Response to chemotherapy estimates by FDG PET is an important prognostic factor in patients with Ewing sarcoma.

BACKGROUND: Response to chemotherapy is a prognostic factor in patients with Ewing sarcoma (ES); the role of FDG PET to predict response in these patients has not been thoroughly investigated. We evaluated the diagnostic accuracy and the potential of FDG PET to predict response to chemotherapy (CHT). MATERIALS AND METHODS: We analyzed data of 50 patients with ES (median age 12.6 years). All patients were treated with neoadjuvant CHT, and underwent surgery for local control. All patients had (18)F-FDG PET/CT at diagnosis and after induction CHT, prior to local control. We compared response assessed by histopathology with FDG PET using standard uptake values (SUVs). RESULTS: Median SUV at diagnosis (SUV I) was 5 (range 1.2-17), and median SUV after neoadjuvant chemotherapy (SUV II) was 1.8 (range 0-8.4). Median SUV II/I ratio was 0.3 (range 0-1). SUV at diagnosis was significantly lower in patients with good histological response than in patients with poor histological response (median 3.8 vs. 7.2, p 0.02). We found a significant correlation between SUV II and outcome; the positive predictive value of an SUV II ≤ 2.5 for favorable response was 84.21 %, and the median SUV II was significantly higher in patients with disease progression (2.3 vs. 1.6, p = 0.04). In multivariate analysis, necrosis and SUV II were significant predictors of outcome. CONCLUSIONS: (18)F-FDG PET demonstrates high diagnostic accuracy for response to initial chemotherapy in patients with ES and it correlates with outcome. The role of FDG PET in predicting response and outcome should be further investigated.

Consolidation of first-line therapy with busulphan and melphalan, and autologous stem cell rescue in children with Ewing's sarcoma.

According to the published report on current practice of hematopoietic SCT in Europe, high-dose therapy (HDT) with autologous stem cell support is a standard of care in paediatric patients with high risk (HR) or relapsed Ewing's sarcoma (ES). Randomized trials, however, have not confirmed the value of this procedure yet. In this retrospective analysis we intended to evaluate the role of HDT as a consolidation therapy in first remission of ES. A total of 102 patients were included in the analysis and divided according to the following risk factors: metastatic disease at presentation, feasibility of surgery and histological response after induction. Forty-one patients were classified as standard risk (SR) patients, while the remaining 61 children, with at least one risk factor, were classified as HR patients. HR group patients were non-randomized and qualified according to the decision of the local clinician to give a conventional consolidation (CC) or to perform high-dose chemotherapy and radiotherapy in selected patients. Twenty-six children were given CC while 35 patients were treated with HDT. The HDT consisted of oral BU 4 mg/kg p.o. in divided doses daily for 4 days (total dose 16 mg/kg) followed by melphalan 140 mg/m(2) i.v. on day -2. Probability of relapse-free survival (RFS) in median observation time was significantly worse in HR patients who were given CC therapy as compared with children with HR features receiving high-dose chemotherapy (0.27 vs 0.66 (P = 0.008); OS 0.31 vs 0.71 (P = 0.007), respectively). Patients from the SR group had a probability of RFS of 0.72 and OS of 0.75, and the difference between SR and HR patients after HDT was NS (P = 0.37). Our observation confirms that the consolidation of the first-line treatment with BU and melphalan improves the outcome in ES patients with HR features.

