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Imaging of Bone Tumors and Tumor-Like Lesions pp 199–210Cite as

Assessment of Response to Chemotherapy and Radiotherapy

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Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Key Points

• The most valuable, readily available and easy-to-use techniques to assess response to radiation therapy and chemotherapy in malignant bone tumours are DCE-MR imaging, diffusion MR imaging and colour-Doppler ultrasound.

• Dynamic contrast-enhanced MR imaging allows to study the physiological effects of therapy graphically in TICs or in parametric images, that display tumour microvascularisation, perfusion, capillary permeability and volume of the interstitial space.

• There is not enough evidence to use F-18 FDG-PET routinely for monitoring therapy in bone sarcomas.

Findings indicating good response to therapy in bone sarcomas are:

• Disappearance of high systolic Doppler frequency shifts and an increased resistive index on colour-Doppler ultrasound

• Appearance of high signal intensity in bone marrow on T2-weighted images (after radiation therapy)

• Change to slow and moderate to absent enhancement on DCE-MR imaging

• Increased diffusion of water molecules with high ADC values on diffusion MR imaging

Findings indicating poor response to therapy in bone sarcomas are:

• Persistence of high systolic Doppler frequency shifts and decreased resistive index on colour-Doppler ultrasound

• Increased extent of bone marrow invasion

• Increased tumour volume or identification of a new soft tissue mass

• No decrease in the amount of peritumoral oedema

• Persistence of fast and intense enhancement on DCE-MR imaging

• Persistence of decreased diffusion of water molecules with low ADC values on diffusion MR imaging

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References

  • Abudu A, Davies AM, Pynsent PB, Mangham DC, Tillman RM, Carter SR, Grimer RJ (1999) Tumour volume as a predictor of necrosis after chemotherapy in Ewing’s sarcoma. J Bone Joint Surg Br 81:317–322

    Article  PubMed  CAS  Google Scholar 

  • Arush MW, Israel O, Postovsky S, Militianu D, Meller I, Zaidman I, Sapir AE, Bar-Shalom R (2007) Positron emission tomography/computed tomography with 18fluoro-deoxyglucose in the detection of local recurrence and distant metastases of pediatric sarcoma. Pediatr Blood Cancer 49:901–905

    Article  PubMed  Google Scholar 

  • Bastiaannet E, Groen H, Jager PL, Cobben DC, van der Graaf WT, Vaalburg W, Hoekstra HJ (2004) The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas: a systematic review and meta-analysis. Cancer Treat Rev 30:83–101

    Article  PubMed  CAS  Google Scholar 

  • Bramer JA, Gubler FM, Maas M, Bras H, de Kraker J, van der Eijken JW, Schaap GR (2004) Colour Doppler ultrasound predicts chemotherapy response, but not survival in paediatric osteosarcoma. Pediatr Radiol 34:614–619

    Article  PubMed  Google Scholar 

  • De Baere T, Vanel D, Shapeero LG, Charpentier A, Terrier P, di Paola M (1992) Osteosarcoma after chemotherapy: evaluation with contrast material-enhanced subtraction MR imaging. Radiology 185:587–592

    PubMed  Google Scholar 

  • Duke University School of Medicine website: http://dblab.duhs.duke.edu/modules/PhysiologicalModels

    Google Scholar 

  • Dyke JP, Panicek DM, Healey JH, Meyers PA, Huvos AG, Schwartz LH, Thaler HT, Tofts PS, Gorlick R, Koutcher JA, Ballon D (2003) Osteogenic and Ewing sarcomas: estimation of necrotic fraction during induction chemotherapy with dynamic contrast-enhanced MR imaging. Radiology 228:271–278

    Article  PubMed  Google Scholar 

  • Egmont-Petersen M, Hogendoorn PC, van der Geest RJ, Vrooman HA, van der Woude H, Janssen JP, Bloem JL, Reiber JH (2000) Detection of areas with viable remnant tumour in postchemotherapy patients with Ewing’s sarcoma by dynamic contrast-enhanced MRI using pharmacokinetic modeling. Magn Reson Imaging 18:525–535

    Article  PubMed  CAS  Google Scholar 

  • El Khadrawy AM, Hoffer FA, Reddick WE (1999) Ewing’s sarcoma recurrence versus radiation necrosis in dynamic contrast-enhanced MR imaging: a case report. Pediatr Radiol 29:272–274

    Article  PubMed  Google Scholar 

  • Hayashida Y, Yakushiji T, Awai K, Katahira K, Nakayama Y, Shimomura O, Kitajima M, Hirai T, Yamashita Y, Mizuta H (2006) Monitoring therapeutic responses of primary bone tumours by diffusion-weighted image: initial results. Eur Radiol 16:2637–2643

