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. 2012 Apr 1;18(7):2024-31.
doi: 10.1158/1078-0432.CCR-11-2139. Epub 2012 Feb 14.

18F-FDG-PET/CT Imaging as an early survival predictor in patients with primary high-grade soft tissue sarcomas undergoing neoadjuvant therapy

Ken Herrmann  1 , Matthias R Benz, Johannes Czernin, Martin S Allen-Auerbach, William D Tap, Sarah M Dry, Tibor Schuster, Jeff J Eckardt, Michael E Phelps, Wolfgang A Weber, Fritz C Eilber
Affiliations

18F-FDG-PET/CT Imaging as an early survival predictor in patients with primary high-grade soft tissue sarcomas undergoing neoadjuvant therapy

Ken Herrmann et al. Clin Cancer Res. .

Abstract

Purpose: Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 2[18F]fluoro-2-deoxy-d-glucose ((18)F-FDG)-PET/computed tomographic (CT) imaging after the initial cycle of neoadjuvant therapy could predict overall survival in these patients.

Experimental design: Thirty-nine patients underwent (18)F-FDG-PET/CT before and after one cycle of neoadjuvant therapy. Fifty-six patients underwent end-of-treatment PET. Overall survival was, among others, correlated with changes of SUV(peak) and histopathology.

Results: One-, two-, and five-year survival rates were 95% ± 3.0%, 86% ± 4.6%, and 68% ± 6.6%, respectively. Median time to death was 30.9 months (mean, 27.7; range, 6.9-50.1). Optimal cutoff values for early and late decreases in SUV(peak) (26% and 57%, respectively) were significant predictors of survival in univariate survival analysis [P = 0.041; HR, 0.27; 95% confidence interval (CI), 0.08-0.95 and P = 0.045; HR, 0.31; 95% CI, 0.10-0.98]. Seven of 15 early PET nonresponders but only four of 24 early PET responders died during follow-up (P = 0.068). The only other significant survival predictor was surgical margin positivity (P = 0.041; HR, 3.31; 95% CI, 1.05-10.42). By multivariable analysis, early metabolic response (P = 0.016) and positivity of surgical margins (P = 0.036) remained significant survival predictors.

Conclusion: (18)F-FDG-PET predicted survival after the initial cycle of neoadjuvant chemotherapy in patients with STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.

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Figures

Figure 1
Figure 1
A, Twenty-year-old female treatment responder with primary synovial sarcoma of the left thigh (diagnosis). Baseline SUVpeak decreased by 79% at early and 81% at late follow-up. The largest tumor diameter increased by 1% and 4%, respectively (stable disease according to RECIST). Histopathology revealed 20% necrosis in excised tumor tissue (histopathologic nonresponse). Patient was alive without disease at the last follow-up 44.4 months after inclusion into the study. B, the 43-year-old female treatment nonresponder with NOS of the right chest (diagnosis). Baseline SUV increased by 44% at early and 11% at late follow-up compared with baseline. The largest tumor diameter increased by 6% and 1%, respectively (stable disease according to RECIST). Histopathology revealed 25% necrosis in excised tumor tissue (histopathologic nonresponse). Patient presented disease recurrence 17.0 months and died of the disease 37.8 months after inclusion into the study.
Figure 2
Figure 2
Kaplan–Meier survival curves comparing responders and nonresponders of (A) histopathologic response (P = 0.401), (B) RECIST (P = 0.801),(C) early metabolic response (SUVpeak decrease >26%; P = 0.027), and (D) late metabolic response (SUVpeak decrease >57%; P = 0.035; all P values according to log-rank test). Survival times were calculated from date of surgery (A), date of second PET/CT scan (C), and date of third PET/CT scan (B and D), respectively.
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