title: Baseline Tumor 18F-FDG Uptake and Modifications After 2 Cycles of Neoadjuvant Chemotherapy Are Prognostic of Outcome in ER+/HER2- Breast Cancer.
abstract: This study investigated whether (18)F-FDG PET/CT performed at baseline and during neoadjuvant chemotherapy (NAC) was able to early depict estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer patients with poor clinical outcome.
  
  
  METHODS
  The NAC regimen consisted of 4 cycles of epirubicin plus cyclophosphamide, followed by 4 courses of docetaxel. The patients underwent (18)F-FDG PET/CT at baseline and after 2 cycles of chemotherapy. After completion of NAC, all patients had breast surgery with axillary lymph node dissection. We assessed the impact of 2 PET parameters, maximum standardized uptake values (SUVmax) and total lesion glycolysis, on event-free survival (EFS).
  
  
  RESULTS
  Ninety-eight consecutive patients with clinical stage II or III ER+/HER2- breast cancer were included. (18)F-FDG PET/CT revealed distant metastases in 14 patients (14%). Overall survival was significantly shorter in these patients than in the 84 patients classified as M0 at baseline (18)F-FDG PET/CT (P < 0.001). In M0 patients, a high SUVmax at baseline was associated with shorter EFS (P < 0.001). Twelve patients had a tumor SUVmax of 10 or greater and a 3-y EFS of 49% (vs. 92% in patients with baseline SUVmax < 10). A low change in SUVmax between (18)F-FDG PET/CT examination before starting NAC and after the second cycle of chemotherapy was also associated with recurrence (P = 0.033), as was a low change in total lesion glycolysis (P < 0.001). Contrarily to PET-based prediction, the extent of pathologic response after completion of NAC (partial/complete vs. nonresponders) was poorly correlated to the risk of relapse.
  
  
  CONCLUSIONS
  Baseline tumor (18)F-FDG uptake and modifications after 2 cycles of NAC are prognostic of outcome in patients with ER+/HER2- breast cancer.
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France dgroheux@yahoo.fr.
authors.forename: David
authors.initials: D
authors.lastname: Groheux
authors.affiliation: Department of Statistical Sciences, Saint-Louis Hospital, Paris, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Sanna
authors.affiliation: INSERM, UMR 1101 LaTIM, Brest, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Majdoub
authors.affiliation: Department of Biochemistry, Saint-Louis Hospital, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: de Cremoux
authors.affiliation: Breast Diseases Unit, Department of Medical Oncology, Saint-Louis Hospital, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Giacchetti
authors.affiliation: Breast Diseases Unit, Department of Medical Oncology, Saint-Louis Hospital, Paris, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Teixeira
authors.affiliation: Breast Diseases Unit, Department of Medical Oncology, Saint-Louis Hospital, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Espié
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Merlet
authors.affiliation: Department of Pathology, Saint-Louis Hospital, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: de Roquancourt
authors.affiliation: INSERM, UMR 1101 LaTIM, Brest, France.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Visvikis
authors.affiliation: INSERM, UMR 1101 LaTIM, Brest, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Hatt
authors.affiliation: Department of Statistical Sciences, Saint-Louis Hospital, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France.
authors.forename: Elif
authors.initials: E
authors.lastname: Hindié
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D018572:Disease-Free Survival; D047628:Estrogen Receptor alpha / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D047628:Estrogen Receptor alpha; D019788:Fluorodeoxyglucose F18; D019275:Radiopharmaceuticals; D018719:Erb-b2 Receptor Tyrosine Kinases; C506487:ESR1 protein, human; C508053:ERBB2 protein, human
keywords: 18FDG-PET/CT; ER+/HER2– breast cancer; SUVmax; neoadjuvant chemotherapy; prognosis; total lesion glycolysis