    Article  PubMed  Google Scholar 

  • Holscher HC, Bloem JL, Vanel D, Hermans J, Nooy MA, Taminiau AH, Henry-Amar M (1992) Osteosarcoma: chemotherapy-induced changes at MR imaging. Radiology 182:839–844

    PubMed  CAS  Google Scholar 

  • Holscher HC, Bloem JL, van der Woude HJ, Hermans J, Nooy MA, Taminiau AH, Hogendoorn PC (1995) Can MRI predict the histopathological response in patients with osteosarcoma after the first cycle of chemotherapy? Clin Radiol 50:384–390

    Article  PubMed  CAS  Google Scholar 

  • Iagaru A, Masamed R, Chawla SP, Menendez LR, Fedenko A, Conti PS (2008) F-18 FDG PET and PET/CT evaluation of response to chemotherapy in bone and soft tissue sarcomas. Clin Nucl Med 33:8–13

    Article  PubMed  Google Scholar 

  • Kaste SC, Liu T, Billups CA, Daw NC, Pratt CB, Meyer WH (2004) Tumour size as a predictor of outcome in pediatric non-metastatic osteosarcoma of the extremity. Pediatr Blood Cancer 43:723–728

    Article  PubMed  Google Scholar 

  • Kauffman WM, Fletcher BD, Hanna SL, Meyer WH (1994) MR imaging findings in recurrent primary osseous Ewing sarcoma. Magn Reson Imaging 12:1147–1153

    Article  PubMed  CAS  Google Scholar 

  • Lang P, Honda G, Roberts T, Vahlensieck M, Johnston JO, Rosenau W, Mathur A, Peterfy C, Gooding CA, Genant HK (1995) Musculoskeletal neoplasm: perineoplastic edema versus tumour on dynamic postcontrast MR images with spatial mapping of instantaneous enhancement rates. Radiology 197:831–839

    PubMed  CAS  Google Scholar 

  • Lang P, Wendland MF, Saeed M, Gindele A, Rosenau W, Mathur A, Gooding CA, Genant HK (1998) Osteogenic sarcoma: noninvasive in vivo assessment of tumor necrosis with diffusion-weighted MR imaging. Radiology 206:227–235

    PubMed  CAS  Google Scholar 

  • Lemmi MA, Fletcher BD, Marina NM, Slade W, Parham DM, Jenkins JJ, Meyer WH (1990) Use of MR imaging to assess results of chemotherapy for Ewing sarcoma. AJR Am J Roentgenol 155:343–346

    PubMed  CAS  Google Scholar 

  • MacVicar AD, Olliff JF, Pringle J, Pinkerton CR, Husband JE (1992) Ewing sarcoma: MR imaging of chemotherapy-induced changes with histologic correlation. Radiology 184:859–864

    PubMed  CAS  Google Scholar 

  • McCarville MB, Christie R, Daw NC, Spunt SL, Kaste SC (2005) PET/CT in the evaluation of childhood sarcomas. AJR Am J Roentgenol 184:1293–1304

    PubMed  Google Scholar 

  • Miller SL, Hoffer FA, Reddick WE, Wu S, Glass JO, Gronemeyer SA, Haliloglu M, Nikanorov AY, Xiong X, Pappo AS (2001) Tumour volume or dynamic contrast-enhanced MRI for prediction of clinical outcome of Ewing sarcoma family of tumours. Pediatr Radiol 31:518–523

    Article  PubMed  CAS  Google Scholar 

  • National Institute of Health ImageJ website: http://rsbweb.nih.gov/ij/index.html

    Google Scholar 

  • Ongolo-Zogo P, Thiesse P, Sau J, Desuzinges C, Blay JY, Bonmartin A, Bochu M, Philip T (1999) Assessment of osteosarcoma response to neoadjuvant chemotherapy: comparative usefulness of dynamic gadolinium-enhanced spin-echo magnetic resonance imaging and technetium-99m skeletal angioscintigraphy. Eur Radiol 9:907–914

    Article  PubMed  CAS  Google Scholar 

  • Peterson JJ (2007) F-18 FDG-PET for detection of osseous metastatic disease and staging, restaging, and monitoring response to therapy of musculoskeletal tumours. Semin Musculoskelet Radiol 11:246–260

    Article  PubMed  Google Scholar 

  • Reddick WE, Bhargava R, Taylor JS, Meyer WH, Fletcher BD (1995) Dynamic contrast-enhanced MR imaging evaluation of osteosarcoma response to neoadjuvant chemotherapy. J Magn Reson Imaging 5:689–694

    Article  PubMed  CAS  Google Scholar 

  • Reddick WE, Taylor JS, Fletcher BD (1999) Dynamic MR imaging (DEMRI) of microcirculation in bone sarcoma. J Magn Reson Imaging 10:277–285

    Article  PubMed  CAS  Google Scholar 

  • Shin KH, Moon SH, Suh JS, Yang WI (2000) Tumour volume change as a predictor of chemotherapeutic response in osteosarcoma. Clin Orthop Relat Res 376:200–208

