Usefulness of Combined Metabolic–Volumetric Indices of 18F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer
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The purpose of this study was to investigate the usefulness of metabolic-volumetric indices of 18F- fluorodeoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of neoadjuvant chemotherapy outcomes in breast cancer.
Twenty-four patients with locally advanced breast cancer were enrolled in the study. They underwent baseline 18F-FDG PET/CT scan and received four or six cycles of neoadjuvant chemotherapy, interim 18F-FDG PET/CT was done after second cycle of chemotherapy. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesions were calculated. Reduction rates of these parameters were obtained between baseline and interim 18F-FDG PET/CT. Chemotherapy outcomes were assessed using tumor size reduction rate and histological grading system (Miller and Payne system). Reduction rates of SUVmax, MTV, and TLG correlated with chemotherapy outcomes.
MTV and TLG reduction rates showed significant correlation with tumor size reduction rate (R = 0.68, P = 0.0004; R = 0.62, P = 0.002, respectively). However, SUVmax reduction rate showed no significant correlation. MTV and TLG reduction rates were significantly higher in responders than nonresponders, as determined by Miller and Payne system (P < 0.0007, P < 0.002). However, SUVmax reduction rate showed no significant difference. On ROC analysis, the area under the MTV and TLG curves was 0.886, and that of SUVmax was 0.743. Sensitivity, specificity, positive predictive value, and negative predictive value to predict histopathologic response were the same for MTV and TLG, and the values were 100 %, 85.7 %, 83.3 %, and 100 %, respectively (at the reduction rate of 93.2 % for MTV, and 95.8 % for TLG).
Changes of metabolic–volumetric indices successfully reflected the neoadjuvant chemotherapy outcomes. MTV and TLG could be robust indices in discriminating pathologic responder as SUVmax, after neoadjuvant chemotherapy.
- Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.
- Giordano SH. Update on locally advanced breast cancer. Oncologist. 2003;8:521–30. CrossRef
- Groheux D, Giacchetti S, Espie M, Rubello D, Moretti JL, Hindie E. Early monitoring of response to neoadjuvant chemotherapy in breast cancer with (18)F-FDG PET/CT: defining a clinical aim. Eur J Nucl Med Mol Imaging. 2011;38:419–25.
- Rousseau C, Devillers A, Sagan C, Ferrer L, Bridji B, Campion L, et al. Monitoring of early response to neoadjuvant chemotherapy in stage II and III breast cancer by [18F]fluorodeoxyglucose positron emission tomography. J Clin Oncol. 2006;24:5366–72. CrossRef
- Westerterp M, van Westreenen HL, Reitsma JB, Hoekstra OS, Stoker J, Fockens P, et al. Esophageal cancer: CT, endoscopic US, and FDG PET for assessment of response to neoadjuvant therapy–systematic review. Radiology. 2005;236:841–51. CrossRef
- Kalff V, Duong C, Drummond EG, Matthews JP, Hicks RJ. Findings on 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med. 2006;47:14–22.
- Wahl RL, Zasadny K, Helvie M, Hutchins GD, Weber B, Cody R. Metabolic monitoring of breast cancer chemohormonotherapy using positron emission tomography: initial evaluation. J Clin Oncol. 1993;11:2101–11.
- Schwarz-Dose J, Untch M, Tiling R, Sassen S, Mahner S, Kahlert S, et al. Monitoring primary systemic therapy of large and locally advanced breast cancer by using sequential positron emission tomography imaging with [18F]fluorodeoxyglucose. J Clin Oncol. 2009;27:535–41. CrossRef
- Kumar A, Kumar R, Seenu V, Gupta SD, Chawla M, Malhotra A, et al. The role of 18F-FDG PET/CT in evaluation of early response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. Eur Radiol. 2009;19:1347–57. CrossRef
- Duch J, Fuster D, Munoz M, Fernandez PL, Paredes P, Fontanillas M, et al. 18F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer. Eur J Nucl Med Mol Imaging. 2009;36:1551–7. CrossRef
- Martoni AA, Zamagni C, Quercia S, Rosati M, Cacciari N, Bernardi A et al. Early (18)F-2-fluoro-2-deoxy-d-glucose positron emission tomography may identify a subset of patients with estrogen receptor-positive breast cancer who will not respond optimally to preoperative chemotherapy. Cancer. 2010;116:805–13.
