Prognostic Value of 68Ga-NOTA-RGD PET/CT for Predicting Disease-Free Survival for Patients With Breast Cancer Undergoing Neoadjuvant Chemotherapy and Surgery: A Comparison Study With Dynamic Contrast Enhanced MRI.
OBJECTIVE
We performed pretreatment angiogenesis imaging (Ga-NOTA-arginyl-glycyl-aspartic acid [RGD] PET/CT) to compare its prognostic value to dynamic contrast-enhanced (DCE) MRI in breast cancer patients.


METHODS
Forty-four female patients with stage II or III breast cancer (aged 47.3 ± 8.1 years) were prospectively enrolled and underwent Ga-NOTA-RGD PET/CT and DCE-MRI imaging. All patients received neoadjuvant chemotherapy and underwent surgery. With pretreatment Ga-NOTA-RGD PET/CT, SUVmax of the tumor in the torso (-T) and regional (-R) images were measured. With pretreatment DCE-MRI, the largest diameter of the tumor and maximum enhancement index (EImax; EImax = [highest signal / baseline signal] - 1) of the tumor were assessed.


RESULTS
Ten patients (22.7%) were found to have breast cancer recurrence after 17.9 ± 11.2 months. The SUVmax-R (P = 0.017, cutoff >2.79) of Ga-NOTA-RGD PET/CT, the largest diameter of tumor (P = 0.017, cutoff >6.3 cm), and the EImax (P = 0.008, cutoff >5.38) of DCE-MRI showed significant results by univariate analysis. The 3-year disease-free survival of SUVmax-R was 91.7% versus 59.1% by Kaplan-Meier analysis (hazard ratio, 5.379). Multivariable analysis demonstrated that SUVmax-R with tumor diameter or EImax were the significant parameters. In addition, the combined parameters of SUVmax-R and EImax revealed better predictive value for prediction of breast cancer recurrence (75.0%) than each parameter of SUVmax-R (64.2%) and EImax (68.7%).


CONCLUSIONS
Increased angiogenic activity of regional Ga-NOTA-RGD PET/CT (SUVmax-R) can be an early prognostic marker for the prediction of breast cancer recurrence.
From the *Department of Nuclear Medicine, Seoul National University Hospital; †Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University; ‡Department of Nuclear Medicine, Ewha Womans University; §Cancer Research Institute, Seoul National University, Seoul, Korea; ∥Department of Radiological Sciences, University of California, Irvine, CA; and Departments of ¶Radiology and #Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
Yong-Il
YI
Kim
Hai-Jeon
HJ
Yoon
Jin Chul
JC
Paeng
Gi Jeong
GJ
Cheon
Dong Soo
DS
Lee
June-Key
JK
Chung
E Edmund
EE
Kim
Woo Kyung
WK
Moon
Keon Wook
KW
Kang
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000628:therapy; D003287:Contrast Media; D056831:Coordination Complexes; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D005710:Gallium Radioisotopes; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D009842:Oligopeptides; D009942:Organometallic Compounds; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D043823:Taxoids / Q000008:administration & dosage
C584295:68Ga-1,4,7-triazacyclononane-1,4-7-triacetic acid-isothiocyanatobenzyl-c(Arg-Gly-Asp-Tyr-Lys); D003287:