrosis rate adjusted by tumor volume change is a better predictor of survival of localized osteosarcoma patients. Ann Surg Oncol 2007; 15:906-14. [PMID: 18163171 DOI: 10.1245/s10434-007-9779-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 11/19/2007] [Accepted: 11/30/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND We assessed whether new parameter that considers both tumor volume change and necrosis rate predicts metastasis-free survival of localized osteosarcoma patients. We also evaluated relationship between tumor volume change and necrosis rate or metastasis-free survival. METHODS We retrospectively reviewed 151 patients with stage II osteosarcoma who were treated with surgery and neoadjuvant chemotherapy. The tumor volume change was measured and calculated based on pre- and postchemotherapy magnetic resonance images. The mean metastasis-free interval was 83.1 months. We calculated adjusted tumor necrosis rate as following formula: 100 - (100 - necrosis rate) x postchemotherapy/prechemotherapy tumor volume. Survival and logistic regression analyses were used to evaluate the correlation among size parameters, tumor necrosis rate and survival. RESULTS The 5-year metastasis-free survival rate of 151 patients was 71.4% (95% CI, 67.7-75.1%). American Joint Committee on Cancer (AJCC) stage IIB (RR 2.27; 95% CI, 1.11-4.62; P = 0.025) and poor adjusted tumor necrosis rate (RR 2.02; 95% CI, 1.05-3.89; P = 0.035) independently correlated with metastasis-free survival period. Further, tumor volume change independently correlated with necrosis rate. Decreased tumor volume could predict good response, with sensitivity of 80.2%, specificity of 68.6%, and positive predictive value (PPV) of 74.7%. Increased or stable tumor volume could predict poor response, with sensitivity of 68.6%, specificity of 80.2%, and PPV of 75.0 %. CONCLUSION The necrosis rate adjusted by the tumor volume change is an independent prognostic factor in osteosarcoma. This adjusted tumor necrosis rate may serve as a basis for risk-adapted therapy in combination with other prognostic factors.
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Affiliation(s)
- Min Suk Kim
- Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea
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27
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Moon SH, Shin KH, Suh JS, Yang WI, Noh JK, Hahn SB. Tumor volume change after chemotheraphy as a predictive factor of disease free survival for osteosarcoma. Yonsei Med J 2005; 46:119-24. [PMID: 15744814 PMCID: PMC2823037 DOI: 10.3349/ymj.2005.46.1.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Change in tumor volume after chemotherapy appears to have a prognostic significance for the outcome of osteosarcoma. A newly developed volume measurement method based on three-dimensional summation with a proved reproducibility was utilized to measure osteosarcoma tumor volume. This retrospective analysis included 38 patients with biopsy- proven, nonsurface, skeletal high-grade osteosarcoma. The treatment was started by using three cycles of preoperative chemotherapy with cisplastin (100 mg/m2) and adriamycin (30 mg/m2). The tumor volume was measured before and after preoperative chemotherapy using three-dimensional magnetic resonance image measurement. The percentage of tumor necrosis was assessed by pathologic exam. After three cycle of postoperative chemotherapy, the patients were followed up at regular interval. For the 23 good responder patients, the mean survival time was 73.2 months (95% confidence interval 61.9-84.5 months), and for the 15 poor responder patients, the mean survival time was 50.8 months (95% confidence interval 38.6-63.1 months) (p<0.05). For the 14 patients with increased tumor volume after chemotherapy, the mean survival time was 47.5 months (range: 36.3-58.6 months) and for the 24 patients with stable or decreased tumor volume, the mean survival time was 74.3 months (range: 63.79-84.88 months) (p<0.05). Among the various factors, histopathologic response and tumor volume change after chemotherapy predicted disease free survival (p<0.05). Change in the tumor volume that was measured with a reproducible method and the histopathologic response after chemotherapy were the important predictors of disease free survival for osteosarcoma patients.
