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Evaluation of Chemotherapy Response in Primary Bone Tumors with F-18 FDG Positron Emission Tomography Compared with Histologically Assessed Tumor Necrosis


Original Articles

Purpose The purpose of this study was to evaluate the potential of positron emission tomography using F-18-fluoro-2-deoxy-D-glucose (FDG PET) to assess the chemotherapy response of primary osseous tumors compared with the degree of necrosis determined histologically.

Patients and Methods Seventeen patients with primary bone tumors (11 osteosarcomas, 6 Ewing’s sarcomas) were examined using FDG PET and planar bone scintigraphy before neoadjuvant chemotherapy and before surgery. Tumor response was classified histologically according to Salzer-Kuntschik (grades I–III: good response; grades IV–VI: poor response). In both imaging methods, quantification was performed using tumor to nontumor ratios (T:NT).

Results Histologically, 15 patients were classified as having good responses (grade I, n = 1; grade II, n = 6; grade III, n = 8) and two as having poor responses (grades IV and V). FDG PET showed more than a 30% decrease in T:NT ratios in all patients who had good responses. However, three of these patients had increasing bone scintigraphy T:NT ratios, and another five had decreasing ratios of less than 30%. The patients with poor responses had increasing T:NT ratios and decreasing ratios of less than 30%, respectively, using both imaging methods.

Conclusions FDG PET seems to be a promising tool for evaluating the response of primary osseous tumors to chemotherapy. In this preliminary study, FDG PET was superior to planar bone scintigraphy.

From the Department of Nuclear Medicine,* Gerhard-Domagk Institute of Pathology,† and Department of Pediatrics, Pediatric Hematology and Oncology,‡ University Hospital, Westfälische Wilhelms-Universität, Münster, Germany

Received for publication March 27, 2000.

Accepted May 29, 2000.

Reprint requests: Dr. Christiane Franzius, Klinik und Poliklinik für Nuklearmedizin, Universität Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany. E-mail:

© 2000 Lippincott Williams & Wilkins, Inc.