The relation of radiological tumor volume response to histological response and outcome in patients with localized Ewing Sarcoma.
Adolescent
Adult
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Child
Child, Preschool
Clinical Decision-Making
Female
Humans
Infant
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging
Prognosis
Radiography
Sarcoma, Ewing
/ diagnosis
Treatment Outcome
Tumor Burden
Young Adult
Ewing Sarcoma
MRI
histology
outcome
radiological response
tumor volume response
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
22
08
2018
revised:
08
01
2019
accepted:
10
01
2019
pubmed:
23
2
2019
medline:
17
4
2020
entrez:
22
2
2019
Statut:
ppublish
Résumé
Magnetic resonance imaging (MRI) is the modality of choice for local staging and response evaluation of Ewing sarcoma (EwS). Aim of this study was to determine the relevance of tumor volume response (TVR) in relation to histological response (HisRes) and survival, in order to evaluate if early modification of chemotherapy might be indicated in patients with inadequate TVR. Three dimensional (3D)-tumor volume data at diagnosis, during early induction phase (1-3 courses of chemotherapy; n = 195) and/or late induction phase (4-6 courses; n = 175) from 241 localized patients were retrospectively analyzed. A distinction was made between adequate response (reduction ≥67%) and inadequate response (reduction <67% or progression). Correlations between TVR, HisRes, event free survival (EFS), and overall survival (OS) were analyzed using chi-square tests, log-rank tests, and the Cox-regression model. Early adequate TVR, noted in 41% of patients, did not correlate with EFS (P = 0.92) or OS (P = 0.38). During late induction phase 62% of patients showed an adequate TVR. EFS for patients with late adequate TVR was better (78%) than for those with inadequate late TVR (61%) (P = 0.01); OS was 80% and 69% (P = 0.26), respectively. No correlation was found between TVR and HisRes. Multivariate analysis showed that poor HisRes, pelvic location and late inadequate TVR were associated with poor outcome. Early inadequate TVR does not predict adverse outcome; therefore, changing the treatment to second line chemotherapy is not indicated in case of inadequate early TVR. Late adequate TVR and good HisRes correlate with better EFS; patients with late inadequate TVR might benefit from augmented therapy.
Sections du résumé
BACKGROUND
Magnetic resonance imaging (MRI) is the modality of choice for local staging and response evaluation of Ewing sarcoma (EwS). Aim of this study was to determine the relevance of tumor volume response (TVR) in relation to histological response (HisRes) and survival, in order to evaluate if early modification of chemotherapy might be indicated in patients with inadequate TVR.
METHODS
Three dimensional (3D)-tumor volume data at diagnosis, during early induction phase (1-3 courses of chemotherapy; n = 195) and/or late induction phase (4-6 courses; n = 175) from 241 localized patients were retrospectively analyzed. A distinction was made between adequate response (reduction ≥67%) and inadequate response (reduction <67% or progression). Correlations between TVR, HisRes, event free survival (EFS), and overall survival (OS) were analyzed using chi-square tests, log-rank tests, and the Cox-regression model.
RESULTS
Early adequate TVR, noted in 41% of patients, did not correlate with EFS (P = 0.92) or OS (P = 0.38). During late induction phase 62% of patients showed an adequate TVR. EFS for patients with late adequate TVR was better (78%) than for those with inadequate late TVR (61%) (P = 0.01); OS was 80% and 69% (P = 0.26), respectively. No correlation was found between TVR and HisRes. Multivariate analysis showed that poor HisRes, pelvic location and late inadequate TVR were associated with poor outcome.
CONCLUSIONS
Early inadequate TVR does not predict adverse outcome; therefore, changing the treatment to second line chemotherapy is not indicated in case of inadequate early TVR. Late adequate TVR and good HisRes correlate with better EFS; patients with late inadequate TVR might benefit from augmented therapy.
Identifiants
pubmed: 30790456
doi: 10.1002/cam4.2002
pmc: PMC6434194
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1086-1094Informations de copyright
© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
J Clin Oncol. 2007 Nov 1;25(31):4909-13
pubmed: 17971587
Pediatr Hematol Oncol. 2012 Feb;29(1):12-27
pubmed: 22304007
Radiother Oncol. 1987 Oct;10(2):101-10
pubmed: 3423301
Int J Radiat Oncol Biol Phys. 2015 Jun 1;92(2):349-57
pubmed: 25772182
J Cancer Res Clin Oncol. 1983;106 Suppl:21-4
pubmed: 6577010
Radiology. 1988 Dec;169(3):805-10
pubmed: 3055041
Radiology. 2013 Dec;269(3):870-8
pubmed: 23985275
Cancer Med. 2019 Mar;8(3):1086-1094
pubmed: 30790456
Semin Roentgenol. 2000 Jul;35(3):297-305
pubmed: 10939131
Pediatr Radiol. 2001 Jul;31(7):518-23
pubmed: 11486808
Eur J Radiol. 1991 May-Jun;12(3):201-7
pubmed: 1855513
Semin Musculoskelet Radiol. 2000;4(1):137-46
pubmed: 11061698
Skeletal Radiol. 1998 Feb;27(2):57-71
pubmed: 9526770
Radiology. 1992 Sep;184(3):859-64
pubmed: 1509080
AJR Am J Roentgenol. 1990 Aug;155(2):343-6
pubmed: 2115265
J Bone Joint Surg Br. 1999 Mar;81(2):317-22
pubmed: 10204943
J Clin Oncol. 2010 Jul 10;28(20):3284-91
pubmed: 20547982
J Clin Oncol. 1993 Sep;11(9):1763-9
pubmed: 8355043
PLoS One. 2017 Aug 25;12(8):e0183841
pubmed: 28841702
J Natl Cancer Inst. 2000 Feb 2;92(3):179-81
pubmed: 10655425
Clin Imaging. 2018 Jan - Feb;47:9-13
pubmed: 28806574
J Clin Oncol. 2000 Sep;18(17):3108-14
pubmed: 10963639
J Clin Oncol. 2014 Aug 10;32(23):2440-8
pubmed: 24982464
Pediatr Blood Cancer. 2016 Apr;63(4):604-10
pubmed: 26702872
PLoS One. 2013 Nov 11;8(11):e79008
pubmed: 24244402
Radiology. 2016 Sep;280(3):905-15
pubmed: 26982677
Pediatr Blood Cancer. 2006 Jul;47(1):22-9
pubmed: 16572419
Br J Cancer. 2001 Nov 30;85(11):1646-54
pubmed: 11742482
Skeletal Radiol. 1994 Oct;23(7):493-500
pubmed: 7824974
Ann Oncol. 2010 Sep;21(9):1751-1755
pubmed: 20332135
Pediatr Radiol. 2004 Aug;34(8):595-605
pubmed: 15103428