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Sarcoma Mid-Therapy [F-18]Fluorodeoxyglucose Positron Emission Tomography (FDG PET) and Patient Outcome
Janet F. Eary, MD1; Ernest U. Conrad, MD1; Janet O’Sullivan, MS2; Douglas S. Hawkins, MD3; Scott M. Schuetze, MD, PhD4; Finbarr O’Sullivan, PhD2
1 University of Washington, UWMC Box 356113, Seattle, WA 98195. E-mail address for J.F. Eary: jeary@UW.edu. E-mail address for E.U. Conrad: ernest.conrad@seattlechildrens.org
2 School of Mathematical Sciences, University College Cork, Western Gateway Building, Western Road, Cork, Ireland. E-mail address for J. O’Sullivan: janet.osullivan@ucc.ie. E-mail address for F. O’Sullivan: f.osullivan@ucc.ie
3 Department of Hematology and Oncology, Seattle Children’s Hospital, B 6553, 4800 Sand Point Way, Seattle, WA 98105. E-mail address: doug.hawkins@seattlechildrens.org
4 Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Cancer Center, 1500 East Medical Center Drive, SPC 5912, Ann Arbor, MI 48109. E-mail address: scotschu@med.umich.edu
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  • Disclosure statement for author(s): PDF

Investigation performed at the University of Washington, Seattle, Washington, United States, and University College Cork, Cork, Ireland

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 15;96(2):152-158. doi: 10.2106/JBJS.M.00062
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Our previous research investigated the ability of [F-18]fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging results to predict outcome in patients with sarcoma. Tumor uptake of FDG before and after neoadjuvant chemotherapy was predictive of patient outcome. With this background, a prospective clinical study was designed to assess whether tumor FDG uptake levels in the middle of neoadjuvant chemotherapy added additional prognostic information to pre-therapy imaging data.


Sixty-five patients with either bone or soft-tissue sarcoma were treated with neoadjuvant-based chemotherapy according to the standard clinical practice for each tumor group. All patients had FDG PET studies before therapy, mid-therapy (after two cycles of chemotherapy), and before resection. Tumor FDG uptake (SUVmax, the maximum standardized uptake value) at each imaging time point, tumor type (bone or soft-tissue sarcoma), tumor size, and histopathologic grade were recorded for each patient. The time from the pre-therapy FDG PET study to events of local tumor recurrence, metastasis, or death were extracted from the clinical records for comparison with the imaging data. Univariate and multivariate analyses of the imaging and clinical data were performed.


Univariate and multivariate data analyses showed that the difference (measured as the percentage reduction) between the pre-therapy and mid-therapy maximum tumor uptake values added prognostic value to patient outcome predictions independently of other patient variables.


The utility of a tumor pre-therapy FDG PET scan as a biomarker for the outcome of patients with sarcoma was strengthened by a mid-therapy scan to evaluate the interim treatment response.

Level of Evidence: 

Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Peer Review 

This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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