title: Assessment of Imaging Modalities and Response Metrics in Ewing Sarcoma: Correlation With Survival.
abstract: OBJECTIVE
  Despite the rapidly increasing use of [18F]fluorodeoxyglucose (FDG) -positron emission tomography (PET), the comparison of anatomic and functional imaging in the assessment of clinical outcomes has been lacking. In addition, there has not been a rigorous evaluation of how common radiologic criteria or the location of the radiology reader (local v central) compare in the ability to predict benefit. In this study, we aimed to compare the effectiveness of various radiologic response assessments for the prediction of overall survival (OS) within the same data set of patients with sarcoma.
  
  
  METHODS
  We analyzed assessments made during a clinical trial of a novel IGF1R antibody in Ewing sarcoma: PET Response Criteria in Solid Tumors (PERCIST) for functional imaging and WHO criteria (performed locally and centrally), RECIST, and volumetric analysis for anatomic imaging. We compared the effectiveness of the various criteria for the prediction of progression and survival.
  
  
  RESULTS
  For volume analysis, progression-defined as cumulative lesion volume increase of 100% at 6 weeks-was the optimal cutoff for decreased OS (P < .001). Assessment of the day-9 FDG-PET scan was associated with reduced OS in progressors compared with nonprogressors (P = .001) and with improved OS in responders compared with nonresponders. Significant variations in response (18% to 44%) and progression (9% to 50%) were observed between the different criteria. The comparison of central and local interpretation of anatomic imaging produced similar outcomes. PET was superior to anatomic imaging in identification of a response. Volume analysis identified the most responders among the anatomic imaging criteria.
  
  
  CONCLUSIONS
  An early signal with FDG-PET on day 9 and volume analysis were the best predictors of benefit. Validation of the volumetric analysis is required.
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Vadim S
authors: VS
authors: Koshkin
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Vanessa
authors: V
authors: Bolejack
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Lawrence H
authors: LH
authors: Schwartz
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Richard L
authors: RL
authors: Wahl
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Rashmi
authors: R
authors: Chugh
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Denise K
authors: DK
authors: Reinke
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Binsheng
authors: B
authors: Zhao
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Joo H
authors: JH
authors: O
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Shreyaskumar R
authors: SR
authors: Patel
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Scott M
authors: SM
authors: Schuetze
authors: Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Laurence H
authors: LH
authors: Baker