Aims and objectives
Aim:
Our aim is to review the use of PET CT in evaluating the extent of primary tumour,
staging and post treatment response in neuroblastoma.
Our objective is to evaluate the treatment strategies based on staging.
Background:
Neuroblastoma are tumors originating fromprimitive neuroectodermal cells or neural crest cells which is the most common extracranial solid childhood malignancy.
The mean age of presentation is around 2 years.Most common site of origin is adrenal.
Multimodalityanatomic imaging with ultrasonography,
computed tomography and magnetic resonance imaging,
as well as...
Methods and materials
Ours is a retrospective study of duration 2015 - 2018,
which includes 39 patients.
9 patients with neuroblastoma have undergone PET-CT in our institute for staging evaluation (International Neuroblastoma Risk Group Staging System) and 30 for post treatment response evaluation.
Response assesment PET-CT evaluation were predominantly performed after surgery or 6 cycles of chemotherapy.
Based on this further management like continuing the same drug or changing the drugs were decided.[Fig 3].
Results
Age & Sex Distribution:
Out of 39 patients,
majority of our patients were less than 5 years of age(Fig 4)andmale: female ratio was 2.5:1 (Fig 5)
Staging:
Out of 39 patients 33 had neuroblastoma in adrenal,
3 in retroperitoneum ,
1 in posterior mediastinum ,
1 in pelvis and 1 in head and neck(Fig 6).
Site of origin
Our institute
Literature(Ref 4)
Adrenal
84.6%
35%
Retroperitoneum
7.6%
30-35%
Posterior mediastinum
2.5%
20%
Pelvis
2.5%
2-3%
Head and neck
2.5%
1-5%
Out of 9 who underwent...
Conclusion
Whole body PET CT plays an important role in staging and response evaluation besides diagnosis.
Staging and prognosis of neuroblastoma depends on multiple sites of involvement,
FDG avidity helps in localising occult metastases.
Staging & Response impacts the decision making process in management as we can triage whether to proceed with curative or palliative intent.
Response assessment using FDG PET is important as there can be persistent soft tissue component despite lack of metabolic activity.For response evaluation interim PET CT is able to differentiate early,...
References
1.Swift et al,Updates in Diagnosis,
Management,and Treatment of Neuroblastoma,RadioGraphics 2018; 38:566–580,
2.Brisse H,
McCarville M,
Granata C,
Krug K,
Wootton-Gorges S,
Kanegawa K et al.
Guidelines for Imaging and Staging of Neuroblastic Tumors: Consensus Report from the International Neuroblastoma Risk Group Project.
Radiology.
2011;261(1):243-257.
3.Monclair T ,
Brodeur GM ,
Ambros PF ,
et al .The International Neuroblastoma Risk Group(INRG) staging system: an INRG Task Forcereport .
J Clin Oncol 2009 ; 27 ( 2 ): 298 – 303 .
4.Papaioannou,
G.,
& McHugh,
K....