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Sequential 18F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To investigate the value of response monitoring in both the primary tumour and axillary nodes on sequential PET/CT scans during neoadjuvant chemotherapy (NAC) for predicting complete pathological response (pCR), taking the breast cancer subtype into account.

Methods

In 107 consecutive patients 290 PET/CT scans were performed at baseline (PET/CT1, 107 patients), after 2 – 3 weeks of chemotherapy (PET/CT2, 85 patients), and after 6 – 8 weeks (PET/CT3, 98 patients). The relative changes in SUVmax (from baseline) of the tumour and the lymph nodes and in both combined (after logistic regression), and the changes in the highest SUVmax between scans (either tumour or lymph node) were determined and their associations with pCR of the tumour and lymph nodes after completion of NAC were assessed using receiver operating characteristic (ROC) analysis.

Results

A pCR was seen in 17 HER2-positive tumours (65 %), 1 ER-positive/HER2-negative tumour (2 %), and 16 triple-negative tumours (52 %). The areas under the ROC curves (ROC-AUC) for the prediction of pCR in HER2-positive tumours after 3 weeks were 0.61 for the relative change in tumours, 0.67 for the combined change in tumour and nodes, and 0.72 for the changes in the highest SUVmax between scans. After 8 weeks equivalent values were 0.59, 0.42 and 0.64, respectively. In triple-negative tumours the ROC-AUCs were 0.76, 0.84 and 0.76 after 2 weeks, and 0.87, 0.93 and 0.88 after 6 weeks, respectively.

Conclusion

In triple-negative tumours a PET/CT scan after 6 weeks (three cycles) appears to be optimally predictive of pCR. In HER2-positive tumours neither a PET/CT scan after 3 weeks nor after 8 weeks seems to be useful. The changes in SUVmax of both the tumour and axillary nodes combined correlates best with pCR.

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Acknowledgments

This study was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl), project Breast CARE (grant 03O-104). We are grateful to Marjo Holtkamp, Margaret Schot and Jacqueline van Zyll de Jong for their active participation and guidance of patients throughout this study.

Disclosure

This study was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl); project Breast CARE (grant 03O-104).

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Bas B. Koolen, Wouter V. Vogel & Renato A. Valdés Olmos

  2. Department of Surgical Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Bas B. Koolen, Marie-Jeanne T. F. D. Vrancken Peeters & Emiel J. Th. Rutgers

  3. Department of Radiology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Kenneth E. Pengel & Kenneth G. A. Gilhuijs

  4. Department of Pathology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Jelle Wesseling

  5. Department of Biometrics, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Andrew D. Vincent

  6. Department of Medical Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Sjoerd Rodenhuis

  7. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Kenneth G. A. Gilhuijs

Authors
  1. Bas B. Koolen
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  2. Kenneth E. Pengel
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  5. Marie-Jeanne T. F. D. Vrancken Peeters
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  6. Andrew D. Vincent
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  7. Kenneth G. A. Gilhuijs
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  8. Sjoerd Rodenhuis
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  9. Emiel J. Th. Rutgers
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  10. Renato A. Valdés Olmos
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Corresponding author

Correspondence to Renato A. Valdés Olmos.

Electronic supplementary material

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ESM Table S1

PET/CT findings before and during NAC per subtype. (DOC 86 kb)

ESM Fig. S 1

Chemotherapy regimens as used in this study. HER2-positive tumours were treated with PTC in three cycles of eight weekly administrations. Interim PET/CT scans were performed after three and eight administrations (3 and 8 weeks). HER2-negative tumours were treated with six cycles of AC in a dose-dense schedule (every 2 weeks). Interim PET/CT scans were performed after one and three cycles (2 and 6 weeks). In HER2-negative patients, a switch in chemotherapy regimen was done after the third PET/CT scan. HER2 human epidermal growth factor receptor 2, PTC paclitaxel, trastuzumab and carboplatin, T trastuzumab, AC cyclophosphamide and doxorubicin (JPEG 396 kb)

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Koolen, B.B., Pengel, K.E., Wesseling, J. et al. Sequential 18F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 41, 32–40 (2014). https://doi.org/10.1007/s00259-013-2515-7

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  • DOI: https://doi.org/10.1007/s00259-013-2515-7

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