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Sodium fluoride (Na18F) PET Response Criteria in Solid Tumors (NAFCIST): a framework for response assessment in bone

K Kairemo1, M A Gouda2, L Buschhorn3

  • 1Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston.

ESMO Open
|July 30, 2023
PubMed

Insights

New Na18F Response Criteria in Solid Tumors (NAFCIST) using sodium fluoride (Na18F) PET/CT scans offer improved imaging for osteosarcoma treatment response. This method aids in evaluating bone tumor response earlier than traditional post-surgical assessment.

Area of Science:

  • Oncology
  • Radiology
  • Nuclear Medicine

Background:

  • Current Response Evaluation Criteria in Solid Tumors (RECIST) for osteosarcoma are limited by minimal changes in tumor diameter, hindering early treatment response assessment.
  • Assessing osteosarcoma treatment response typically relies on post-surgical evaluation of tumor necrosis, delaying therapeutic insights.
  • Magnetic resonance imaging (MRI) alone often struggles to accurately discern treatment response in bone tumors before surgery.

Purpose of the Study:

  • To introduce and provide guidance on the novel Na18F Response Criteria in Solid Tumors (NAFCIST) for evaluating osteosarcoma treatment response.
  • To highlight the utility of sodium fluoride (Na18F) positron emission tomography/computed tomography (PET/CT) in assessing bone tumor response to therapy.
  • To address the limitations of traditional imaging criteria in evaluating early therapeutic effects in osteosarcoma.

Main Methods:

  • Utilizing sodium fluoride (Na18F) PET/CT scans, which leverage fluoride's avid uptake in bone, for enhanced imaging of bone response.
  • Developing and applying the Na18F Response Criteria in Solid Tumors (NAFCIST) as a novel assessment tool.
  • Reviewing existing evidence, including a pilot study of radium-223 in osteosarcoma patients, to support NAFCIST.

Main Results:

  • Na18F PET/CT demonstrates potential for superior imaging of bone tumor response compared to traditional methods.
  • NAFCIST provides a framework for evaluating treatment response using Na18F PET/CT data.
  • The pilot study suggests NAFCIST's feasibility in assessing response to therapies like radium-223.

Conclusions:

  • NAFCIST, utilizing Na18F PET/CT, offers a promising approach for early and accurate assessment of osteosarcoma treatment response.
  • This novel imaging-based criterion can overcome the limitations of RECIST in evaluating bone tumors.
  • Practical guidance is provided to facilitate the future application and validation of NAFCIST in clinical studies involving bone tumors.
Keywords:
PET/CTbone tumorsosteosarcomaprecision oncologysodium fluoride

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