Recent Advances on PET-CT in Patients with Paediatric Sarcomas

Sarcomas are a heterogeneous group of entities deriving from the malignant transformation of mesenchymal cells and/or their precursors throughout the body. They may affect children and young adults, representing about one-fifth of all paediatric solid tumours.

Although overall uncommon, especially when compared to lymphomas and brain tumours, rhabdomyosarcoma (a malignant tumour derived from striated muscles) and bone sarcomas, like osteosarcoma and Ewing sarcoma, are most frequently seen in children aged 5-14 years, with an overall incidence of 3-5 new cases per million every year. The pathogenesis of these tumours is still unknown, even if most cases are associated to genetic alterations [e.g. t(11;22)(q24;q12) in 85% cases of Ewing sarcoma]; however, in some cases no specific genetic patterns can be recognized and the lesion is considered sporadic.

Survival is highly dependent on disease extent at diagnosis, since localized forms which may benefit from multi-modal treatment including neoadjuvant chemotherapy, surgical resection and eventually adjuvant radiation therapy carry a better prognosis (80-90% 5-years survival in rhabdomyosarcoma) than advanced ones at initial staging due to extensive metastatic spread (less than 20% 5-years survival).

PET-CT, a Nuclear Medicine imaging tool, has proved to be useful in detecting distant metastases and in evaluating the treatment response and disease recurrence in a wide variety of malignancies. Particularly, PET-CT may be invaluable in determining the effectiveness of treatment with new systemic chemotherapy schemes, immunotherapy agents (including PD-1/PD-L1 targeted drugs as atezolizumab), or more recently the effectiveness of CAR-T cells or adoptive cellular therapy which have emerged as new potential treatments for paediatric sarcomas especially at relapse.

Thanks to its ability in detecting viable tumoral cells even in the absence of structural alterations or of pre-to-post-treatment changes in lesion size, PET-CT especially using 18F-FDG allows an early diagnosis of otherwise unknown distant disease (with impact on therapeutic strategy) and an early distinction between responding and non-responding patients (with impact on prognosis).

More recently, novel non-FDG based radiopharmaceuticals, as integrin receptor ligands or FAPI-derived molecules, have demonstrated even better performances than 18F-FDG for staging/restaging paediatric sarcomas, also in a theragnostic view.

This Research Topic welcomes all original research articles, case reports, reviews, mini-reviews and meta-analyses aiming to provide new insight and to explore the most recent advances on PET-CT in patients with paediatric sarcomas, also focusing on new non-FDG radiopharmaceuticals and/or on the use of PET-CT in novel treatment strategies, and for a theragnostic approach.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Data Report
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• ... View all formats

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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Data Report
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Policy Brief
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: PET-CT, Paediatric Sarcomas, New Radiopharmaceuticals, Theragnostic, Early Staging and Response Detection

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