PET response criteria in solid tumors predicts progression-free survival and time to local or distant progression after chemotherapy with regional hyperthermia for soft-tissue sarcoma.
We evaluated the prognostic accuracy of established PET and CT response criteria in patients with soft-tissue sarcoma (STS) after combined chemotherapy plus regional hyperthermia (RHT).


METHODS
Seventy-three patients underwent (18)F-FDG PET/CT before and after 2-4 cycles of neoadjuvant chemotherapy with RHT for STS. Progression-free survival (PFS) and time to local and distant progression were among other factors correlated with response according to PET Response Criteria in Solid Tumors (PERCIST 1.0) and Response Evaluation Criteria in Solid Tumors (RECIST 1.1).


RESULTS
Metabolic response by PERCIST (n = 44/73) was an independent predictor for PFS (P = 0.002; hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.18-0.68) and time to local or distant progression. Other independent predictors for PFS by multivariate analysis were adjuvant radiotherapy (P = 0.010; HR, 0.39; 95% CI, 0.20-0.80) and a baseline tumor size less than 5.7 cm (P = 0.012; HR, 0.43; 95% CI, 0.22-0.83). Response by RECIST 1.1 was seen in a small group of patients (n = 22/73) and allowed prediction of PFS for patients with sarcoma outside the abdomen (P = 0.048; HR, 0.13; 95% CI, 0.02-0.98).


CONCLUSIONS
Metabolic response by (18)F-FDG PET predicts PFS and time to local and distant progression after 2-4 cycles of neoadjuvant chemotherapy plus RHT for STS.
Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany wolfgang.fendler@med.uni-muenchen.de.
Wolfgang P
WP
Fendler
Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
Mona
M
Lehmann
Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
Andrei
A
Todica
Department of Nuclear Medicine, Julius-Maximilians-University of Würzburg, Würzburg, Germany.
Ken
K
Herrmann
Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Thomas
T
Knösel
Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany Center for Bone and Soft Tissue Sarcoma (SarKUM), Ludwig-Maximilians-University of Munich, Munich, Germany.
Martin K
MK
Angele
Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany Center for Bone and Soft Tissue Sarcoma (SarKUM), Ludwig-Maximilians-University of Munich, Munich, Germany Department of Orthopaedic Surgery, Orthopaedic Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Hans Roland
HR
Dürr
Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany Center for Bone and Soft Tissue Sarcoma (SarKUM), Ludwig-Maximilians-University of Munich, Munich, Germany Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Josefine
J
Rauch
Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany.
Peter
P
Bartenstein
Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Clemens C
CC
Cyran
Department of Nuclear Medicine, Vienna General Hospital, Vienna, Austria; and.
Marcus
M
Hacker
Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany Center for Bone and Soft Tissue Sarcoma (SarKUM), Ludwig-Maximilians-University of Munich, Munich, Germany Department of Internal Medicine III, Ludwig-Maximilians-University of Munich, Munich, Germany.
Lars H
LH
Lindner
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed / Q000379:methods
D000970:Antineoplastic Agents
FDG; PET; hyperthermia; soft-tissue sarcoma; survival