Preliminary experience using PET-CT in pediatric bone and soft tissue tumors

Abstract

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Objectives: To review preliminary experience using PET-CT in the staging and surveillance of children with bone and soft tissue tumors and to determine the optimum scan timing.

Methods: 39 children with presumed diagnosis of bone or soft tissue tumor were imaged with low dose FDG-PET-CT (61 scans) and compared to other standard imaging to detect malignancy at diagnosis, evaluate tumor response and detect relapse. To assess impact, 61 scans were retrospectively grouped into the following clinical time intervals: T1: pre biopsy; T2: pre local therapy; T3: end of therapy; T4: surveillance.

Results: Unsuspected metastases or disease progression was detected in 14/61 scans. At T1, 10/12 scans pathologically confirmed sarcoma. At T2, response to neoadjuvant therapy was identified in 8/12 scans. In 2/8 surgery was altered on the basis of scan response. At T3 and T4, 17/35 scans confirmed clinical course. At T4, in the absence of clinical signs or detected radiologic relapse, 9/21 scans had no impact.

Conclusions: FDG PET-CT shows promise in the management of pediatric bone and soft tissue tumors. The chosen four scan time intervals appear most useful. Surveillance scans are indicated only when there are clinical symptoms or management decisions required.