Osteosarcoma: correlation between radiological and histological changes after intra-arterial chemotherapy

Abstract

The statistical correlation between three different radiological methods (conventional radiography, computed tomography and angiography) and tumor necrosis (TN) of the resected specimen have been studied in a series of 31 patients diagnosed with osteosarcoma (OS). They were treated with a multidisciplinary approach including intraarterial and intravenous chemotherapy followed by limb salvage procedures, plus intraoperative radiotherapy and adjuvant chemotherapy. A clear statistical correlation has been obtained between TN and angiography (p = 0.02) and between TN and two specific radiological signs: "tumoral stain and neovascularity" (p = 0.02) and "peritumoral fat planes" (p = 0.05). Conventional radiography, computed tomography and other radiological signs studied (nutrient vessel, soft tissue mass and central peripheral calcifications) did not show any significant correlation with TN. These results seem to suggest that angiography is a method to evaluate TN preoperatively and also to define the efficacy of neoadjuvant chemotherapy in OS.

Imaging Evaluation of the Response of High-Grade Osteosarcoma and EwingSarcoma to Chemotherapy with Emphasis on Dynamic Contrast-Enhanced MagneticResonance Imaging

“…30 Other investigators found a correlation between tumoral stain and neovascularity and an unfavorable response, but it was not statistically significant. 24 However, a recent pilot study, using MR angiography on nine osteosarcomas and two Ewing sarcomas, showed a decrease in neovascularity and number of feeding vessels to the tumor with successful chemotherapy as opposed to an increase in or no change in tumor neovasculature with ineffective treatment. 42 With this technique, two-dimensional maximum intensity projections can delineate small vessel neovascularity, and three-dimensional projections can portray the spatial relationships of tumor, feeder vessels, and normal vascular structures.…”

“…Prior to the early 1990s, the available imaging techniques (radiography, angiography, computed tomography [CT], standard contrast-enhanced magnetic resonance [MR] imaging, and scintigraphy) contributed information about the tumor type, its extent, and metastases [18][19][20][21][22][23] but could not accurately determine chemotherapeutic effectiveness. [24][25][26][27][28][29][30] During the last 8 years, we and other investigators have developed dynamic contrast-enhanced MR imaging with postprocessing for distinguishing viable tumor from necrotic and nonviable tumor and inflammation and thereby the poor responder from the good responder to chemotherapy in evaluation of musculoskeletal neoplasms (Fig. 1).…”

Location of residual viable tumor cells after neoadjuvant chemotherapy: A new concept with high prognostic performance in osteosarcoma

“…Although the vascularity of tumors on angiograms from intraarterial chemotherapy has been shown to be correlated with histologic response, angiograms show poor spatial resolution on tumor blush (LRVTC) and surrounding tissues. In fact, MRI images are needed to define the location of tumor blush, to localize the location of the tumors, and distinguish hypervascularity of adjacent soft tissue.…”

“…The locations of tumor blush on the last angiogram were regarded as locations of residual viable tumor cells (LRVTC) after neoadjuvant chemotherapy, based on strong correlations between angiogram and pathology that were previously reported . Based on spatial relationships of the contours of affected bones on the angiograms in two dimensions, the location of tumor blush was assessed as intracompartmental (within the affected bones) or extracompartmental (across the affected bones) with reference to MRI.…”

A giant cell rich osteosarcoma of the proximal ulnar bone treated by elbow arthroplasty: A case report

“…Conventional osteosarcoma is the most common type with an aggressive characteristic. They are predominant in the epimetadiaphysis of the long bone [5,7].…”