Role of F-FDG-PET/CT in the initial staging of very high-risk Ewing Sarcoma in a prospective multicentric Phase II Study: Is there still a place for bone marrow sampling?

Jamie Probert, Valerie Laurence, Camille Cordero, Veronique Mosseri, Anne-Sophie Plissonnier, Thibaut Cassou-Mounat, Estelle Thebaud, Cécile Verité, Laure Saumet, Ludovic Mansuy, Natacha Entz-Werle, Nina Jehanno, Gabriel Revon Rivière, Thibaud Valentin, Nathalie Gaspar, Marie-Pierre Castex, Dominique Plantaz, Cyril Lervat, Maria Rios, Nadège Corradini, Mehdi Brahmi

Journal: British journal of cancer 2024;131(10):1605-1612

PMID: 39379569

Full Text on Nature Publishing Group View on PubMed

Abstract

BACKGROUND

The Ewing Sarcoma Family of Tumors (ESFT) constitutes a group of rare malignancies, wherein approximately one-third of cases exhibit metastatic spread, particularly impacting prognosis when bone and/or bone marrow (BM) are involved. Primary extra-pulmonary metastatic ESFT often necessitates intensified therapeutic approaches. Accurate staging plays a pivotal role in clinical decision-making, with fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) currently serving as a non-invasive modality for assessing ESFT's BM extent.

METHODS

In the French phase II COMBINAIR3 (NCT03011528) study, a comprehensive approach for patients with extra-pulmonary ESFT metastasis was evaluated. We prospectively compared the efficacy of PET/CT to BM aspiration and biopsy (BMAB) analysis in patients undergoing initial staging.

RESULTS

Among the 42 patients analyzed (median age 14 y, 2:1 male/female ratio), 45% presented with pelvic primary tumors and 83% had bone/BM involvement at diagnosis. Our findings showed PET/CT had 100% specificity and 83.3% sensitivity in detecting initial BM involvement. Overall, PET/CT correctly classified 92.8% of patients, reaching 100% accuracy in patients identified with bone involvement, thus surpassing the standard BMAB.

DISCUSSION

These results suggest that the conventional use of BMAB in the initial staging of high-risk ESFT patients can be omitted, promoting PET/CT as a non-invasive alternative, thus improving staging accuracy and treatment decisions in ESFT management.

Address: Department of Nuclear Medicine, Curie Institute, Paris, France. [email protected].; Department of Pediatric Oncology, Institute for Paediatric Haematology and Oncology, Léon Bérard Center, Lyon, France.; Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France.; Department of Medical Oncology, Léon Bérard Center, Lyon, France.; Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France.; Department of Pediatric Hematology, Immunology and Oncology, APHM - La Timone Children's Hospital, Marseille, France.; Department of Pediatric and AYA Oncology, Centre Oscar Lambret, Lille, France.; Department of Pediatric Onco-hematology, University Hospital of Rennes, Rennes, France.; Department of Pediatric Oncology, CHU, Strasbourg, France.; Children's University Hospital, Department of Pediatric Hematology and Oncology, Nancy, France.; Department of Pediatric Hematology and Oncology, University Hospital of Grenoble, Grenoble, France.; Institut de Cancérologie de Lorraine-Alexis Vautrin, Vandoeuvre-lès-Nancy, France.; Department of Pediatric Onco-Hematology, University Hospital of Montpellier, Montpellier, France.; Department of Pediatric and Adolescent Hematology and Oncology, Pellegrin Hospital, Bordeaux, France.; Pediatric Oncology Immunology Hematology Unit, Children's University Hospital - Toulouse University Hospital, Toulouse, France.; Department of Pediatric Oncology, Hôpital Mère-Enfant, Nantes, France.; Nuclear Medicine Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.; DREH Pôle Promotion, Institut Curie, Saint-Cloud, France.; Department of Biostatistics, Curie Institut, Saint-Cloud, France.; Adolescents and Young Adults Unit, Medical Oncology and SIREDO (Care, Innovation and Research for Children, Adolescents, and Young Adults with Cancer) Departments, Curie Institute, Paris, France.

DOI: 10.1038/s41416-024-02864-8

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MeSH Terms: Humans, Sarcoma, Ewing, Female, Positron Emission Tomography Computed Tomography, Male, Fluorodeoxyglucose F18, Adolescent, Prospective Studies, Bone Neoplasms, Bone Marrow, Neoplasm Staging, Child, Adult, Young Adult, Radiopharmaceuticals