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Multicenter Study
. 2022 Jan 14;17(1):e0261565.
doi: 10.1371/journal.pone.0261565. eCollection 2022.

PET metabolic tumor volume as a new prognostic factor in childhood rhabdomyosarcoma

Helio Fayolle  1 , Nina Jehanno  2 , Valerie Lauwers-Cances  3 , Marie-Pierre Castex  4 , Daniel Orbach  5 , Thomas Mognetti  6 , Corradini Nadège  7 , Pierre Payoux  8 , Anne Hitzel  1
Affiliations
Multicenter Study

PET metabolic tumor volume as a new prognostic factor in childhood rhabdomyosarcoma

Helio Fayolle et al. PLoS One. .

Abstract

Purpose: Childhood RMS is a rare malignant disease in which evaluation of tumour spread at diagnosis is essential for therapeutic management. F-18 FDG-PET imaging is currently used for initial RMS disease staging.

Materials and methods: This multicentre retrospective study in six French university hospitals was designed to analyse the prognostic accuracy of MTV at diagnosis for patients with RMS between 1 January 2007 and 31 October 2017, for overall (OS) and progression-free survival (PFS). MTV was defined as the sum of the primitive tumour and the largest metastasis, where relevant, with a 40% threshold of the primary tumour SUVmax. Additional aims were to define the prognostic value of SUVmax, SUVpeak, and bone lysis at diagnosis.

Results: Participants were 101 patients with a median age of 7.4 years (IQR [4.0-12.5], 62 boys), with localized disease (35 cases), regional nodal spread (43 cases), or distant metastases (23). 44 patients had alveolar subtypes. In a univariate analysis, a MTV greater than 200 cm3 was associated with OS (HR = 3.47 [1.79;6.74], p<0.001) and PFS (HR = 3.03 [1.51;6.07], p = 0.002). SUVmax, SUVpeak, and bone lysis also influenced OS (respectively p = 0.005, p = 0.004 and p = 0.007) and PFS (p = 0.029, p = 0.019 and p = 0.015). In a multivariate analysis, a MTV greater than 200 cm3 was associated with OS (HR = 2.642 [1.272;5.486], p = 0.009) and PFS (HR = 2.707 [1.322;5.547], p = 0.006) after adjustment for confounding factors, including SUVmax, SUVpeak, and bone lysis.

Conclusion: A metabolic tumor volume greater than 200 cm3, SUVmax, SUVpeak, and bone lysis in the pre-treatment assessment were unfavourable for outcome.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart.
N: number of patients.
Fig 2
Fig 2. Lumbar-aortic lymph node involvement in a 7-year-old child with a pelvic alveolar RMS.
Metabolic tumour volume represents all the voxels within the initial volume of interest with SUV values equal to or above an automatic threshold of 40% of SUVmax. A) CT scan: the volume is hardly measurable, mainly owing to the presence of extensive necrosis. B) Fused PET-CT with metabolic tumour volume, SUVmax and SUVpeak.
Fig 3
Fig 3. Left mandibular isolated primary tumour in a 4-year-old child with embryonal RMS.
Primary tumour lysis of the left mounting mandibular branch. A) CT scan only in bone window. B) Fused PET-CT in bone window. C) CT scan only in soft-tissue window. D) Fused PET-CT in soft-tissue window.
Fig 4
Fig 4
A) Overall survival. B) Progression-free survival.
Fig 5
Fig 5. Overall survival according to MTV.
Fig 6
Fig 6. Progression-free survival according to MTV.
See this image and copyright information in PMC

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