title: ¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer.
abstract: Changes in tumor metabolic activity have been shown to be an early indicator of treatment effectiveness for breast cancer, mainly in the neoadjuvant setting. The histopathologic response at the completion of chemotherapy has been used as the reference standard for assessment of the accuracy of (18)F-FDG PET in predicting a response during systemic treatment. Although a pathologic complete response (pCR) remains an important positive prognostic factor for an individual patient, a recent metaanalysis could validate pCR as a surrogate marker for patient outcomes only in aggressive breast cancer subtypes. For establishment of the clinical application of metabolic treatment response studies, larger series of specific breast cancer subtypes-including hormone receptor-positive, human epidermal growth factor receptor 2-positive, and triple-negative breast cancers-are necessary. In addition, thresholds for relative changes in (18)F-FDG uptake to distinguish between responding and nonresponding tumors need to be validated for different systemic treatment approaches, with progression-free survival and overall survival as references. A PET-based treatment stratification is applicable clinically only if valid alternative therapies are available. Of note, patients who do not achieve a pCR might still benefit from neoadjuvant therapy enabling breast-conserving surgery. In the metastatic setting, residual tumor metabolic activity after the initiation of systemic therapy is an indicator of active disease, whereas a complete resolution of metabolic activity is predictive of a successful treatment response.
authors.affiliation: Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Avril
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Muzic
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Donna
authors.initials: D
authors.lastname: Plecha
authors.affiliation: Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; and.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Traughber
authors.affiliation: Department of Medicine (Hematology and Oncology), Seidman Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Shaveta
authors.initials: S
authors.lastname: Vinayak
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio Norbert.Avril@Case.edu.
authors.forename: Norbert
authors.initials: N
authors.lastname: Avril
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008991:Monitoring, Physiologic; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG; 18F-FDG PET; PET/CT; breast cancer; therapy monitoring; treatment response
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