Response to chemotherapy estimates by FDG PET is an important prognostic factor in patients with Ewing sarcoma

Background. Response to chemotherapy is a prognostic factor in patients with Ewing sarcoma (ES); the role of FDG PET to predict response in these patients has not been thoroughly investigated. We evaluated the diagnostic accuracy and the potential of FDG PET to predict response to chemotherapy (CHT). Materials and methods. e analyzed data of 50 patients with ES (median age 12.6 years). All patients were treated with neoadjuvant CHT, and underwent surgery for local control. All patients had 18F-FDG PET/CT at diagnosis and after induction CHT, prior to local control. We compared response assessed by histopathology with FDG PET using standard uptake values (SUVs). Results. Median SUV at diagnosis (SUV I) was 5 (range 1.2-17), and median SUV after neoadjuvant chemotherapy (SUV II) was 1.8 (range 0-8.4). Median SUV II/I ratio was 0.3 (range 0-1). SUV at diagnosis was significantly lower in patients with good histological response than in patients with poor histological response (median 3.8 vs. 7.2, p 0.02). We found a significant correlation between SUV II and outcome; the positive predictive value of an SUV II ≤ 2.5 for favorable response was 84.21 %, and the median SUV II was significantly higher in patients with disease progression (2.3 vs. 1.6, p = 0.04). In multivariate analysis, necrosis and SUV II were significant predictors of outcome. Conclusions. 18F-FDG PET demonstrates high diagnostic accuracy for response to initial chemotherapy in patients with ES and it correlates with outcome. The role of FDG PET in predicting response and outcome should be further investigated (AU)

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[Analysis of DNA histograms and histopathologic assessment of necrosis after preoperative chemotherapy of osteosarcoma in children and youth]. / Analiza histogramow DNA oraz histopatologiczne badania stopnia nekrozy po przedoperacyjnej chemioterapii w miesakach lkosciopochodnych u dzieci i mlodziezy.

Analysis of nucler DNA content (DNA histograms by flow cytometry) in 26 children and youth with osteosarcoma treated at the National Research Institute of Mother and Child, was carried out. The relationship between aneuploid populations, index DNA and phases of cell cycle and the clinical course, histopathologic grading and histopathologic assessment of preoperative chemotherapy effect (% of tumour necrosis) were analysed. Osteosarcomas in children with changed schedules of chemotherapy (therapy complications) in relation to the above parameters were also examined. The results show, that increased aneuploid population and index DNA (less distinct for S phase of anueptoid population) are linked with weaker chemotherapy effect. It can indicate a bigger proliferative potential in this kind of tumours - it often occurs with a more dramatic course of disease. According to the authors flow cytometry studies are helpful and complementary to histopathologic diagnosis.

[Sacrococcygeal tumours--diagnosis-treatment strategies based on personal examinations]. / Guzy okolicy krzyzowo-guzicznej--postepowanie diagnostyczno-lecznicze na podstawie badan wlasnych.

Sacrococcygeal tumours very often appear soon after birth when they are usually benign. In older children more frequently malignant tumours are observed. The authors present diagnostic and therapeutic strategy based on clinical material consisting of 34 patients (15 benign tumours, 19 malignant tumours) treated at the National Research Institute of Mother and Child in the period 1980-1999.

[Results of treatment in osteosarcoma--chemotherapy with ADM and CDDP]. / Wyniki leczenia pacjentów z miesakiem kosciopochodnym z zastosowaniem chemioterapii z ADM i CDDP.

Malignant bone neoplasms contribute to about 7% of paediatric cancer. Within the last 20 years much has changed in cancer treatment. Neoadjuvant chemotherapy, as the first phase of comprehensive treatment, results in regression of the tumour and makes limb salvage surgery possible. An exact analysis of 36 patients with osteosarcoma of different localisation, treated at the National Research Institute of Mother and Child between 1991 and 1996 was carried out. Treatment was started with pre-operative adjuvant chemotherapy with ADM and CDDP, administrated during 6 weeks. The regimen and the length of administration depended on stage of disease and tumour reaction to chemotherapy. Amputations or limb salvage surgery was conducted as a second phase of therapy. Postoperative chemotherapy was given for 6 months. Tumour reaction to chemotherapy was described according to the Huvos scale - percentage map of necrosis and regression areas in the neoplastic tissue. The analysis shows good results after chemotherapy with ADM and CDDP.