Colour Doppler ultrasound predicts chemotherapy response, but not survival in paediatric osteosarcoma.
BACKGROUND
Histological response to chemotherapy is an important prognostic factor in osteosarcoma, influencing therapeutic considerations. It would be advantageous to be able to assess chemotherapy response, and predict survival, prior to tumour resection. Colour Doppler US (CDUS) is non-invasive, non-demanding for the patient, and easy to plan. This makes the method especially suitable for children, who comprise the majority of patients.


OBJECTIVE
To establish the value of CDUS for pre-operative prediction of chemotherapy response and survival, using widely available US equipment.


METHODS
CDUS was performed in 21 consecutive patients before and after chemotherapy. Peak systolic velocity (PSV) in the soft-tissue component of the tumour and quotient of resistive index (QRI) of the feeding artery and contralateral control were calculated. A pathologist, unaware of CDUS results, assessed the response to chemotherapy after resection.


RESULTS
QRI change after chemotherapy was significantly higher in histological responders. No correlation of QRI change with survival was found. There was no significant difference in PSV change comparing any subgroup. CDUS appeared useful in predicting chemotherapy response (sensitivity 83%, specificity 86%), especially for negative response (predictive value 92%). Survival could not be predicted accurately.


CONCLUSIONS
CDUS can predict chemotherapy response, but not survival. The method could be useful in planning treatment prior to definitive surgery.
Bramer
Jos A M
JA
Department of Orthopaedic Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. jbramer@wxs.nl
Gubler
Feikje M
FM
Maas
Mario
M
Bras
Hans
H
de Kraker
Jan
J
van der Eijken
Jan W
JW
Schaap
Gerard R
GR
D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012074:Remission Induction; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color