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Ewing sarcoma during follow-up.

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    A new follow-up imaging protocol effectively detects Ewing sarcoma (EwS) recurrence before symptoms appear. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was crucial in identifying most early recurrences, highlighting its value in routine EwS patient monitoring.

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    Area of Science:

    • Oncology
    • Radiology
    • Medical Imaging

    Background:

    • Ewing sarcoma (EwS) recurrence often presents asymptomatically, necessitating sensitive detection methods.
    • Current follow-up protocols may not consistently identify early signs of tumour recurrence.
    • Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) offers high sensitivity for detecting metabolically active tumour tissue.

    Purpose of the Study:

    • To assess the efficacy of a prospective follow-up imaging protocol for detecting asymptomatic Ewing sarcoma recurrence.
    • To evaluate the role of FDG-PET(/CT) within a comprehensive follow-up strategy.
    • To determine if scheduled imaging can identify recurrence before symptom onset.

    Main Methods:

    • Retrospective analysis of imaging and clinical data from successfully treated EwS patients (EURO E.W.I.N.G. 99 trial).
    • Patients underwent a comprehensive follow-up protocol including X-ray, CT, MRI, bone scan, and PET(/CT) at varying intervals.
    • Focus on recurrences detected by scheduled imaging versus clinical presentation.

    Main Results:

    • Of 80 patients followed, 30 experienced recurrence over an average of 3.6 years.
    • Scheduled imaging detected 19 (63%) recurrences before symptom onset.
    • FDG-PET/CT identified 8 of these 19 early recurrences first, despite its limited use, demonstrating its high sensitivity for EwS recurrence detection.

    Conclusions:

    • The implemented follow-up protocol effectively detects Ewing sarcoma recurrence prior to symptom manifestation.
    • FDG-PET/CT plays a pivotal role in the early detection of EwS recurrence and should be considered for routine follow-up.
    • Combining PET with low-dose chest CT may be sufficient for detecting pulmonary nodules in EwS follow-up.