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Positron Emission Tomography for Staging of Pediatric Sarcoma Patients: Results of a Prospective Multicenter Trial

Thomas Völker, Timm Denecke, Ingo Steffen, Daniel Misch, Stefan Schönberger, Michail Plotkin, Juri Ruf, Christian Furth, Brigitte Stöver, Hubertus Hautzel, Günter Henze, Holger Amthauer

From the Klinik für Pädiatrie m.S. Onkologie und Hämatologie; Otto-Heubner-Zentrum and Klinik für Strahlenheilkunde, Bereiche Nuklearmedizin und Radiologie inklusive Abteilung für Kinderradiologie; Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin; and Klinik für Kinder Onkologie, Hämatologie, und Immunologie and Nuklearmedizinische Klinik, Universitätsklinikum Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany

Address reprint requests to Timm Denecke, MD, Klinik für Strahlenheilkunde, Bereiche Nuklearmedizin und Radiologie, Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany; e-mail: timm.denecke{at}charite.de

Purpose The objective of this study was to evaluate the impact of positron emission tomography (PET) using fluorine-18–fluorodeoxyglucose (FDG) for initial staging and therapy planning in pediatric sarcoma patients.

Patients and Methods In this prospective multicenter study, 46 pediatric patients (females, n = 22; males, n = 24; age range, 1 to 18 years) with histologically proven sarcoma (Ewing sarcoma family tumors, n = 23; osteosarcoma, n = 11; rhabdomyosarcoma, n = 12) were examined with conventional imaging modalities (CIMs), including ultrasound, computed tomography (CT), magnetic resonance imaging, and bone scintigraphy according to the standardized algorithms of the international therapy optimization trials, and whole-body FDG-PET. A lesion- and patient-based analysis of PET alone and CIMs alone and a side-by-side (SBS) analysis of FDG-PET and CIMs were performed. The standard of reference consisted of all imaging material, follow-up data (mean follow-up time, 24 ± 12 months), and histopathology and was determined by an interdisciplinary tumor board.

Results FDG-PET and CIMs were equally effective in the detection of primary tumors (accuracy, 100%). PET was superior to CIMs concerning the correct detection of lymph node involvement (sensitivity, 95% v 25%, respectively) and bone manifestations (sensitivity, 90% v 57%, respectively), whereas CT was more reliable than FDG-PET in depicting lung metastases (sensitivity, 100% v 25%, respectively). The patient-based analysis revealed the best results for SBS, with 91% correct therapy decisions. This was significantly superior to CIMs (59%; P < .001).

Conclusion In staging pediatric sarcoma, subsidiary FDG-PET scanning depicts important additional information and has a relevant impact on therapy planning when analyzed side-by-side with CIMs.

Supported by Grant No. 50-2714-He 1 from the Deutsche Krebshilfe e.V.

T.V. and T.D. contributed equally to this work.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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