Nuklearmedizin 2017; 56(06): 233-238
DOI: 10.3413/Nukmed-0909-17-07
Original Article
Schattauer GmbH

Ewing sarcoma during follow-up

The value of a predefined imaging protocol including FDG-PET/CT for the detection of tumour recurrenceEwing-Sarkom in der NachsorgeDer Wert eines vordefinierten BildgebungsProtokolls mit FDG-PET/CT zur Detektion von Tumor-Rezidiven
Melina Heinemann
1   University Hospital Münster, Department of Nuclear Medicine, Münster, Germany
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Andreas Ranft
2   University Hospital Essen, Pediatrics III, West German Cancer Centre, German Cancer Research Centre, Essen, Germany
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Heribert Jürgens
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Thorsten Langer
4   University Hospital Schleswig-Holstein, Campus Lübeck, Department of Paediatric Haematology and Oncology, Lübeck, Germany
,
Volker Vieth
5   University Hospital Münster, Department of Clinical Radiology, Münster, Germany
,
Beate Timmermann
6   West German Proton Centre, West German Cancer Centre, German Cancer Research Centre, University Hospital Essen, Essen, Germany
,
Matthias Weckesser
1   University Hospital Münster, Department of Nuclear Medicine, Münster, Germany
,
Uta Dirksen*
2   University Hospital Essen, Pediatrics III, West German Cancer Centre, German Cancer Research Centre, Essen, Germany
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Lars Stegger*
1   University Hospital Münster, Department of Nuclear Medicine, Münster, Germany
› Author Affiliations
Funding This work was supported by Deutsche Krebshilfe (DKH 108128), Bundesministerium für Bildung und Forschung (TranSaRNet), Deutsches Zentrum für Luft- und Raumfahrt e.V. and the European Union (01GM0869), EuroBoNet, EU-FP6; ENCCA, EEC (602856–2, EU FP7), PanCareLife (602030–2) EU-FP7; PROVABES ERA-NetTRANSCAN (01KT1310); BMBF-01ER0807.
Further Information

Publication History

Received: 03 July 2017

accepted in revised form: 30 August 2017

Publication Date:
11 January 2018 (online)

Summary

Aim: To evaluate the performance of a prospectively defined follow-up imaging protocol that includes FDG-PET(/CT) to detect tumour recurrence in Ewing sarcoma (EwS) before becoming symptomatic.

Methods: Imaging results and clinical data during follow-up were retrospectively analysed from all patients treated successfully within the EURO E.W.I.N.G. 99 trial at the University Hospital Münster, Germany. All patients received follow-up imaging according to a comprehensive protocol that included regular X-ray, CT, MRI, bone scan and PET(/CT), albeit not all on the same day and with varying intervals for the different modalities.

Results: 80 of 105 patients underwent follow-up at our institution after complete remission. 30 patients had recurrent tumour during the follow-up period of 3.6 years on average. 19 recurrences (63%) were detected by scheduled imaging before the advent of clinical symptoms. The majority of these recurrences (8 out of 19; 42%) was detected first by PET/ CT (and confirmed with additional imaging thereafter), even though the total number of PET/CTs was comparatively low (138) and PET/CT was not systematically scheduled before other imaging techniques. Recurrences detected by bone scan were also detectable by PET.

Conclusions: The implemented follow-up protocol was effective in the detection of EwS recurrence before the advent of symptoms. Most cases of those detected before onset of symptoms were detected by PET/CT first. This hybrid imaging modality should therefore be considered in the routine follow-up of EwS patients, as is standard in our hospital. In combination with PET, low-dose chest CT seems to be sufficient in the detection of small pulmonary nodules.

Zusammenfassung

Ziel: Evaluation eines prospektiv definierten bildgebenden Nachsorge-Protokolls einschließlich FDG-PET(/CT) zur Erkennung von Rezidiven eines Ewing-Sarkoms (EwS) vor dem Auftreten von Symptomen.

Methoden: Die Ergebnisse der Bildgebung und klinische Daten im Rahmen der Nachsorge wurden retrospektiv bei allen Patienten erhoben, die erfolgreich innerhalb der EURO E.W.I.N.G 99 Studie am Universitätsklinikum Münster behandelt wurden. Alle Patienten erhielten eine Nachsorge gemäß einem umfassenden Bildgebungs-Protokoll, welches regelmäßige Röntgenuntersuchungen, CT, MRT, Skelett-Szintigraphie und PET(/CT) beinhaltete, die allerdings nicht alle am selben Tag und mit unterschiedlichen Intervallen für die einzelnen Modalitäten durchgeführt wurden.

Ergebnisse: 80 von 105 Patienten erhielten eine Nachsorge in unserem Zentrum nach kompletter Remission. 30 Patienten erlitten ein Rezidiv innerhalb der Nachsorgeperiode von durchschnittlich 3,6 Jahren. 19 Rezidive (63 %) wurden durch die vorgegebene Bildgebung vor dem Auftreten von Symptomen entdeckt. Die Mehrzahl (8 von 19; 42%) der so entdeckten Rezidive wurde als erstes durch PET/CT-Untersuchungen erkannt (und danach durch andere Bildgebungsmethoden bestätigt), obwohl die Gesamtzahl der durchgeführten PET/CTs vergleichsweise gering war (138) und diese Untersuchung nicht systematisch vor anderen Bildgebungsverfahren terminiert wurde. Rezidive, welche durch die Skelett-Szintigraphie entdeckt wurden, waren auch in der PET erkennbar.

