Just wanted to pass it on.
Imaging and response in soft tissue sarcomas
https://experts.umich.edu/en/publicatio ... e-sarcomas
Imaging and response in soft tissue sarcomas
Imaging and response in soft tissue sarcomas
In reading an article on pseudo capsulation of most sarcomas , I linked to this discussion on how imaging of tumors , especially with various sarcoma tumors ,it's been stated that the increase seen with the scan(s) may not be progression . Instead it can be neurcrotic tissue Inflammation. So the recist values maybe aren't applicable ?
Just wanted to pass it on.
Imaging and response in soft tissue sarcomas
https://experts.umich.edu/en/publicatio ... e-sarcomas
Just wanted to pass it on.
Imaging and response in soft tissue sarcomas
https://experts.umich.edu/en/publicatio ... e-sarcomas
Debbie
Re: Imaging and response in soft tissue sarcomas
Abstract
The ability of RECIST to identify the sarcomas that are responding biologically to cytotoxic therapies is poor. Moreover, it has not been shown conclusively that RECIST response portends an improved clinical outcome, or conversely that lack of RECIST response is associated with earlier death from disease. Soft tissue sarcomas are a diverse group of neoplasms of which many are structurally complex. The heterogeneity of tissues that make up sarcomas and the highly vascular nature of high-grade lesions likely contribute significantly to the poor correlation of changes in tumor size with cellular responses to chemotherapy and radiotherapy. Imaging modalities that measure biologic processes have been studied in sarcomas, but most of the studies have been exploratory in nature, the results are preliminary, and a correlation with clinical outcomes has not been reported with the exception of FDG PET. Nevertheless, functional imaging methods are promising means to depict important biologic changes in sarcomas in response to therapy. The treatment of extremity sarcomas using ILP has provided a platform of uniform treatment with which to study the ability of FDG PET, DCE-MRI, and MRS to predict pathologic response. A consistent finding was that a change in tumor size did not correlate with histologic response. A change in FDG uptake, the rate of tissue enhancement, and phosphomonoester levels correlated with histologic findings, thus functional imaging of a biologic process more accurately reflected tumor viability after ILP than conventional MRI. FDG PET may be the most useful of the three methods because of higher spatial resolution in the images, availability, and the ability to detect a response early after therapy. However, tumor necrosis factor is not widely available, and changes in the biologic parameters of sarcomas treated with ILP versus systemic chemotherapy may not be similar. FDG PET findings have correlated with disease recurrence/progression and survival in extremity soft tissue sarcomas and GIST. These findings should be corroborated with larger multi-institutional trials and trials of other agents to determine whether PET is informative for a more diverse group of sarcoma patients. As more active drugs for the treatment of GIST become available clinically, PET may be the most useful method to monitor tumor response to therapy and influence therapeutic decisions. The ability of PET and other functional imaging modalities to detect early responses to therapy make them more suitable than RECIST to predict clinical outcomes from chemotherapy. A concerted effort to conduct appropriately designed clinical, multicenter studies is needed to replace tumor size with biochemical parameters in the assessment of response. The biochemical parameter and imaging modality most suited to measure response may be histology specific, thus identifiable only through cooperative efforts.
The ability of RECIST to identify the sarcomas that are responding biologically to cytotoxic therapies is poor. Moreover, it has not been shown conclusively that RECIST response portends an improved clinical outcome, or conversely that lack of RECIST response is associated with earlier death from disease. Soft tissue sarcomas are a diverse group of neoplasms of which many are structurally complex. The heterogeneity of tissues that make up sarcomas and the highly vascular nature of high-grade lesions likely contribute significantly to the poor correlation of changes in tumor size with cellular responses to chemotherapy and radiotherapy. Imaging modalities that measure biologic processes have been studied in sarcomas, but most of the studies have been exploratory in nature, the results are preliminary, and a correlation with clinical outcomes has not been reported with the exception of FDG PET. Nevertheless, functional imaging methods are promising means to depict important biologic changes in sarcomas in response to therapy. The treatment of extremity sarcomas using ILP has provided a platform of uniform treatment with which to study the ability of FDG PET, DCE-MRI, and MRS to predict pathologic response. A consistent finding was that a change in tumor size did not correlate with histologic response. A change in FDG uptake, the rate of tissue enhancement, and phosphomonoester levels correlated with histologic findings, thus functional imaging of a biologic process more accurately reflected tumor viability after ILP than conventional MRI. FDG PET may be the most useful of the three methods because of higher spatial resolution in the images, availability, and the ability to detect a response early after therapy. However, tumor necrosis factor is not widely available, and changes in the biologic parameters of sarcomas treated with ILP versus systemic chemotherapy may not be similar. FDG PET findings have correlated with disease recurrence/progression and survival in extremity soft tissue sarcomas and GIST. These findings should be corroborated with larger multi-institutional trials and trials of other agents to determine whether PET is informative for a more diverse group of sarcoma patients. As more active drugs for the treatment of GIST become available clinically, PET may be the most useful method to monitor tumor response to therapy and influence therapeutic decisions. The ability of PET and other functional imaging modalities to detect early responses to therapy make them more suitable than RECIST to predict clinical outcomes from chemotherapy. A concerted effort to conduct appropriately designed clinical, multicenter studies is needed to replace tumor size with biochemical parameters in the assessment of response. The biochemical parameter and imaging modality most suited to measure response may be histology specific, thus identifiable only through cooperative efforts.
Debbie