Predicting Outcome in Patients with Rhabdomyosarcoma: Role of [18 F]Fluorodeoxyglucose Positron Emission Tomography

• Published in: International journal of radiation oncology, biology, physics Vol. 90; no. 5; pp. 1136 - 1142
• Main Authors: Casey, Dana L., BA, Wexler, Leonard H., MD, Fox, Josef J., MD, Dharmarajan, Kavita V., MD, Schoder, Heiko, MD, Price, Alison N., MD, Wolden, Suzanne L., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; CHEMOTHERAPY; Child; Child, Preschool; Disease-Free Survival; Female; FLUORINE 18; FLUORODEOXYGLUCOSE; Fluorodeoxyglucose F18; HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Induction Chemotherapy - methods; Male; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; Positron-Emission Tomography - methods; Predictive Value of Tests; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiopharmaceuticals; Retrospective Studies; Rhabdomyosarcoma, Alveolar - diagnostic imaging; Rhabdomyosarcoma, Alveolar - drug therapy; Rhabdomyosarcoma, Alveolar - mortality; Rhabdomyosarcoma, Alveolar - pathology; Rhabdomyosarcoma, Embryonal - diagnostic imaging; Rhabdomyosarcoma, Embryonal - drug therapy; Rhabdomyosarcoma, Embryonal - mortality; Rhabdomyosarcoma, Embryonal - pathology; ROC Curve; Treatment Outcome; UPTAKE; Young Adult
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2014.08.005

Purpose To evaluate whether [18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) response of the primary tumor after induction chemotherapy predicts outcomes in rhabdomyosarcoma (RMS). Methods and Materials After excluding those with initial tumor resection, 107 patients who underwent FDG-PET after induction chemotherapy at Memorial Sloan Kettering Cancer Center from 2002 to 2013 were reviewed. Local control (LC), progression-free survival (PFS), and overall survival (OS) were calculated according to FDG-PET response and maximum standardized uptake value (SUV) at baseline (PET1/SUV1), after induction chemotherapy (PET2/SUV2), and after local therapy (PET3/SUV3). Receiver operator characteristic curves were used to determine the optimal cutoff for dichotomization of SUV1 and SUV2 values. Results The SUV1 (<9.5 vs ≥9.5) was predictive of PFS ( P =.02) and OS ( P =.02), but not LC. After 12 weeks (median) of induction chemotherapy, 45 patients had negative PET2 scans and 62 had positive scans: 3-year PFS was 72% versus 44%, respectively ( P =.01). The SUV2 (<1.5 vs ≥1.5) was similarly predictive of PFS ( P =.005) and was associated with LC ( P =.02) and OS ( P =.03). A positive PET3 scan was predictive of worse PFS ( P =.0009), LC ( P =.05), and OS ( P =.03). Conclusions [18 F]fluorodeoxyglucose positron emission tomography is an early indicator of outcomes in patients with RMS. Future prospective trials may incorporate FDG-PET response data for risk-adapted therapy and early assessment of new treatment regimens.