Monitoring Primary Systemic Therapy of Large and Locally Advanced Breast Cancer by Using Sequential Positron Emission Tomography Imaging With [18F] Fluorodeoxyglucose
Monitoring Primary Systemic Therapy of Large and Locally Advanced Breast Cancer by Using Sequential Positron Emission Tomography Imaging With [18F] Fluorodeoxyglucose
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DOI：
10.1200/jco.2008.17.2650
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发表时间：
2009-02-01
影响因子：
45.3
通讯作者：
Avril, Norbert
中科院分区：
文献类型：
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作者：
Schwarz-Dose, Joerg;Untch, Michael;Avril, Norbert
目的评价正电子发射断层扫描（PET）使用[F-18]氟脱氧葡萄糖（FDG）预测早期组织病理学反应在主要系统治疗的大或局部晚期乳腺癌。在基线（n = 104）以及第一个周期（n = 87）和第二个周期（n = 81）化疗后，对104名患者进行了272次FDG-PET扫描。评估FDG摄取的标准化摄取值（SUV）的水平和相对变化预测组织病理学反应的能力。所有患者化疗后进行手术，和组织病理学反应定义为微小残留病变或严重残留病变作为参考standard.Results17（16%）的104例患者的组织病理学反应和87（84%）无反应。基线SUV小于3.0的所有患者（n = 24）均未达到组织病理学缓解。在第一个化疗周期后，组织病理学应答者（n = 15）的SUV下降了51% ± 18%，而无应答者为37% ± 21%（n = 54; P = 0.01）。SUV降低45%的阈值正确识别了15个应答者中的11个，并且组织病理学无应答者被识别为阴性预测值为90%。相似的结果被发现后，第二个周期时，使用的阈值为55%的相对减少SUV.ConclusionFDG-PET允许预测治疗反应的水平FDG摄取的SUV在基线和化疗后的每个周期。此外，第一个和第二个周期后SUV的相对变化是反应的有力预测因素。因此，FDG-PET可能有助于乳腺癌患者的个体化治疗分层。
PurposeTo evaluate positron emission tomography (PET) using [F-18] fluorodeoxyglucose (FDG) for prediction of histopathologic response early during primary systemic therapy of large or locally advanced breast cancer.Patients and MethodsIn a prospective multicenter trial, 272 FDG-PET scans were performed in 104 patients at baseline (n = 104) and after the first (n = 87) and second cycle (n = 81) of chemotherapy. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response. All patients underwent surgery after chemotherapy, and histopathologic response defined as minimal residual disease or gross residual disease served as the reference standard.ResultsSeventeen (16%) of 104 patients were histopathologic responders and 87 were (84%) nonresponders. All patients for whom baseline SUV was less than 3.0 (n = 24) did not achieve a histopathologic response. SUV decreased by 51% +/- 18% after the first cycle of chemotherapy in histopathologic responders (n = 15), compared with 37% +/- 21% in nonresponders (n = 54; P = .01). A threshold of 45% decrease in SUV correctly identified 11 of 15 responders, and histopathologic nonresponders were identified with a negative predictive value of 90%. Similar results were found after the second cycle when using a threshold of 55% relative decrease in SUV.ConclusionFDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after each cycle of chemotherapy. Moreover, relative changes in SUV after the first and second cycle are a strong predictor of response. Thus, FDG-PET may be helpful for individual treatment stratification in breast cancer patients.