Ewing sarcoma (EWS) is a type of primary bone cancer that mainly affects children, teenagers, and young adults. For those whose cancer has not spread (metastasised), the survival rate with current treatment is good. However, if EWS has metastasised particularly to other bones, the survival rate is much reduced. Identifying bone metastases as early as possible is therefore critical for this reason, but also because treatment for metastasised cancer requires more intensive treatments, including chemotherapy and radiotherapy. It is therefore crucial to firstly identify those whose cancer has metastasised so they can receive the appropriate treatment, and secondly, accurately locate all metastases in the body to ensure effective treatment.
Some small studies suggest that a new imaging technique called ‘Whole Body Diffusion Weighted-MRI’ (WB-DWIBS where IBS stands for Imaging Body Scan), may be more effective than current standard methods of PET/CT scans in detecting metastases in bones. PET (positron emission tomography) is a scan which involves injecting a radioactive substance called 18F-FDG, which is preferentially taken up by and highlights cancer cells. CT (computed tomography) scans use x-rays to produce images within the body and are carried out before PET scans. Combining both provides a map of where cancer cells, including metastatic deposits, are around the body, helping to diagnose and plan treatments.
What are the aims of this research project?
A clinical trial support grant has been awarded to Professor
Bernadette Brennan at the Royal Manchester Children’s Hospital to provide
additional support to the INTER-EWING-1
trial. This study aims to determine if WB-DWIBS is better at detecting bone
metastases in EWS than PET/CT scans. Both scan types will be performed in
patients enrolled in the trial diagnosis, and if metastases are found, an
additional WB-DWIBS will be performed after chemotherapy has begun, to monitor
the behaviour of the metastases in response to chemotherapy. Independent
experts will assess the scans to determine which methods have more successfully
detected metastases.
How could this project improve treatment options for Ewing sarcoma patients?
If WB-DWIBS is shown to be better at detecting bone metastases compared to the [18F]FDG PET/CT current scans in use, this will allow for treatments that are more tailored for each patient, and more targeted to sites of metastases, offering more accurate therapy, and potentially improving survival rates for people with EWS that has metastasised. It could also become a routine tool used in patient care. If it is the case that WB-DWIBS is not shown to be more effective, use of this imaging technique can be avoided, saving costs and reducing unnecessary procedures for patients. This research will standardise the imaging for staging of newly diagnosed patients and may help predict outcomes.
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