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. 2017 Aug 25;8(15):2892-2898.
doi: 10.7150/jca.20077. eCollection 2017.

18F-FDG PET/CT as an Indicator of Survival in Ewing Sarcoma of Bone

Usama Salem  1 , Behrang Amini  1 , Hubert H Chuang  2 , Najat C Daw  3 , Wei Wei  4 , Tamara Miner Haygood  1 , John E Madewell  1 , Colleen M Costelloe  1
Affiliations

18F-FDG PET/CT as an Indicator of Survival in Ewing Sarcoma of Bone

Usama Salem et al. J Cancer. .

Abstract

Objective: The existing literature of 18 F-FDG PET/CT in Ewing sarcoma investigates mixed populations of patients with both soft tissue and bone primary tumors. The aim of our study was to evaluate whether the maximum standardized uptake value (SUVmax) obtained with 18F-FDG PET/CT before and after induction chemotherapy can be used as an indicator of survival in patients with Ewing sarcoma originating exclusively in the skeleton. Materials and Methods: A retrospective database search from 2004-2011 identified 28 patients who underwent 18 F-FDG PET/CT before (SUV1, n= 28) and after (SUV2, n=23) induction chemotherapy. Mean follow up was 3.3 years and median follow up for survivors was 6.3 years (range: 2.6-9.8 years). Multivariate and univariate Cox proportional hazard model was used to assess for correlation of SUV1, SUV2, and the change in SUVmax with overall survival (OS) and progression-free survival (PFS). Results: Mean SUVmax was 10.74 before (SUV1) and after 4.11 (SUV2) induction chemotherapy. High SUV1 (HR = 1.05, 95% CI: 1.0-1.1, P = 0.01) and SUV2 (HR =1.2, 95% CI: 1.0-1.4, P = 0.01) were associated with worse OS. A cut off point of 11.6 was identified for SUV1. SUV1 higher than 11.6 had significantly worse OS (HR = 5.71, 95% CI: 1.85 - 17.61, P = 0.003) and PFS (HR = 3.16, 95% CI: 1.13 - 8.79, P = 0.03, P < 0.05 is significant). Conclusion: 18F-FDG PET/CT can be used as a prognostic indicator for survival in primary Ewing sarcoma of bone.

Keywords: Ewing sarcoma; FDG PET/CT; Overall survival; Progression free survival.; SUV.

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Conflict of interest statement

Competing Interests: Our third co-author is a consultant for Sage Health Management Solutions.

Figures

Figure 1
Figure 1
Management of Ewing sarcoma patients at our institution (number of patients in brackets)
Figure 2
Figure 2
Locations of the primary tumor
Figure 3
Figure 3
SUVmax cutoff values associated with OS and PFS A: Overall Survival Probability: Patients with SUVmax >11.6 had significantly worse OS [7 events (deaths) in total number of 8 patients] compared to those with lower SUVmax [6 events (deaths) in total number of 20 patients], (HR = 5.71, 95% CI: 1.85 - 17.61, P = 0.003) B: Progression Free Survival Probability: Patients with SUVmax >11.6 had significantly worse PFS [7 events (deaths or progression) in a total number of 8 patients] compared to those with lower SUVmax [8 events (deaths or progression) in a total number of 20 patients], (HR = 3.16, 95% CI: 1.13 - 8.79, P = 0.03)
Figure 3
Figure 3
SUVmax cutoff values associated with OS and PFS A: Overall Survival Probability: Patients with SUVmax >11.6 had significantly worse OS [7 events (deaths) in total number of 8 patients] compared to those with lower SUVmax [6 events (deaths) in total number of 20 patients], (HR = 5.71, 95% CI: 1.85 - 17.61, P = 0.003) B: Progression Free Survival Probability: Patients with SUVmax >11.6 had significantly worse PFS [7 events (deaths or progression) in a total number of 8 patients] compared to those with lower SUVmax [8 events (deaths or progression) in a total number of 20 patients], (HR = 3.16, 95% CI: 1.13 - 8.79, P = 0.03)
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