TY - JOUR
T1 - Dynamic contrast-enhanced magnetic resonance imaging as a prognostic factor in predicting event-free and overall survival in pediatric patients with osteosarcoma
AU - Guo, Junyu
AU - Reddick, Wilburn E.
AU - Glass, John O.
AU - Ji, Qing
AU - Billups, Catherine A.
AU - Wu, Jianrong
AU - Hoffer, Fredric A.
AU - Kaste, Sue C.
AU - Jenkins, Jesse J.
AU - Ortega Flores, Ximena C.
AU - Quintana, Juan
AU - Villarroel, Milena
AU - Daw, Najat C.
PY - 2012/8/1
Y1 - 2012/8/1
N2 - BACKGROUND: The objective of this study was to prospectively evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as an early imaging indicator of tumor histologic response to preoperative chemotherapy and as a possible prognostic factor for event-free survival (EFS) and overall survival in pediatric patients with newly diagnosed, nonmetastatic osteosarcoma who were treated on a single, multi-institutional phase 2 trial. METHODS: Three serial DCE-MRI examinations at week 0 (before treatment), week 9, and week 12 (tumor resection) were performed in 69 patients with nonmetastatic osteosarcoma to monitor the response to preoperative chemotherapy. Four DCE-MRI kinetic parameters (the influx volume transfer constant [K trans], the efflux rate constant [k ep], the relative extravascular extracellular space [v e], and the relative vascular plasma space [v p]) and the corresponding differences (ΔK trans, Δk ep, Δv e, and Δv p) of averaged kinetic parameters between the outer and inner halves of tumors were calculated to assess their associations with tumor histologic response, EFS, and overall survival. RESULTS: The parameters K trans, v e, v p, and k ep decreased significantly from week 0 to week 9 and week 12. The parameters K trans, v p, and Δk ep at week 9 were significantly different between responders and nonresponders (P =.046, P =.021, and P =.008, respectively). These 3 parameters were indicative of histologic response. The parameter Δv e at week 0 was a significant prognostic factor for both EFS (P =.02) and overall survival (P =.03). CONCLUSIONS: DCE-MRI was identified as a prognostic factor for EFS and overall survival before treatment on this trial and was indicative of a histologic response to neoadjuvant therapy. Further studies are needed to verify these findings with other treatment regimens and establish the potential role of DCE-MRI in the development of risk-adapted therapy for osteosarcoma.
AB - BACKGROUND: The objective of this study was to prospectively evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as an early imaging indicator of tumor histologic response to preoperative chemotherapy and as a possible prognostic factor for event-free survival (EFS) and overall survival in pediatric patients with newly diagnosed, nonmetastatic osteosarcoma who were treated on a single, multi-institutional phase 2 trial. METHODS: Three serial DCE-MRI examinations at week 0 (before treatment), week 9, and week 12 (tumor resection) were performed in 69 patients with nonmetastatic osteosarcoma to monitor the response to preoperative chemotherapy. Four DCE-MRI kinetic parameters (the influx volume transfer constant [K trans], the efflux rate constant [k ep], the relative extravascular extracellular space [v e], and the relative vascular plasma space [v p]) and the corresponding differences (ΔK trans, Δk ep, Δv e, and Δv p) of averaged kinetic parameters between the outer and inner halves of tumors were calculated to assess their associations with tumor histologic response, EFS, and overall survival. RESULTS: The parameters K trans, v e, v p, and k ep decreased significantly from week 0 to week 9 and week 12. The parameters K trans, v p, and Δk ep at week 9 were significantly different between responders and nonresponders (P =.046, P =.021, and P =.008, respectively). These 3 parameters were indicative of histologic response. The parameter Δv e at week 0 was a significant prognostic factor for both EFS (P =.02) and overall survival (P =.03). CONCLUSIONS: DCE-MRI was identified as a prognostic factor for EFS and overall survival before treatment on this trial and was indicative of a histologic response to neoadjuvant therapy. Further studies are needed to verify these findings with other treatment regimens and establish the potential role of DCE-MRI in the development of risk-adapted therapy for osteosarcoma.
KW - dynamic contrast-enhanced magnetic resonance imaging
KW - osteosarcoma
KW - outcome
KW - prognostic factors
KW - tumor microcirculation
KW - tumor response
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U2 - 10.1002/cncr.26701
DO - 10.1002/cncr.26701
M3 - Article
C2 - 22180392
AN - SCOPUS:84864153718
SN - 0008-543X
VL - 118
SP - 3776
EP - 3785
JO - Cancer
JF - Cancer
IS - 15
ER -