PET can help guide treatment decisions for a common pediatric cancer

August 3, 2009

A new study published in the August issue of The Journal of Nuclear Medicine shows that positron emission tomography (PET) is an important tool for depicting the extent of neuroblastoma in some patients, particularly for those in the early stages of the disease. Neuroblastoma accounts for six to ten percent of all childhood cancers in the United States and 15 percent of cancer deaths in children. Accurately identifying where in the body the disease is located and whether it is spreading is critical for choosing appropriate types of treatment, which can include surgery, chemotherapy, radiation and—in the most advanced cases—a combination of all of these treatments along with bone marrow transplant or investigational therapies.

In recent years, 123I-metaiodobenzylguanidine (MIBG) has been the main functional imaging agent used to assess the disease. Fluorodeoxyglucose (FDG) PET imaging of neuroblastoma is increasing, but questions remain regarding when and in which patients FDG PET imaging is most useful.

"Functional imaging plays an important role in assessing neuroblastoma, from initially diagnosing and staging the disease to determining whether patients are responding to treatment or whether the disease has recurred," said Susan E. Sharp, M.D., assistant professor of clinical radiology at Cincinnati Children's Hospital Medical Center and lead author of the study. "Our study found that while MIBG remains the front-line imaging tool for neuroblastoma, FDG-PET imaging can benefit some patients, especially those with early-stage disease."

The study also found that FDG PET may also be useful in imaging neuroblastoma tumors that do not readily absorb MIBG. In these cases, imaging with MIBG alone may not reveal some malignant lesions in the body.

Neuroblastoma—a form of cancer that starts in certain types of very primitive developing found in an embryo or fetus—occurs most frequently in infants and young children. There are about 650 new cases of the cancer reported in the U.S. each year, according to the National Cancer Institute. The cancer most often originates on the adrenal glands—the triangular-shaped glands above the kidneys. Neuroblastoma often spreads to other parts of the body before any symptoms are apparent.

Patients with the disease are classified as low-, medium- or high-risk based on a combination of clinical staging of the disease and certain biologic and genetic characteristics, such as the age of the patient, extent of disease spread, microscopic appearance and genetic factors.

Treatment for each of the risk categories is very different. If the cancer is limited to one part of the body, it is often curable with surgery, sometimes with the addition of chemotherapy. However, long-term survival for children older than 18 months of age with advanced disease is poor despite aggressive treatments that include a combination of , surgery, and investigational therapies.

In the study, a total of 113 paired MIBG scans and FDG PET scans in 60 patients with neuroblastoma at two major pediatric cancer institutions were reviewed. PET was used in conjunction with localization computerized tomography (CT) scans, and MIBG planar and SPECT imaging were combined. The study shows that for stage 1 and stage 2 neuroblastoma patients, FDG-PET depicted more primary or residual neuroblastoma, although MIBG imaging may be needed to exclude higher-stage disease that has spread to the bone or bone marrow. MIBG is superior in evaluating stage 4 neuroblastoma, primarily because it can detect and follow the response to treatment of tumor in the bone or more accurately.

More information: S. Sharp, B. Shulkin, M. Gelfand, S. Salisbury, W. Furman, Departments of Radiology and Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati; and Departments of Radiological Sciences and Oncology, St. Jude Children's Research Hospital, Memphis,"123 I-MIBG Scintigraphy and 18F-FDG PET in Neuroblastoma," The , August 2009.

Source: Society of Nuclear Medicine (news : web)

Related Stories

Recommended for you

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...

How CD44s gives brain cancer a survival advantage

July 19, 2017
Understanding the mechanisms that give cancer cells the ability to survive and grow opens the possibility of developing improved treatments to control or cure the disease. In the case of glioblastoma multiforme, the deadliest ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.