title: Tumour response of osteosarcoma to neoadjuvant chemotherapy evaluated by magnetic resonance imaging as prognostic factor for outcome.
abstract: OBJECTIVE
  This study evaluated the feasibility of computed magnetic resonance imaging (MRI) volumetry in conventional osteosarcomas. Secondly, we investigated whether computed volumetry provides new prognostic indicators for histological response of osteosarcomas after neoadjuvant chemotherapy.
  
  
  METHODS
  In a retrospective cohort study, data from the Vienna Bone Tumour Registry was used. MR images from 14 patients (male:female = 1.8, mean age 19 years) were analysed prior to and after neoadjuvant chemotherapy according to current therapy regimens. Histological response to chemotherapy was graded according to the Salzer-Kuntschik classification. Computed volumetry was performed for the intraosseous part, as well as the soft-tissue component and the tumour as a whole.
  
  
  RESULTS
  In a setting of appropriate radiological equipment, the method has been considered to be well implementable into clinical routine. The mean tumour volume prior to chemotherapy was 321 (±351) ml. In good responders (n = 6), overall tumour volume decreased by 47% (p = 0.345), whereas poor responders (n = 8) showed a 19% decrease (p = 0.128). Neoadjuvant multidrug therapy remarkably changed the tumour composition. This is seen in a decrease of the mean ratio of soft-tissue to intraosseous tumour volume from 8.67 in poor responders and 1.15 in good responders to 1.26 and 0.45 (p = 0.065), respectively. Interestingly, the bony compartment of good responders showed a volume increase during neoadjuvant chemotherapy (p = 0.073). However, we did not find prognostic markers for histological tumour response to pre-operative chemotherapy.
  
  
  CONCLUSIONS
  Separated volumetry of tumour segments revealed interesting insights into therapy-induced growth patterns. If verified in a larger study population, these results should be taken into account when planning ablative surgery.
authors.affiliation: Department of Orthopaedic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria, christoph.laux@me.com.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Laux
authors.forename: Gundula
authors.initials: G
authors.lastname: Berzaczy
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Susanna
authors.initials: S
authors.lastname: Lang
authors.forename: Martin
authors.initials: M
authors.lastname: Dominkus
authors.forename: Reinhard
authors.initials: R
authors.lastname: Windhager
authors.forename: Iris-Melanie
authors.initials: IM
authors.lastname: Nöbauer-Huhmann
authors.forename: Philipp T
authors.initials: PT
authors.lastname: Funovics
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult