Periosteal Osteosarcoma: Emerging Clinical Concepts, Evolving Treatment Options: A Narrative Review.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Compliance with Ethical Guidelines: This article is based on previous studies and contains no new studies with human participants or animals performed by any authors. Competing Interests: ADK is the Editor-in-Chief for CPHRs. 10. J Nucl Med. 2023 Sep;64(9):1371-1377. doi: 10.2967/jnumed.122.265278. Epub 2023 Jul 6. [(18)F]FDG PET/CT in the Initial Staging and Restaging of Soft-Tissue or Bone Sarcoma in Patients with Negative or Equivocal Findings for Metastases or Limited Recurrence on Conventional Work-up: Results of a Prospective Multicenter Registry. Metser U(1), Kulanthaivelu R(2), Salawu A(3), Razak A(3), Mak V(4), Li X(5), Langer DL(4), MacCrostie P(4), Singnurkar A(6). Author information: (1)University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; ur.metser@uhn.ca. (2)University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. (3)Division of Medical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada. (4)Cancer Imaging Program, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada. (5)Department of Biostatistics, University Health Network, Toronto, Ontario, Canada; and. (6)Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. Erratum in J Nucl Med. 2024 May 1;65(5):809. The purpose of this study was to determine the impact of [18F]FDG PET/CT on the initial staging, restaging, clinical management, and outcomes of patients with soft-tissue and bone sarcomas. Methods: This single-arm, prospective multicenter registry enrolled 304 patients with 320 [18F]FDG PET/CT scans (November 2018 to October 2021). Eligibility included the initial staging of a grade 2 or higher or ungradable soft-tissue or bone sarcoma, with negative or equivocal findings for nodal or distant metastases on conventional imaging before curative-intent therapy, or restaging of patients with a history of treated sarcoma with a suspicion or confirmation of local recurrence or limited metastatic disease who were being considered for curative-intent or salvage therapy. The presence of local recurrence or metastases on [18F]FDG PET/CT was recorded. Clinical management after [18F]FDG PET/CT compared with pre-[18F]FDG PET/CT planned management and quantitative metabolic tumor parameters (SUVmax, metabolic tumor volume, total lesion glycolysis) were correlated with the outcome data for 171 patients. Results: At the initial staging, [18F]FDG PET/CT detected metastases in 17 of 105 patients (16.2%) with no metastases on conventional work-up and confirmed metastases in 44 of 92 patients (47.8%) with equivocal findings for metastases. At the time of restaging, [18F]FDG PET/CT detected local recurrence in 37 of 123 patients (30.1%) and distant metastases in 71 of 123 patients (57.7%). Overall, the change in treatment intent and treatment type was recorded in 64 of 171 cases (37.4%) and 56 of 171 cases (32.8%), respectively. The presence of metastases on [18F]FDG PET/CT was associated with shorter progression-free survival at the initial staging (P = 0.04) and shorter overall survival at the time of recurrence (P = 0.002). All quantitative metabolic tumor parameters correlated with progression-free survival and overall survival. Conclusion: [18F]FDG PET/CT frequently detects additional sites of disease compared with conventional imaging in patients with sarcomas that were being considered for curative-intent or salvage therapy. This increased detection impacts the clinical management in a third of patients referred for initial staging or presumed limited recurrence after primary therapy. The presence of metastases on [18F]FDG PET/CT is associated with poorer outcomes. © 2023 by the Society of Nuclear Medicine and Molecular Imaging. DOI: 10.2967/jnumed.122.265278