The value of computed tomographic measurements in osteosarcoma as a predictor of response to adjuvant chemotherapy

The response to pre-operative adjuvant chemotherapy was assessed with computed tomography (CT) in 41 osteosarcomas of the long bones of the lower limb. Measurements were made of cross-sectional tumour areas and volumes on both the pre- and post-chemotherapy CT examinations. Changes in these measurements were compared with the percentage necrosis determined from examination of the tumour histology from the excised specimen in 39 cases. An increase in the relative size of the tumour (expressed as a ratio of the pretreatment volume) showed a statistically significant correlation with a poor tumour response as judged by the degree of tumour necrosis. Further analysis of the results showed that quantitative assessment of tumour response by CT is able to identify cases with poor response to therapy (negative predictive value = 0.9). This is, however, only achieved with a low specificity (0.5-0.6). These findings are in agreement with other studies of tumour volume changes using MR imaging.