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Changes in Blood Flow and Metabolism in Locally Advanced Breast Cancer Treated with Neoadjuvant Chemotherapy

David A. Mankoff, MD, PhD1, Lisa K. Dunnwald, BS1, Julie R. Gralow, MD2, Georgiana K. Ellis, MD2, Erin K. Schubert, BA1, Jeffrey Tseng, MD1, Thomas J. Lawton, MD3, Hannah M. Linden, MD2 and Robert B. Livingston, MD2

1 Division of Nuclear Medicine, University of Washington, Seattle, Washington
2 Division of Medical Oncology, University of Washington, Seattle, Washington
3 Department of Pathology, University of Washington, Seattle, Washington



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  		FIGURE 1. Thick sagittal images of breast and chest of patients before therapy (left) and after 2 mo of therapy (right) showing 18F-FDG and 15O-water uptake. 18F-FDG images are summed images of data 30–60 min after injection; 15O-water images are summed 30–60 s after injection. Patient with macroscopic CR (A), patient with PR (B), and patient with NR (C) are shown.

 


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  		FIGURE 2. Percentage change in MRFDG and blood flow vs. clinical response, for patients having response (R) and patients having NR. MRFDG and blood flow without partial-volume corrections are shown. Error bars indicate SEM.

 


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  		FIGURE 3. Percentage change in MRFDG and blood flow vs. pathologic response, for macroscopic CR, PR, and NR. MRFDG and blood flow results without partial-volume correction (A) and with simple partial-volume correction (B) are shown. Error bars indicate SEM.

 


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  		FIGURE 4. Kaplan-Meier plots of disease-free survival for representative parameters: (A) residual MRFDG at 2 mo, (B) residual blood flow at 2 mo, (C) macroscopic CR vs. other response, and (D) posttherapy axillary nodal status.

 


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  		FIGURE 5. Kaplan-Meier plot of overall survival stratified by residual blood flow at 2 mo.

 


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  		FIGURE 6. Diagram illustrating hypothesis that hypoxia underlies resistance of some LABC to neoadjuvant chemotherapy and that downstream effects of hypoxia explain PET findings and response to treatment.

 




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