Efficiency of fluorodeoxyglucose positron emission tomography/computed tomography to predict prognosis in breast cancer patients received neoadjuvant chemotherapy.

Toshiyuki Ishiba,Takanobu Sato,Goshi Oda,Makoto Nagahara,Hitoshi Sugimoto,Tsuyoshi Nakagawa,Peter Danenberg,Tomoyuki Fujioka,Hiroyuki Uetake,Kazunori Kubota,Tokuko Hosoya,Kathleen Danenberg,Mai Kasahara

doi:10.1186/s40064-015-1634-y

Abstract

Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with advanced breast cancer. Pathological complete response (pCR) after NAC is an important prognostic indicator, but some patients with pCR continue to experience recurrence. So new predictive and prognostic markers in addition to pCR are needed following NAC for breast cancer. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can evaluate metastases in the entire body simultaneously, and has several potential advantages over conventional imaging modalities. The purpose of this study was to evaluate whether FDG-PET/CT can determine NAC response and whether FDG-PET/CT can be a new prognostic marker. We imaged 83 breast cancer tumors with FDG-PET/CT, ultrasound (US), and magnetic resonance imaging (MRI) to evaluate NAC efficacy. As we previously analyzed 110 breast cancers with FDG PET/CT, we defined a threshold of >1.7 maximum standardized uptake value (SUVmax) as abnormal fluorodeoxyglucose (FDG) uptake. After NAC, 16 (19.3 %) tumors had a complete response, 54 (65.1 %) had a partial response, 11 (13.3 %) showed stable disease, and 2 (2.4 %) showed progressive disease. One of the two patients with progressive disease had bone metastasis detected by FDG-PET/CT and was not operated on. Remote metastases were evident in 2.4 % of patients after NAC as determined by FDG-PET/CT. Overall, 17 patients had pathological complete response (pCR). The sensitivity of abnormal FDG uptake after NAC for non-pCR was 20.3 % and the specificity was 94.7 %. Patients with abnormal FDG uptake after NAC experienced significantly more recurrences (P = 0.004) and more of them died (P = 0.010). Moreover, the difference in disease-free survival was more significant in the estrogen receptor (ER)-negative group. FDG-PET after NAC may be more effective for predicting prognosis than for evaluating treatment response. This tendency was particularly remarkable in ER-negative breast cancer tumors. FDG-PET/CT is useful for reevaluating surgical applicability after NAC.

Highlights

Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with locally advanced breastIshiba et al SpringerPlus (2015) 4:817 prognostic effects of clinicopathologic factors in breast cancer patients with NAC have suggested that pathological complete response is an important prognostic indicator (Chaturvedi et al 2005; Kuerer et al 1999; Buzdar et al 2005)
FDG-PET/computed tomography (CT) was reported to be useful as a prognostic indicator for patients with primary breast carcinoma and high standardized uptake value (SUV), which represented a worse prognosis with respect to both overall and relapse-free survival (Oshida et al 1998)
Thirty-nine patients were treated with docetaxel followed by FEC (5-FU, epirubicin, and cyclophosphamide), thirty-nine patients were treated with weekly paclitaxel docetaxel followed by FEC, and five patients were treated with other regimens

Summary

Introduction

Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with locally advanced breastIshiba et al SpringerPlus (2015) 4:817 prognostic effects of clinicopathologic factors in breast cancer patients with NAC have suggested that pathological complete response (pCR) is an important prognostic indicator (Chaturvedi et al 2005; Kuerer et al 1999; Buzdar et al 2005). New predictive and prognostic markers in addition to pCR are sought following NAC for breast cancer. Because fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can evaluate metastases in the entire body at one time, we have previously performed FDG-PET/CT to evaluate NAC efficacy. A meta-analysis revealed that FDG-PET is a valuable tool for detecting breast cancer recurrence and metastases (Isasi et al 2005). Some studies have reported that FDG-PET may become the method of choice for assessing asymptomatic patients with elevated tumor marker levels (Siggelkow et al 2004). FDG-PET/CT was reported to be useful as a prognostic indicator for patients with primary breast carcinoma and high standardized uptake value (SUV), which represented a worse prognosis with respect to both overall and relapse-free survival (Oshida et al 1998)

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