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Utilizing [18F]-FDG PET/CT Imaging for Enhanced Staging and Treatment Decisions in Pediatric Rhabdomyosarcoma
by
, , , , , ,
Hadeel Halalsheh
1,2,*
,
Nada Odeh
2,
Arwa Kiswani
1,
Mohammad Alzoubi
2,
Adam Diab
2,
Noor Al-Assaf
2,
Akram Al-Ibraheem
2,3
,
Ahmad Kh. Ibrahimi
4,
Mohammad Boheisi
5 and
Iyad Sultan
1,2,3 1
Department of Pediatrics, King Hussein Cancer Center, Amman 11941, Jordan
2
School of Medicine, The University of Jordan, Amman 11941, Jordan
3
Nuclear Medicine Department, King Hussein Cancer Center, Amman 11941, Jordan
4
Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
5
Nursing Department, King Hussein Cancer Center, Amman 11941, Jordan
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(10), 1629; https://doi.org/10.3390/cancers18101629
Submission received: 26 March 2026
/
Revised: 29 April 2026
/
Accepted: 2 May 2026
/
Published: 18 May 2026
(This article belongs to the Section Pediatric Oncology)
Simple Summary
Rhabdomyosarcoma is the most common soft tissue cancer in children. Accurately determining the stage of the disease is crucial for choosing the most effective treatment. Traditionally, doctors rely on conventional imaging, such as CT and MRI scans. Our study evaluated whether adding an [18F]-FDG PET/CT scan improves this staging process. By reviewing the records of 56 children treated at our center, we found that PET/CT is a highly accurate tool, particularly for detecting disease in lymph nodes and bones. Most importantly, the information provided by the PET/CT scan directly altered the clinical treatment plan for 16.1% of the patients. These changes primarily involved adjusting radiation therapy to be more precise—either by targeting hidden cancer spots or by sparing healthy tissue. We also observed that the metabolic intensity of the tumor on the PET scan (measured as SUVmax) may help predict patient outcomes, though larger studies are needed to confirm this. Ultimately, our findings support the routine use of PET/CT to help personalize and optimize treatment for children with rhabdomyosarcoma.
Abstract
Background: Accurate staging is vital for optimizing outcomes in pediatric rhabdomyosarcoma (RMS). While [18F]-FDG PET/CT is increasingly utilized, its specific impact on clinical management and its prognostic value compared to conventional imaging (CI) require further evaluation. Methods: In this retrospective single-center study, we reviewed 56 pediatric patients with RMS who underwent [18F]-FDG PET/CT at our center. Imaging findings were compared with CI (CT/MRI) and correlated with clinical management and survival outcomes. Results: In the total cohort (n = 56), PET/CT demonstrated high concordance with CI for nodal assessment, with an apparent sensitivity of 89.5% and specificity of 94.6%. PET/CT identified skeletal metastases in 5 patients (8.9%) and correctly characterized suspicious pulmonary nodules in one case, though it failed to detect a 0.6 cm lung nodule visualized on chest CT. Notably, PET/CT findings directly altered clinical management in 16.1% of patients (n = 9), primarily through radiotherapy adjustments, including field expansions (n = 4), field reductions (n = 3), and the initiation of previously unplanned radiotherapy (n = 2). At a median follow-up of 33.3 months, an exploratory analysis showed that patients with an SUVmax ≥3.6 had a lower 3-year EFS (57.6% vs. 71.6%; p = 0.51) and OS (60.4% vs. 71.6%; p = 0.63); neither comparison reached statistical significance. Conclusion: [18F]-FDG PET/CT is a powerful adjunct in pediatric RMS staging, particularly for nodal and skeletal evaluation. Its ability to refine radiotherapy planning in nearly one-sixth of cases underscores its clinical utility. SUVmax is not a validated prognostic or predictive biomarker in pediatric RMS; prospective, adequately powered multicenter studies, ideally incorporating volumetric PET parameters, are needed before any role in risk-stratified therapy can be defined.