Schlussfolgerungen: Das implementierte Bildgebungs-Nachsorgeprotokoll erwies sich als effektiv darin, EwS-Rezidive vor Symptom-Manifestation zu entdecken. Die meisten der vor Auftreten von Symptomen detektierten Rezidive wurden zuerst durch die PET/CT nachgewiesen. Die PET/CT sollte daher in die Nachsorge von EwS-Patienten eingeschlossen werden, so wie es bereits in unserem Klinikum Standard ist. In Kombination mit PET scheint die Low-dose-ThoraxCT suffizient zur Erkennung kleiner pulmonaler Läsionen zu sein.

* Lars Stegger and Uta Dirksen contributed equally


 
  • References

  • 1 Al-Ibraheem A, Buck AK, Benz MR. et al. (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma. Cancer 2013; 119: 1227-1234.
  • 2 Arush MW, Israel O, Postovsky S. et al. Positron emission tomography/computed tomography with 18fluoro-deoxyglucose in the detection of local recurrence and distant metastases of pediatric sarcoma. Pediatr Blood Cancer 2007; 49: 901-905.
  • 3 Durr HR, Tunn PU, Bakhshai Y. Surveillance in patients with bone sarcomas. When, how, and for how long?. Unfallchirurg 2014; 117: 523-527.
  • 4 Ferrari S, Sundby Hall K, Luksch R. et al. Nonmetastatic Ewing family tumors: high-dose chemotherapy with stem cell rescue in poor responder patients. Results of the Italian Sarcoma Group/Scandinavian Sarcoma Group III protocol. Ann Oncol 2011; 22: 1221-1227.
  • 5 Franzius C, Daldrup-Link HE, Sciuk J. et al. FDGPET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol 2001; 12: 479-486.
  • 6 Franzius C, Sciuk J, Daldrup-Link HE. et al. FDGPET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med 2000; 27: 1305-1311.
  • 7 Gerth HU, Juergens KU, Dirksen U. et al. Significant benefit of multimodal imaging: PET/CT compared with PET alone in staging and follow-up of patients with Ewing tumors. J Nucl Med 2007; 48: 1932-1939.
  • 8 Gyorke T, Zajic T, Lange A. et al. Impact of FDG PET for staging of Ewing sarcomas and primitive neuroectodermal tumours. Nucl Med Commun 2006; 27: 17-24.
  • 9 Hu Z, Yang W, Liu H. et al. From PET/CT to PET/ MRI: advances in instrumentation and clinical applications. Mol Pharm 2014; 11: 3798-3809.
  • 10 Johnson GR, Zhuang H, Khan J. et al. Roles of positron emission tomography with fluorine-18-deoxyglucose in the detection of local recurrent and distant metastatic sarcoma. Clin Nucl Med 2003; 28: 815-820.
  • 11 Juergens KU, Weckesser M, Stegger L. et al. Tumor staging using whole-body high-resolution 16-channel PET-CT: does additional low-dose chest CT in inspiration improve the detection of solitary pulmonary nodules?. Eur Radiol 2006; 16: 1131-1137.
  • 12 Kauffman WM, Fletcher BD, Hanna SL. et al. MR imaging findings in recurrent primary osseous Ewing sarcoma. Magn Reson Imaging 1994; 12: 1147-1153.
  • 13 Korholz D, Verheyen J, Engelbrecht V. et al. Follow-up of patients with osteosarcoma and Ewing’s sarcoma: a retrospective cost-benefit analysis. Klin Padiatr 2000; 212: 220-223.
  • 14 Luksch R, Tienghi A, Hall KS. et al. Primary meta-static Ewing’s family tumors: results of the Italian Sarcoma Group and Scandinavian Sarcoma Group ISG/SSG IV Study including myeloablative chemotherapy and total-lung irradiation. Ann Oncol 2012; 23: 2970-2976.
  • 15 McNulty W, Cox G, Au-Yong I. Investigating the solitary pulmonary nodule. BMJ 2012; 344: e2759.
  • 16 Muangman N, Maitreesorrasan N, Totanarungroj K. Comparison of low dose and standard dose MDCT in detection of metastatic pulmonary nodules. J Med Assoc Thai 2011; 94: 215-223.
  • 17 Sharma P, Khangembam BC, Suman KC. et al. Diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Eur J Nucl Med Mol Imaging 2013; 40: 1036-1043.
  • 18 Stahl M, Ranft A, Paulussen M. et al. Risk of recurrence and survival after relapse in patients with Ewing sarcoma. Pediatr Blood Cancer 2011; 57: 549-553.
  • 19 Womer RB, West DC, Krailo MD. et al. Randomized controlled trial of interval-compressed chemotherapy for the treatment of localized Ewing sarcoma: a report from the Children’s Oncology Group. J Clin Oncol 2012; 30: 4148-4154.