Ferumoxytol-enhanced Magnetic Resonance Imaging (MRI) in pediatric and adult patients with sarcoma
Allison O'Neill, M.D.
BACKGROUND: Each year in the United States, there are approximately 8,000 cases of sarcoma with 850 occurring in children and adolescents. Patients with single-site, surgically-resectable disease, have a far better prognosis than those with lymph node spread (80% vs. 20% 5-year survival). Patients with tumor types that spread to lymph nodes typically undergo lymph node biopsy to determine disease extent given the limited ability of imaging studies to predict involved nodes. Iron oxide nanoparticles are microscopic molecules that can travel through the blood and enter the lymphatic system; they contain an iron core, which interferes with MRI signaling, allowing more sensitive detection of tumor-involved nodes.
GAP: Lymph node sampling is not uniformly pursued in pediatric patients and can be quite invasive. Iron-based nanoparticles have been sucessfully used with MRI to image adults with prostate cancer but have yet to be used for pediatric patients or to investigate nodal spread in soft tissue sarcoma.
Primary: Nanoparticle-MRI can accurately detect metastatic lymph nodes, when compared with biopsy, in patients with soft tissue sarcoma.
Secondary: Iron oxide nanoparticles are safe in pediatric patients. Nanoparticle scans are easily interpreted by radiologists, and allow for more sensitive imaging of lymph nodes than conventional MRI.
METHODS: All patients must have a new diagnosis of soft tissue sarcoma and be scheduled to undergo lymph node sampling. Patients will undergo conventional MRI, receive an infusion of nanoparticles, and return for repeat MRI 3-5 days later. Patients will undergo lymph node sampling. Nanoparticle studies and biopsy findings will be correlated.
DISCUSSION: We hope that nanoparticle-MRI will be superior to conventional MRI and eventually replace the need for lymph node biopsy. We then plan to investigate the role of lymphatic spread in other pediatric malignancies with the goal of altering therapy and improving outcomes.
Cancer, Drug Therapy, Human, Magnetic Resonance Imaging, Prospective Cohort, Treatment