title: Role of dynamic MRI and clinical assessment in predicting histologic response to neoadjuvant chemotherapy in bone sarcomas.
abstract: BACKGROUND
  Neoadjuvant chemotherapy has become the first-line therapy in management of malignant bone tumors. Response to it is best assessed with evaluation of tumor necrosis postoperatively. This study was carried out to evaluate the role of clinical parameters and dynamic magnetic resonance imaging (MRI) to predict the histologic response before surgery.
  
  
  METHODS
  Our study included 14 patients (12 osteosarcoma and 2 malignant fibrous histiocytoma) with mean age of 21.8 years, treated with neoadjuvant chemotherapy followed by surgery, who were evaluated clinically and with dynamic MRI twice, before starting chemotherapy and before surgery. Clinical parameters (pain, tumor girth, maximum tumor diameter, surface temperature, and consistency) and dynamic MRI parameter (slope of signal intensity-time curve) were correlated with histologic response (percentage of necrosis) using Pearson and Spearman correlation test.
  
  
  RESULTS
  Significant correlation with histologic necrosis was seen in change in pain, tumor girth, maximum tumor diameter, surface temperature, and dynamic MRI slope (P<0.01). Change in consistency did not show significant correlation (P>0.05). Complete relieve of pain with reduction of >4 grades, ≥5% reduction in tumor girth, ≥8% reduction in tumor diameter, attainment of normal body temperature or decrease of ≥2°F temperature, and ≥60% reduction in slope proved to be an indicator of good histologic response.
  
  
  CONCLUSIONS
  Both dynamic MRI and clinical evaluation are reliable methods of assessment of response of the bone tumors to neoadjuvant chemotherapy.
authors: *Department of Orthopaedics, Acharyashree Bhikshu Government Hospital, New Delhi Departments of †Orthopaedics ‡Pathology §Radiodiagnosis ∥Radiotherapy, JIPMER, Pondicherry, India.
authors: Priyadarshi
authors: P
authors: Amit
authors: Dilip K
authors: DK
authors: Patro
authors: Debdatta
authors: D
authors: Basu
authors: Sundar
authors: S
authors: Elangovan
authors: Vadasoundaram
authors: V
authors: Parathasarathy
mesh_terms: D000293:Adolescent; D000328:Adult; D001831:Body Temperature; D001859:Bone Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods; D012516:Osteosarcoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D010146:Pain / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult