PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005...
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![Page 1: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/1.jpg)
PET after Chemotherapy in Rhabdomyosarcoma
Connective Tissue Oncology SocietyNovember 19, 2005
Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko Schoder, Paul A. Meyers,
Suzanne L. Wolden
Memorial Sloan-Kettering Cancer Center
![Page 2: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/2.jpg)
Background
• Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood.
• Staging system is clinical and radiographic.
• PET for initial staging– Identify involved LN, distant metastases– Determine involvement of CT/MRI equivocal
sites
![Page 3: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/3.jpg)
Chest wall embryonal RMS (SUV 5.1)
Supraclavicular LN (SUV 2.8)
PET at Diagnosis
![Page 4: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/4.jpg)
Hypothesis
• Initial treatment will result in a decreased SUV at the primary site of disease
• Study design- retrospective review of RMS patients who had PET scans at diagnosis and after receiving initial therapy
![Page 5: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/5.jpg)
Methods
• PET scans performed on • Biograph PET/CT scanner (Siemens)
• Discovery LS PET/CT scanner (General Electric)
• GE ADVANCE PET scanner (General Electric)
• SUV at primary, regional, distant sites, and areas of clinical suspicion
• Scans obtained 1 hour after iv 18F-FDG
![Page 6: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/6.jpg)
Patient Characteristics
• All patients with RMS treated at MSKCC from 2/02 till 12/04 were reviewed
• 20 had PET at the time of diagnosis and after receiving chemotherapy– 11 patients had PET prior to any chemo– 9 patients within first cycle of chemotherapy
(13 days)
![Page 7: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/7.jpg)
Patient Characteristics
• 13 females, 7 males• Median age 12.3 years (range 2-38 years)• 10 embryonal, 10 alveolar• Stage
– Stage II: 1– Stage III: 14– Stage IV: 5
• Group– Group 3: 15– Group 4: 5
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Primary Site
Parameningeal45%
GU8%
Head and neck13%
Trunk17%
Extremity17%
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Treatment Prior to PET
• All patients received 2-8 cycles of chemotherapy prior to follow up PET
• 5 patients completed radiation prior to PET
![Page 10: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/10.jpg)
Rapid Response of PET to Chemotherapy
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Rapid Response of PET to Chemotherapy
![Page 12: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/12.jpg)
Initial SUVMedian SUV
SUV range
All patients (n=20)
5.5 2.4-12.7
Baseline PET prior to chemo(n=11)
8.1 4.1-12.7
Baseline PET within 1 cycle of chemo (n=9)
4.1* 2.4-8.4*p=0.006
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Results
• First follow up PET– median of 2.8 months after chemotherapy
(1.3-7.3m)
– median of 4 cycles of chemotherapy
• 18 patients had a decrease in SUV– Median decrease 3.7, range (0.2-11.7)
![Page 14: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/14.jpg)
Results
• 12 patients with normal PET by first follow up– 3 had completed radiation
• 18 had eventual normalization of PET• No correlation of early normalization of PET with
– primary site of disease, histology, stage, group– gender, age at diagnosis– SUV at diagnosis
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Time to Normalization
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Pathologic correlation
Residual tumor6 (86%)
No residual tumor1 (14%)
Positive PET7
Residual tumor1 (33%)
No residual tumor2 (67%)
Negative PET3
10 patients with biopsy or 2nd look surgerywho had PET within 6 weeks prior to procedure
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Response on PET
3 year old boy with alveolarRMS in the glutealand pelvic regions
![Page 18: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/18.jpg)
Response on PET
Irinotecan/ Carboplatin
3 year old boy with alveolarRMS in the glutealand pelvic regions
![Page 19: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/19.jpg)
Response on PET
14 year old female with an alveolarparanasal RMS
![Page 20: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/20.jpg)
Response on PET
14 year old female with an alveolarparanasal RMS
Irinotecan/ Carboplatin
![Page 21: PET after Chemotherapy in Rhabdomyosarcoma Connective Tissue Oncology Society November 19, 2005 Michelle L. Klem, Leonard H. Wexler, Ravinder Grewal, Heiko.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd35503460f94acafc6/html5/thumbnails/21.jpg)
Conclusions
• PET has potential utility in monitoring response to treatment.
• SUV at primary site is higher when initial PET is prior to therapy. PET should be performed prior to chemotherapy when possible.
• A decrease in SUV was seen with therapy.• Most patients had normalization by first follow up PET. • Normalization of PET correlated with pathologic
response to therapy.• Further work is needed to assess if response on PET
can be used to guide therapy and predict response in RMS.