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Nuklearmedizin 2017; 56(06): 233-238
DOI: 10.3413/Nukmed-0909-17-07
Original Article
Schattauer GmbH

Ewing sarcoma during follow-up

The value of a predefined imaging protocol including FDG-PET/CT for the detection of tumour recurrenceEwing-Sarkom in der NachsorgeDer Wert eines vordefinierten BildgebungsProtokolls mit FDG-PET/CT zur Detektion von Tumor-Rezidiven
Melina Heinemann
1   University Hospital Münster, Department of Nuclear Medicine, Münster, Germany
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Andreas Ranft
2   University Hospital Essen, Pediatrics III, West German Cancer Centre, German Cancer Research Centre, Essen, Germany
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Heribert Jürgens
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Thorsten Langer
4   University Hospital Schleswig-Holstein, Campus Lübeck, Department of Paediatric Haematology and Oncology, Lübeck, Germany
,
Volker Vieth
5   University Hospital Münster, Department of Clinical Radiology, Münster, Germany
,
Beate Timmermann
6   West German Proton Centre, West German Cancer Centre, German Cancer Research Centre, University Hospital Essen, Essen, Germany
,
Matthias Weckesser
1   University Hospital Münster, Department of Nuclear Medicine, Münster, Germany
,
Uta Dirksen   *
2   University Hospital Essen, Pediatrics III, West German Cancer Centre, German Cancer Research Centre, Essen, Germany
3   University Hospital Münster, Department of Paediatric Haematology and Oncology, Münster, Germany
,
Lars Stegger   *
1   University Hospital Münster, Department of Nuclear Medicine, Münster, Germany
› Author AffiliationsFunding This work was supported by Deutsche Krebshilfe (DKH 108128), Bundesministerium für Bildung und Forschung (TranSaRNet), Deutsches Zentrum für Luft- und Raumfahrt e.V. and the European Union (01GM0869), EuroBoNet, EU-FP6; ENCCA, EEC (602856–2, EU FP7), PanCareLife (602030–2) EU-FP7; PROVABES ERA-NetTRANSCAN (01KT1310); BMBF-01ER0807.
Further Information

Publication History

Received: 03 July 2017

accepted in revised form: 30 August 2017

Publication Date:
11 January 2018 (online)

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Summary

Aim: To evaluate the performance of a prospectively defined follow-up imaging protocol that includes FDG-PET(/CT) to detect tumour recurrence in Ewing sarcoma (EwS) before becoming symptomatic.

Methods: Imaging results and clinical data during follow-up were retrospectively analysed from all patients treated successfully within the EURO E.W.I.N.G. 99 trial at the University Hospital Münster, Germany. All patients received follow-up imaging according to a comprehensive protocol that included regular X-ray, CT, MRI, bone scan and PET(/CT), albeit not all on the same day and with varying intervals for the different modalities.

Results: 80 of 105 patients underwent follow-up at our institution after complete remission. 30 patients had recurrent tumour during the follow-up period of 3.6 years on average. 19 recurrences (63%) were detected by scheduled imaging before the advent of clinical symptoms. The majority of these recurrences (8 out of 19; 42%) was detected first by PET/ CT (and confirmed with additional imaging thereafter), even though the total number of PET/CTs was comparatively low (138) and PET/CT was not systematically scheduled before other imaging techniques. Recurrences detected by bone scan were also detectable by PET.

Conclusions: The implemented follow-up protocol was effective in the detection of EwS recurrence before the advent of symptoms. Most cases of those detected before onset of symptoms were detected by PET/CT first. This hybrid imaging modality should therefore be considered in the routine follow-up of EwS patients, as is standard in our hospital. In combination with PET, low-dose chest CT seems to be sufficient in the detection of small pulmonary nodules.

Zusammenfassung

Ziel: Evaluation eines prospektiv definierten bildgebenden Nachsorge-Protokolls einschließlich FDG-PET(/CT) zur Erkennung von Rezidiven eines Ewing-Sarkoms (EwS) vor dem Auftreten von Symptomen.

Methoden: Die Ergebnisse der Bildgebung und klinische Daten im Rahmen der Nachsorge wurden retrospektiv bei allen Patienten erhoben, die erfolgreich innerhalb der EURO E.W.I.N.G 99 Studie am Universitätsklinikum Münster behandelt wurden. Alle Patienten erhielten eine Nachsorge gemäß einem umfassenden Bildgebungs-Protokoll, welches regelmäßige Röntgenuntersuchungen, CT, MRT, Skelett-Szintigraphie und PET(/CT) beinhaltete, die allerdings nicht alle am selben Tag und mit unterschiedlichen Intervallen für die einzelnen Modalitäten durchgeführt wurden.

Ergebnisse: 80 von 105 Patienten erhielten eine Nachsorge in unserem Zentrum nach kompletter Remission. 30 Patienten erlitten ein Rezidiv innerhalb der Nachsorgeperiode von durchschnittlich 3,6 Jahren. 19 Rezidive (63 %) wurden durch die vorgegebene Bildgebung vor dem Auftreten von Symptomen entdeckt. Die Mehrzahl (8 von 19; 42%) der so entdeckten Rezidive wurde als erstes durch PET/CT-Untersuchungen erkannt (und danach durch andere Bildgebungsmethoden bestätigt), obwohl die Gesamtzahl der durchgeführten PET/CTs vergleichsweise gering war (138) und diese Untersuchung nicht systematisch vor anderen Bildgebungsverfahren terminiert wurde. Rezidive, welche durch die Skelett-Szintigraphie entdeckt wurden, waren auch in der PET erkennbar.

Schlussfolgerungen: Das implementierte Bildgebungs-Nachsorgeprotokoll erwies sich als effektiv darin, EwS-Rezidive vor Symptom-Manifestation zu entdecken. Die meisten der vor Auftreten von Symptomen detektierten Rezidive wurden zuerst durch die PET/CT nachgewiesen. Die PET/CT sollte daher in die Nachsorge von EwS-Patienten eingeschlossen werden, so wie es bereits in unserem Klinikum Standard ist. In Kombination mit PET scheint die Low-dose-ThoraxCT suffizient zur Erkennung kleiner pulmonaler Läsionen zu sein.

Keywords

Ewing sarcoma - follow-up - CT - Bone scan - FDG-PET - PET/CT

Schlüsselwörter

Ewing-Sarkom - Nachsorge - CT - Skelettszintigraphie - FDG-PET - PET/CT

* Lars Stegger and Uta Dirksen contributed equally


 

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