Potential utility of early metabolic response by 18F-2-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography in a selected group of breast cancer patients receiving preoperative chemotherapy

• Published in: European journal of cancer (1990) Vol. 49; no. 7; pp. 1539 - 1545
• Main Authors: Zucchini, G., Quercia, S., Zamagni, C., Santini, D., Taffurelli, M., Fanti, S., Martoni, A.A.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.05.2013; Elsevier
• Subjects: 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography; Adult; Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - drug therapy; Breast Neoplasms - metabolism; Early response evaluation; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Medical sciences; Middle Aged; Multimodal Imaging - methods; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Optimal pathologic response; Outcome Assessment (Health Care) - methods; Pharmacology. Drug treatments; Positron-Emission Tomography; Preoperative chemotherapy; Preoperative Period; Prognosis; Receptor, ErbB-2 - metabolism; Receptors, Estrogen - metabolism; Remission Induction; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; Tumors; Optimal pathologic response; Breast cancer; 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography; Early response evaluation; Preoperative chemotherapy; Radionuclide study; 2-deoxy-2-fluoroglucose; Breast disease; Cancerology; Mammary gland; Human; Evaluation; Radiodiagnosis; Patient; Malignant tumor; Metabolism; Mammary gland diseases; Chemotherapy; Treatment; F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography; Medical imagery; Early; Computerized axial tomography; Preoperative; Positron emission tomography; Cancer; Emission tomography
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2012.12.024

To assess 18F-2-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography’s (18F-FDG-PET/CT) potential clinical utility to allow early treatment changes during preoperative chemotherapy (PCT) in patients with early/locally advanced breast cancer (BC). Sixty newly diagnosed early/locally advanced BC patients received 6–8cycles of PCT. Optimal pathologic response (pR) was the absence of cancer cells in breast and axillary lymph nodes. All other conditions were defined as pathologic non-response (pNR). 18F-FDG-PET/CT maximum standardised uptake value (SUVmax) was measured at baseline and after 2cycles of PCT. Metabolic response was defined as SUVmax percentage changes (Δ-SUV) >50% and was compared with pR rates. Thirteen (22%) patients achieved pR; according to immunohistochemistry, 16% of ER-positive/HER2-negative patients, 29% and 27% of HER2-positive and triple negative patients respectively achieved pR. 18F-FDG-PET/CT showed the highest specificity (38%) and negative predictive value (100%) in ER-positive/HER2-negative patients. In this subgroup, at a median follow-up of 36.6months, median disease-free survival was still not reached in metabolic responders while it was 37months in metabolic non-responders (p=0.049). Early metabolic non-response was always associated to pNR and poor prognosis in ER-positive/HER2-negative patients. In this subgroup, 18F-FDG-PET/CT might be useful to select patients who will probably benefit from early therapeutic strategy modifications.