Tumor Necrosis Rate Adjusted by Tumor Volume Change Is a Better Predictor of Survival of Localized Osteosarcoma Patients

Edelhauser

International Orthopaedics (SICOT)

et al. 2011

Purpose The purpose of this study was to investigate (a) whether pre-operative serum CRP is a predictor of survival in patients with high-grade osteosarcoma, (b) whether postoperative infection is a predictor of survival in these patients and (c) whether CRP is a predictor of postoperative infection, and especially deep prosthetic infection. Methods In this retrospective single-centre study, preoperative serum CRP levels in 79 patients (37 females, 42 males; average age, 18 years; mean follow-up, 46 months) undergoing resection of an osteosarcoma were correlated with clinical data and survival. Results The mean pre-operative serum CRP level of all 79 patients was 0.53 mg/dl (SD, 1.27 mg/dl). Patients dying of their underlying disease had significantly higher CRP levels compared to patients surviving throughout the follow-up period (1.09 mg/dl ± 2.02 mg/dl versus 0.32 mg/dl ± 0.75 mg/dl, respectively; p=0.015). CRP levels were significantly correlated with survival (Pearson's correlation coefficient= −0.25; p =0.026) and histological subtype (Pearson's correlation coefficient=−0.42; p<0.001), but not with sex, age, histological response, tumour size or metastatic disease. In uni-and multivariate survival analysis, age, response to chemotherapy and serum CRP were associated with disease-specific survival. Patients with a CRP level over 1 mg/dl had a significantly lower diseasespecific five-year survival of 36.7% compared to 73.8% in patients with normal CRP values (p=0.020). Infection was not correlated with disease-specific survival. Pre-operative serum CRP levels were not correlated with post-operative infection or deep prosthetic infection. Conclusions Pre-operative serum CRP seems to be an independent predictor of survival in patients with highgrade osteosarcoma. Further studies are needed to confirm these results on a large-scale basis.

Section: Discussionmentioning

confidence: 99%

Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma

Edelhauser

International Orthopaedics (SICOT)

et al. 2011

“…However, because tumor necrosis can be assessed only in the resected specimens after the completion of neoadjuvant chemotherapy, the continuation of ineffective chemotherapy can cause the development of resistant clones (3). To overcome these limitations, noninvasive imaging modalities including bone scintigraphy (5), CT (6), MR imaging (2,3,7,8), and 18 F-FDG PET (9)(10)(11) have been investigated to predict the effect of neoadjuvant chemotherapy. 18 F-FDG PET enables the assessment of glucose metabolism and hence also the metabolic activity of cancer tissue by calculating a standardized uptake value (SUV).…”

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confidence: 99%

“…To overcome these limitations, noninvasive imaging modalities including bone scintigraphy (5), CT (6), MR imaging (2,3,7,8), and 18 F-FDG PET (9)(10)(11) have been investigated to predict the effect of neoadjuvant chemotherapy. 18 F-FDG PET enables the assessment of glucose metabolism and hence also the metabolic activity of cancer tissue by calculating a standardized uptake value (SUV). Change in SUV after neoadjuvant chemotherapy has been reported to be useful in predicting tumor response in osteosarcoma (9)(10)(11).…”

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confidence: 99%

“…Change in ADC value after neoadjuvant chemotherapy also has been reported to be useful in monitoring therapeutic response of osteosarcoma (2,3,7,8). To our knowledge, however, there is no published study comparing the response assessment of 18 F-FDG PET and DWI in patients with osteosarcoma.…”

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confidence: 99%

“…In this prospective study, we evaluated the potential of 18 F-FDG PET/CT and DWI to monitor the histologic response in patients with extremity osteosarcoma receiving neoadjuvant chemotherapy using sequential PET/CT and MR imaging.…”

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confidence: 99%

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Combination of ¹⁸F-FDG PET/CT and Diffusion-Weighted MR Imaging as a Predictor of Histologic Response to Neoadjuvant Chemotherapy: Preliminary Results in Osteosarcoma

et al. 2013

Self Cite

We evaluated the potential of 18 F-FDG PET/CT and diffusionweighted imaging (DWI) to monitor the histologic response in patients with extremity osteosarcoma receiving neoadjuvant chemotherapy, using sequential PET/CT and MR imaging. Methods: We prospectively registered 28 patients with high-grade osteosarcoma treated with 2 cycles of neoadjuvant chemotherapy and surgery. All patients underwent sequential 18 F-FDG PET/CT and MR imaging before (PET/MR1) and after neoadjuvant chemotherapy (PET/MR2). Maximum standardized uptake value (SUV), tumor volume based on MR imaging (MRV), and the mean apparent diffusion coefficient (ADC) values were measured on PET/MR1 (SUV1, MRV1, and ADC1) and PET/MR2 (SUV2, MRV2, and ADC2). The percentage changes in maximum SUV (ΔSUV), MRV (ΔMRV), and ADC (ΔADC) were calculated, and the correlations among these parameters were evaluated. After surgery, the effects of neoadjuvant chemotherapy were graded histopathologically: grades III and IV (necrosis of $ 90%) indicated a good response, and grades I and II (necrosis of , 90%) indicated a poor response. The optimum cutoff values of ΔSUV, ΔMRV, ΔADC, and their combination for predicting histologic response were assessed by single-and multi-receiver-operating-characteristic curve analysis. Results: Twenty-seven patients were enrolled in the present study after 1 patient with inadequate acquisition of MR imaging was excluded. ΔSUV and ΔADC negatively correlated with each other (r 5 20.593, P 5 0.001), and ΔMRV did not correlate with ΔSUV or ΔADC. The cutoff value, sensitivity, specificity, and accuracy for predicting good histologic response were # 252%, 67%, 87%, and 78%, respectively, for ΔSUV and . 13%, 83%, 73%, and 78%, respectively, for ΔADC. However, ΔMRV did not predict histologic response. Sensitivity, specificity, and accuracy were 83%, 87%, and 85%, respectively, using the combined criterion of ΔSUV # 231% and ΔADC . 13%. Conclusion: In the current preliminary study, both PET/CT and DWI are useful for predicting histologic response after neoadjuvant chemotherapy in osteosarcoma. Combining PET/CT and DWI may be an effective method to predict the histologic response of patients to neoadjuvant chemotherapy.

Magnetic Resonance Imaging

MRI biomarkers in osseous tumors

Fukuda

Wengler

Carvalho

et al. 2019

Although radiography continues to play a critical role in osseous tumor assessment, there have been remarkable advances in cross‐sectional imaging. MRI has taken a lead in this assessment due to high tissue contrast and spatial resolution, which are well suited for bone lesion assessment. More recently, although somewhat lagging other organ systems, quantitative parameters have shown promising potential as biomarkers for osseous tumors. Among these sequences are chemical shift imaging (CSI), apparent diffusion coefficient (ADC), and intravoxel incoherent motion (IVIM) from diffusion‐weighted imaging (DWI), quantitative dynamic contrast enhanced (DCE)‐MRI, and magnetic resonance spectroscopy (MRS). In this article, we review the background and recent roles of these quantitative MRI biomarkers for osseous tumors. Level of Evidence: 3 Technical Efficacy Stage: 3 J. MAGN. RESON. IMAGING 2019. J. Magn. Reson. Imaging 2019;50:702–718.