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PET Can Help Guide Treatment Decisions for a Common Pediatric Cancer
August 03, 2009PET Images of Early-Stage Neuroblastoma can Provide Important Information for Certain Patients
RESTON, Va.-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 nerve cells 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 chemotherapy, surgery, bone marrow transplant 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 bone marrow more accurately.
Society of Nuclear Medicine
"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 nerve cells 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 chemotherapy, surgery, bone marrow transplant 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 bone marrow more accurately.
Society of Nuclear Medicine
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Scientists at Burnham Institute for Medical Research (Burnham) have found that the Caspase-8 protein, long known to play a major role in promoting programmed cell death (apoptosis), helps relay signals that can cause cancer cells to proliferate, migrate and invade surrounding tissues.
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Variations in 5 genes raise risk for most common brain tumors
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Genetic finding could lead to targeted therapy for neuroblastoma
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Researchers identify gene that regulates tumors in neuroblastoma
Virginia Commonwealth University researchers have identified a gene that may play a key role in regulating tumor progression in neuroblastoma, a form of cancer usually found in young children.
New therapy enlists immune system to boost cure rate in a childhood cancer
A multicenter research team has announced encouraging results for an experimental therapy using elements of the body's immune system to improve cure rates for children with neuroblastoma, a challenging cancer of the nervous system.
Immunotherapy effective against neuroblastoma in children
A phase III study has shown that adding an antibody-based therapy that harnesses the body's immune system resulted in a 20 percent increase in the number of children living disease-free for at least two years with neuroblastoma.
Drug therapy reduces neuroblastoma tumor growth in pre-clinical investigation
Researchers from the Children's Cancer Hospital at The University of Texas M. D. Anderson Cancer Center have discovered a new drug combination that significantly hinders tumor growth in neuroblastoma, a childhood cancer.
Drug inhibits neuroblastoma blood supply in pre-clinical tests
Researchers from the Children's Cancer Hospital at The University of Texas M. D. Anderson Cancer Center have found a way to prevent blood vessels from aiding the growth of neuroblastoma, a childhood cancer.
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