    Article  PubMed  Google Scholar 

  • Uhl M, Saueressig U, van Buiren M, Kontny U, Niemeyer C, Köhler G, Ilyasov K, Langer M (2006a) Osteosarcoma: preliminary results of in vivo assessment of tumour necrosis after chemotherapy with diffusion- and perfusion-weighted magnetic resonance imaging. Invest Radiol 41:618–623

    Article  CAS  Google Scholar 

  • Uhl M, Saueressig U, Koehler G, Kontny U, Niemeyer C, Reichardt W, Ilyasof K, Bley T, Langer M (2006b) Evaluation of tumour necrosis during chemotherapy with diffusion-weighted MR imaging: preliminary results in osteosarcomas. Pediatr Radiol 36:1306–1311

    Article  Google Scholar 

  • van der Woude HJ, Bloem JL, Schipper J, Hermans J, van Eck-Smit BL, van Oostayen J, Nooy MA, Taminiau AH, Holscher HC, Hogendoorn PC (1994a) Changes in tumour perfusion induced by chemotherapy in bone sarcomas: color Doppler flow imaging compared with contrast-enhanced MR imaging and three-phase bone scintigraphy. Radiology 191:421–431

    Google Scholar 

  • van der Woude HJ, Bloem JL, Holscher HC, Nooy MA, Taminiau AH, Hermans J, Falke TH, Hogendoorn PC (1994b) Monitoring the effect of chemotherapy in Ewing’s sarcoma of bone with MR imaging. Skeletal Radiol 23:493–500

    Google Scholar 

  • van der Woude HJ, Bloem JL, van Oostayen JA, Nooy MA, Taminiau AH, Hermans J, Reynierse M, Hogendoorn PC (1995a) Treatment of high-grade bone sarcomas with neoadjuvant chemotherapy: the utility of sequential color Doppler sonography in predicting histopathologic response. AJR Am J Roentgenol 165:125–133

    Google Scholar 

  • van der Woude HJ, Bloem JL, Verstraete KL, Taminiau AH, Nooy MA, Hogendoorn PC (1995b) Osteosarcoma and Ewing’s sarcoma after neoadjuvant chemotherapy: value of dynamic MR imaging in detecting viable tumour before surgery. AJR Am J Roentgenol 165:593–598

    Google Scholar 

  • van der Woude HJ, Bloem JL, Hogendoorn PC (1998) Preoperative evaluation and monitoring chemotherapy in patients with high-grade osteogenic and Ewing’s sarcoma: review of current imaging modalities. Skeletal Radiol 27:57–71

    Article  PubMed  Google Scholar 

  • van der Woude HJ, Vanderschueren G (1999) Ultrasound in musculoskeletal tumours with emphasis on its role in tumour follow-up. Radiol Clin North Am 37:753–766

    Article  PubMed  Google Scholar 

  • Verstraete KL, Dierick A, De Deene Y, Uyttendaele D, Vandamme F, Roels H, Kunnen M (1994a) First-pass images of musculoskeletal lesions: a new and useful diagnostic application of dynamic contrast-enhanced MRI. Magn Reson Imaging 12:687–702

    Article  CAS  Google Scholar 

  • Verstraete KL, De Deene Y, Roels H, Dierick A, Uyttendaele D, Kunnen M (1994b) Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging–parametric “first-pass” images depict tissue vascularisation and perfusion. Radiology 192:835–843

    CAS  Google Scholar 

  • Verstraete KL, Van der Woude HJ, Hogendoorn PC, De-Deene Y, Kunnen M, Bloem JL (1996) Dynamic contrast-enhanced MR imaging of musculoskeletal tumours: basic principles and clinical applications. J Magn Reson Imaging 6:311–321

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Chief Department of Radiology, Ghent University Hospital – UZG/MR/1K12, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Koenraad Verstraete

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  1. Koenraad Verstraete
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Editor information

Editors and Affiliations

  1. MRI Department, Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, B31 2AP, Birmingham, UK

    A. Mark Davies

  2. Section of Musculoskeletal Radiology, Imaging Institute, Diagnostic Radiology/A21, School of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, 9500 Euclid Ave., 44195, Cleveland, OH, USA

    Murali Sundaram

  3. Imaging Department, Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, B31 2AP, Birmingham, UK

    Steven L. J. James

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© 2009 Springer-Verlag Berlin Heidelberg

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Verstraete, K. (2009). Assessment of Response to Chemotherapy and Radiotherapy. In: Davies, A., Sundaram, M., James, S. (eds) Imaging of Bone Tumors and Tumor-Like Lesions. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77984-1_11

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  • DOI: https://doi.org/10.1007/978-3-540-77984-1_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-77982-7

  • Online ISBN: 978-3-540-77984-1

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