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Affiliation(s)
- Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Ho Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Keong Noh
- Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Bong Hahn
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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28
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Abstract
The change in osteosarcoma tumor volume after preoperative adjuvant chemotherapy and its relationship to the histopathologic response was investigated using various reproducible volumetric methods. Tumor volume was measured before and after chemotherapy in 41 patients with osteosarcoma using an ellipsoid formula in plain radiography and magnetic resonance imaging and three-dimensional magnetic resonance imaging measurement. Based on intraobserver and interobserver variability for the volumetric measurements of each method, three-dimensional magnetic resonance imaging measurement was the most reproducible. In three-dimensional magnetic resonance measurements, the correlation of the histopathologic response with absolute and relative total tumor volume changes and extraosseous volume change were significant. The good responder group showed a greater reduction in tumor volume after chemotherapy, although there was no significant difference in pretreatment tumor volume between the good and poor responder groups. The group with a decreased or stable tumor volume represented a good histopathologic response with a sensitivity of 85%, specificity of 76%, and positive predictive value of 88%. The change in tumor volume of osteosarcoma measured by three-dimensional magnetic resonance imaging could predict histopathologic response after three cycles of neoadjuvant chemotherapy.
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Affiliation(s)
- K H Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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29
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Abstract
Magnetic resonance imaging is an important modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of unenhanced MR in detection, diagnosis and staging, intravenous use of gadolinium-contrast media (gd-CM) is indicated in selected cases. The purpose of this article is to review the basic pharmacokinetic principles and imaging techniques for static and dynamic contrast-enhanced MR imaging and to highlight the most important indications for administration of gd-CM in patients with musculsokeletal tumors and tumor-like lesions: adding specificity in tissue characterization, staging of local extent and biopsy planning, monitoring preoperative chemotherapy and detection of recurrence.
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Affiliation(s)
- K L Verstraete
- Department of Magnetic Resonance/MR/-1K 12 I.B., University Hospital Gent, De Pintelaan 185, B-9000, Gent, Belgium.
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30
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Kunisada T, Ozaki T, Kawai A, Sugihara S, Taguchi K, Inoue H. Imaging assessment of the responses of osteosarcoma patients to preoperative chemotherapy: angiography compared with thallium-201 scintigraphy. Cancer 1999; 86:949-56. [PMID: 10491520 DOI: 10.1002/(sici)1097-0142(19990915)86:6<949::aid-cncr9>3.0.co;2-h] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Assessment of the responses of osteosarcoma patients to preoperative chemotherapy is of clinical importance. The purpose of this study was to estimate the accuracy of angiography and thallium-201 scintigraphy, compared with histology, in assessing the responses of patients with osteosarcoma to preoperative chemotherapy. METHODS Nineteen patients with osteosarcoma who were diagnosed between 1992 and 1997 were studied. The findings of angiography and thallium-201 scintigraphy before and after preoperative chemotherapy were compared with the percentage of necrosis of tumor cells and the response grade as determined histologically. Quantitative analysis of the isotopic uptake by thallium-201 scintigraphy before and after chemotherapy, defined as the alteration ratio, was correlated with the percentage of tumor necrosis. RESULTS Angiography yielded a sensitivity of 88%, a specificity of 73%, and a predictive accuracy of positive test of 70%, whereas thallium-201 scintigraphy achieved 88%, 100%, and 100%, respectively. Both angiographic and scintigraphic assessment showed a significant correlation with response grade as determined histologically (P < 0.05 and P < 0.0003, respectively). The alteration ratio of thallium-201 scintigraphy showed a strong, highly significant correlation with the percentage of tumor necrosis (P < 0.0001). CONCLUSIONS A change in the tumor uptake of thallium-201 scintigraphy after preoperative chemotherapy can predict the tumor necrosis in osteosarcoma precisely. Thallium scintigraphy is a noninvasive technique and seems to be more useful than angiography in assessing the response of osteosarcoma to preoperative chemotherapy.
