Dynamic contrast-enhanced magnetic resonance imaging as a prognostic factor in predicting event-free and overall survival in pediatric patients with osteosarcoma

BACKGROUND: The objective of this study was to prospectively evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as an early imaging indicator of tumor histologic response to preoperative chemotherapy and as a possible prognostic factor for event-free survival (EFS) and overall survival in pediatric patients with newly diagnosed, nonmetastatic osteosarcoma who were treated on a single, multi-institutional phase 2 trial. METHODS: Three serial DCE-MRI examinations at week 0 (before treatment), week 9, and week 12 (tumor resection) were performed in 69 patients with nonmetastatic osteosarcoma to monitor the response to preoperative chemotherapy. Four DCE-MRI kinetic parameters (the influx volume transfer constant [K ^trans], the efflux rate constant [k _ep], the relative extravascular extracellular space [v _e], and the relative vascular plasma space [v _p]) and the corresponding differences (ΔK ^trans, Δk _ep, Δv _e, and Δv _p) of averaged kinetic parameters between the outer and inner halves of tumors were calculated to assess their associations with tumor histologic response, EFS, and overall survival. RESULTS: The parameters K ^trans, v _e, v _p, and k _ep decreased significantly from week 0 to week 9 and week 12. The parameters K ^trans, v _p, and Δk _ep at week 9 were significantly different between responders and nonresponders (P =.046, P =.021, and P =.008, respectively). These 3 parameters were indicative of histologic response. The parameter Δv _e at week 0 was a significant prognostic factor for both EFS (P =.02) and overall survival (P =.03). CONCLUSIONS: DCE-MRI was identified as a prognostic factor for EFS and overall survival before treatment on this trial and was indicative of a histologic response to neoadjuvant therapy. Further studies are needed to verify these findings with other treatment regimens and establish the potential role of DCE-MRI in the development of risk-adapted therapy for osteosarcoma.