Mama neoadyuvancia

Eur J Nucl Med Mol Imaging (2009) 36:1551–1557 DOI 10.1007/s00259-009-1116-y

ORIGINAL ARTICLE

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F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer

Joan Duch & David Fuster & Montserrat Muñoz & Pedro Luís Fernández & Pilar Paredes & Montserrat Fontanillas & Flavia Guzmán & Sebastià Rubí & Francisco Juan Lomeña & Francesca Pons

Received: 3November 2008 / Accepted: 25 February 2009 / Published online: 27 March 2009 # Springer-Verlag 2009

Abstract Purpose The aim of this study was to prospectively evaluate 18F-FDG PET/CT in predicting response to neoadjuvant chemotherapy in large primary breast cancer. Methods Fifty consecutive patients underwent PET/CT at baseline and after the second cycle. Baseline MRI was performed to establishtumour size. All findings were confirmed by histopathological analysis. Changes in maximum standardized uptake value (SUVmax) between baseline study and after two cycles of neoadjuvant chemotherapy (epirubicin + cyclophosphamide + taxanes) were compared using response evaluation criteria in solid tumours (RECIST) criteria and the Miller and Payne (M&P) scale. Results The mean tumour size was4.3±1.4 cm. Forty patients were considered responders and ten as nonresponders. SUVmax changes in patients with good prognosis (M&P grades 4–5) were higher than in patients with bad prognosis (M&P grades 1–3) (p=0.025). SUVmax changes between responders and non-responders following RECIST criteria were also statistically significant (p= 0.0028). A cut-off ΔSUV value of 40% differentiates both groups,with a sensitivity of 77% and a specificity of 80%. Conclusion 18F-FDG PET/CT can predict response to neoadjuvant chemotherapy at an early stage. Keywords Breast cancer . PET/CT . Early prediction response . Neoadjuvant chemotherapy
J. Duch (*) : D. Fuster : M. Muñoz : P. L. Fernández : P. Paredes : M. Fontanillas : F. Guzmán : S. Rubí : F. J. Lomeña : F. Pons Nuclear Medicine Department, HospitalClínic de Barcelona, Villarroel, 170, 08036 Barcelona, Spain e-mail: joanduch@gmail.com

Introduction Management of large primary breast cancer has two main clinical challenges: the control of local disease and the eradication of micrometastatic distant disease, which is frequently present at diagnosis and accounts for the poor survival rate of these patients [1]. With this in mind, neoadjuvantchemotherapy has been used to downstage the primary tumour and also reduce or eliminate micrometastatic disease. At present, standard treatment is neoadjuvant chemotherapy followed by mastectomy with axillary lymphadenectomy and irradiation of the chest wall. However, some patients do not respond to chemotherapy treatment, and it is important to identify these patients early in the course oftreatment to save them from unnecessary side effects of ineffective treatment, such as nausea, alopecia, haematological toxicity, neurotoxicity (e.g. taxanes) or cardiotoxicity (e.g. anthracyclines) [2]. A complete pathological response of the primary tumour to chemotherapy has been previously shown to be an important prognostic indicator for disease-free and overall survival [3–5]. But clinicalresponse does not always reliably reflect histopathological response and the therapeutic effect of systemic therapy is not determined accurately until definitive surgical excision. Anatomical imaging with mammography, ultrasonography and magnetic resonance imaging (MRI) are used to assess how the tumour responds. These methods are dependent on tumour size, have limited reproducibility and cannotdistinguish between fibrotic scar tissue and viable tumour. The accuracy of these techniques is limited because of the delay between the treatment with chemotherapy and tumour shrinkage. Frequently, several cycles of chemotherapy are necessary to significantly change tumour size and, therefore, current anatomical imaging modalities do not reliably predict therapy response early in the course of...