PET/MR imaging protocol helps ID chemotherapy-induced damage in children

A single 90-minute examination designed to assess chemotherapy-induced injuries of the brain, heart and joints among childhood cancer survivors has been proven feasible by a new study.

The work may promote the initiation of timelier interventions to minimize treatment-induced harms suffered by pediatric patients, the researchers state.

The study, led by Ashok J. Theruvath, with the department of radiology and the molecular imaging program at the Lucile Packard Children’s Hospital in Stanford, California, was published online Aug. 4 in Radiology.

Advances in early cancer detection and treatments have led to growing numbers of cancer survivors in recent years, with survivors at risk of developing serious, life-changing adverse effects because of oncology therapies.

“Although pediatric cancer patients comprise a minority among cancer survivors, cancer therapy can have more severe effects upon their developing tissues, a longer-lasting effect due to their longer life span, and hence, a more severe effect upon our society’s workforce,” wrote Theruvath and colleagues. “There is a window of time between cancer therapy and subsequent morbidity during which corrective actions can be taken.”

Developing diagnostic tools to identify early tissue damage is important, although, according to the research team, such efforts have received scant attention.

The researchers developed a PET/MR imaging protocol for the detection of chemotherapy-related damage to the brain, heart and bone in a single session. Between April and July 2016, the researchers enrolled 10 pediatric cancer patients (five male and five females, with a mean age of 15.2 years) who had recently finished chemotherapy. The patients had all been diagnosed with leukemia, lymphoma or sarcoma and had completed a course of chemotherapy that included high-dose intravenous methotrexate, anthracyclines, and/or corticosteroids.

All patients completed the single-session evaluation. Eight of the 10 had abnormal findings on their brain, heart and bone images. Among that group of eight, six had corresponding clinical symptoms and two had none.  Six of the children had asymptomatic findings on their brain (three) or joint (three).

“Although acute tissue injuries during chemotherapy can be reversible, chronic tissue injuries after chemotherapy can evolve into lifelong secondary morbidity,” the authors wrote.  They went on to describe a variety of specific rescue interventions that could promote healthier long-term futures for pediatric cancer patients.

This was a small, nonrandomized pilot study.

“Further randomized statistically well powered studies are needed to confirm our results and to determine if brain, heart and bone imaging can change outcomes,” Theruvath and colleagues wrote.