- Seol YM, Kwon BR, Song MK, Choi YJ, Shin HJ, Chung JS et al. Measurement of tumor volume by PET to evaluate prognosis in patients with head and neck cancer treated by chemo-radiation therapy. Acta Oncol. 2010;49:201–8.
- Roedl JB, Halpern EF, Colen RR, Sahani DV, Fischman AJ, Blake MA. Metabolic tumor width parameters as determined on PET/CT predict disease-free survival and treatment response in squamous cell carcinoma of the esophagus. Mol Imaging Biol. 2009;11:54–60. CrossRef
- Chung MK, Jeong HS, Park SG, Jang JY, Son YI, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res. 2009;15:5861–8. CrossRef
- Zhu D, Ma T, Niu Z, Zheng J, Han A, Zhao S, et al. Prognostic significance of metabolic parameters measured by (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer. Lung Cancer. 2011;73:332–7. CrossRef
- Choi K-H, Yoo IR, Han EJ, Kim YS, Kim GW, Na SJ, et al. Prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinomas treated by surgery. Nucl Med Mol Imaging. 2011;45:43–51. CrossRef
- Kim BS, Kim IJ, Kim S-J, Nam H-Y, Pak KJ, Kim K, et al. The prognostic value of the metabolic tumor volume in FIGO stage IA to IIB cervical cancer for tumor recurrence: measured by F-18 FDG PET/CT. Nucl Med Mol Imaging. 2011;45:36–42. CrossRef
- Costelloe CM, Macapinlac HA, Madewell JE, Fitzgerald NE, Mawlawi OR, Rohren EM, et al. 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med. 2009;50:340–7. CrossRef
- Cheon GJ, Kim MS, Lee JA, Lee SY, Cho WH, Song WS, et al. Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med. 2009;50:1435–40. CrossRef
- Im HJ, Kim TS, Park SY, Min HS, Kim JH, Kang HG, et al. Prediction of tumour necrosis fractions using metabolic and volumetric 18F-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma. Eur J Nucl Med Mol Imaging. 2012;39:39–49. CrossRef
- Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003;12:320–7. CrossRef
- Murphy JD, La TH, Chu K, Quon A, Fischbein NJ, Maxim PG, et al. Postradiation metabolic tumor volume predicts outcome in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2011;80:514–21. CrossRef
- Lyou CY, Cho N, Kim SM, Jang M, Park JS, Baek SY et al. Computer-aided evaluation of breast MRI for the residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Korean J Radiol. 2011;12:34–43.
- Symmans WF, Peintinger F, Hatzis C, Rajan R, Kuerer H, Valero V, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25:4414–22. CrossRef
- McDermott GM, Welch A, Staff RT, Gilbert FJ, Schweiger L, Semple SI, et al. Monitoring primary breast cancer throughout chemotherapy using FDG-PET. Breast Cancer Res Treat. 2007;102:75–84. CrossRef
- Vranjesevic D, Schiepers C, Silverman DH, Quon A, Villalpando J, Dahlbom M, et al. Relationship between 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med. 2003;44:1238–42.
- Usefulness of Combined Metabolic–Volumetric Indices of 18F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer
Nuclear Medicine and Molecular Imaging
Volume 47, Issue 1 , pp 36-43
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Breast cancer
- Neoadjuvant chemotherapy
- Metabolic tumor volume
- Total lesion glycolysis
- 18F-FDG PET/CT
- Author Affiliations
- 1. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
- 5. Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- 2. Department of Nuclear Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Borame-gil 41, Dongjak-gu, Seoul, 156-707, Korea
- 4. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 3. Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggyi, Korea