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Early Prediction of Response to Chemotherapy in Metastatic Breast Cancer Using Sequential ¹⁸F-FDG PET

¹ Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
² Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
³ Division of Nuclear Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Chemotherapy is currently the treatment of choice for patients with high-risk metastatic breast cancer. Clinical response is determined after several cycles of chemotherapy by changes in tumor size as assessed by conventional imaging procedures including CT, MRI, plain film radiography, or ultrasound. The aim of this study was to evaluate the use of sequential ¹⁸F-FDG PET to predict response after the first and second cycles of standardized chemotherapy for metastatic breast cancer. Methods: Eleven patients with 26 metastatic lesions underwent 31 ¹⁸F-FDG PET examinations (240–400 MBq of ¹⁸F-FDG; 10-min 2-dimensional emission and transmission scans). Clinical response, as assessed by conventional imaging after completion of chemotherapy, served as the reference. ¹⁸F-FDG PET images after the first and second cycles of chemotherapy were analyzed semiquantitatively for each metastatic lesion using standardized uptake values (SUVs) normalized to patients’ blood glucose levels. In addition, whole-body ¹⁸F-FDG PET images were viewed for overall changes in the ¹⁸F-FDG uptake pattern of metastatic lesions within individual patients and compared with conventional imaging results after the third and sixth cycles of chemotherapy. Results: After completion of chemotherapy, 17 metastatic lesions responded, as assessed by conventional imaging procedures. In those lesions, SUV decreased to 72% ± 21% after the first cycle and 54% ± 16% after the second cycle, when compared with the baseline PET scan. In contrast, ¹⁸F-FDG uptake in lesions not responding to chemotherapy (n = 9) declined only to 94% ± 19% after the first cycle and 79% ± 9% after the second cycle. The differences between responding and nonresponding lesions were statistically significant after the first (P = 0.02) and second (P = 0.003) cycles. Visual analysis of ¹⁸F-FDG PET images correctly predicted the response in all patients as early as after the first cycle of chemotherapy. As assessed by ¹⁸F-FDG PET, the overall survival in nonresponders (n = 5) was 8.8 mo, compared with 19.2 mo in responders (n = 6). Conclusion: In patients with metastatic breast cancer, sequential ¹⁸F-FDG PET allowed prediction of response to treatment after the first cycle of chemotherapy. The use of ¹⁸F-FDG PET as a surrogate endpoint for monitoring therapy response offers improved patient care by individualizing treatment and avoiding ineffective chemotherapy.

Key Words: ¹⁸F-FDG • PET • metastases • breast cancer • prediction of response to therapy

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