Abstract
Objective:The study was aimed to find the utility of 18F FDG PET CT in assessing response to neoadjuvant chemotherapy (NACT) in female patients with locally advanced breast cancer (LABC). Methods:All willing women with biopsy proven LABC, following clinical evaluation underwent baseline 18F FDG PET CT along with mammosonograpy and contrast enhanced computerized chest radiography (CECT). The response was assessed clinically before each cycle of chemotherapy using RECIST criteria. Those who were progressing clinically were offered alternate chemotherapy or radiation or surgery. Clinical responders were re-evaluated with 18F FDG PET CT, mammosonogram and CT chest before surgery. The pathological response as assed with residual cancer burden score was used as gold standard. Results:Of the 30 women eligible, 26 women underwent repeat evaluation and surgery. The mean age was 49 years, 16 women were postmenopausal and 15 tumors were receptor positive. On final histopathology 15 % had completer response and 46 % were non responders. Using a cut off value of 50% of the baseline SUVmax, PET-CT had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 64%, 75%, 75%, 65%, and 69%, respectively in differentiating pathological responders from non-responders. Conclusion:18F FDG PET-CT predicted the response with greater accuracy than CT or clinical examination. Hence it can be used to identify non responders early in the course and alternate treatment can be offered to patients.
Highlights
Neoadjuvant chemotherapy (NACT) has become the initial treatment of choice for majority of locally advanced breast cancer (LABC)
The study was aimed to find the utility of 18 flouro fluorodeoxy glucose (18F FDG) PET CT in assessing response to neoadjuvant chemotherapy (NACT) in female patients with locally advanced breast cancer (LABC)
There was no significant difference in the mean baseline tumor size, mean follow up tumor size and mean change in tumor size on clinical examination and CT between pathological responders (pR) and non- pathological responders (non-pR) groups; pathological complete responder (pCR) and non-pCR groups
Summary
Neoadjuvant chemotherapy (NACT) has become the initial treatment of choice for majority of locally advanced breast cancer (LABC). Depending on the receptor status hormonal treatment is later administered for a minimum of five years In this sequence of treatment assessing the response to chemotherapy is an important step for optimal timing and achieving good therapeutic outcome for the individual patient. Further good response to NACT being a surrogate marker of prognosis, helps in appropriate management of the patient if it can be assessed early in the course of treatment with accuracy (Minckwitz et al, 2008). In this regard 18F-FDG PET-CT can assess metabolic as well as morphological response as early as 2nd or 3rd cycle when done at baseline. This study was planned to know the usefulness of 18F FDG PET-CT in assessing the response of tumor to NACT in patients with LABC
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