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Affiliation(s)
- T Kunisada
- Department of Orthopaedic Surgery, Okayama University Medical School, Okayama, Japan
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31
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Ham SJ, Schraffordt Koops H, van der Graaf WT, van Horn JR, Postma L, Hoekstra HJ. Historical, current and future aspects of osteosarcoma treatment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1998; 24:584-600. [PMID: 9870738 DOI: 10.1016/s0748-7983(98)93896-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- S J Ham
- Department of Orthopaedic Surgery, Groningen University Hospital, The Netherlands
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33
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Abstract
Over the last several decades, significant advances have been made in our ability to understand and treat osteosarcoma. In this article we describe the diagnosis, evaluation, and treatment of patients with this disease. The surgical issues are discussed. We review the major clinical trials that have led to our current level of understanding. The current studies for the treatment of osteosarcoma are described.
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Affiliation(s)
- P A Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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34
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Kawai A, Sugihara S, Kunisada T, Uchida Y, Inoue H. Imaging assessment of the response of bone tumors to preoperative chemotherapy. Clin Orthop Relat Res 1997:216-25. [PMID: 9137193 DOI: 10.1097/00003086-199704000-00024] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Assessment of the response of bone tumors to preoperative chemotherapy is of clinical importance. The authors determined the value of 3 imaging techniques (digital subtraction angiography, thallium scintigraphy, and dynamic magnetic resonance imaging) in guiding patient management by assessing the response of 17 bone sarcomas to preoperative chemotherapy compared with histologic evaluation of the resected specimens. Digital subtraction angiography showed a sensitivity of 87.5%, specificity of 57.1%, and accuracy of 73.3%. Thallium scintigraphy (sensitivity, 85.7%; specificity, 85.7%; accuracy, 85.7%) was superior to angiography in predicting tumor responses. The results of dynamic magnetic resonance imaging were analyzed on the basis of the value of slopes, which represents the percent increase in signal intensity per minute. The differences in slope before and after chemotherapy and the postchemotherapy slope values correlated with the histologic responses. The assessment by dynamic magnetic resonance imaging showed a sensitivity of 100%, specificity of 85.7%, and accuracy of 90.9%. Thallium scintigraphy and dynamic magnetic resonance imaging were considered noninvasive, reliable techniques that had about equal ability to assess the response of bone sarcomas to preoperative chemotherapy. Dynamic magnetic resonance imaging offers major advantages in the spatial resolution and can be more readily quantitated when compared with thallium scintigraphy.
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Affiliation(s)
- A Kawai
- Department of Orthopaedic Surgery, Okayama University Medical School, Japan
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35
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Bloem JL, van der Woude HJ, Geirnaerdt M, Hogendoorn PC, Taminiau AH, Hermans J. Does magnetic resonance imaging make a difference for patients with musculoskeletal sarcoma? Br J Radiol 1997; 70:327-37. [PMID: 9166066 DOI: 10.1259/bjr.70.832.9166066] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
MR imaging has had an unparalleled impact on the treatment of patients with musculoskeletal sarcoma. Basically, the high accuracy of local staging has made the introduction of reconstructive and limb salvage procedures instead of amputation of disarticulation available to the majority of patients with musculoskeletal sarcoma. Pre-operative work-up with MRI is not only more accurate, but also much faster and cheaper than the conventional work-up. Staging is the single most important reason for performing MR imaging in patients with musculoskeletal tumours. The impact of MR specificity is less dramatic but the benefit to the patient is an increased safety margin. When diagnostic errors with devastating consequences are made nowadays, it is usually because the proper protocol has not been followed. A patient with a potentially malignant, or equivocal, musculoskeletal mass deserves to have a combined radiographic-MRI examination prior to invasive procedures. MRI does not currently have a major impact on chemotherapy decisions and colour Doppler ultrasound has a higher accuracy than MRI. However, selected cases, i.e. intraosseous tumours, dynamic Gd-enhanced MRI, can replace colour Doppler ultrasound.
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Affiliation(s)
- J L Bloem
- Department of Radiology, Leiden University Hospital, The Netherlands
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36
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PRIMARY TUMORS OF THE MUSCULOSKELETAL SYSTEM. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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37
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Evaluation of soft tissue sarcomas response to preoperative treatment: Assessment by angiography, thallium scintigraphy, and dynamic MRI. Int J Clin Oncol 1996. [DOI: 10.1007/bf02348274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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