Prognostic Value of Bone Marrow Uptake Using 18F-FDG PET/CT Scans in Solid Neoplasms

Abstract

Background: Fluorine-18-fluorodeoxyglucose positron emission tomography/computerized tomography (18F-FDG PET/CT) uptake is known to increase in infective and inflammatory conditions. Systemic inflammation plays a role in oncologic prognosis. Consequently, bone marrow increased uptake in oncology patients could potentially depict the systemic cancer burden. Methods: A single institute cohort analysis and a systematic review were performed, evaluating the prognostic role of 18F-FDG uptake in the bone marrow in solid neoplasms before treatment. The cohort included 113 esophageal cancer patients (adenocarcinoma or squamous cell carcinoma). The systematic review was based on 18 studies evaluating solid neoplasms, including gynecological, lung, pleura, breast, pancreas, head and neck, esophagus, stomach, colorectal, and anus. Results: Bone marrow 18F-FDG uptake in esophageal cancer was not correlated with staging, pathological response, and survival. High bone marrow uptake was related to advanced staging in colorectal, head and neck, and breast cancer, but not in lung cancer. Bone marrow 18F-FDG uptake was significantly associated with survival rates for lung, head and neck, breast, gastric, colorectal, pancreatic, and gynecological neoplasms but was not significantly associated with survival in pediatric neuroblastoma and esophageal cancer. Conclusion: 18F-FDG bone marrow uptake in PET/CT has prognostic value in several solid neoplasms, including lung, gastric, colorectal, head and neck, breast, pancreas, and gynecological cancers. However, future studies are still needed to define the role of bone marrow role in cancer prognostication.

Keywords

• bone marrow
• esophageal neoplasms
• neoadjuvant therapy
• positron emission tomography
• nuclear medicine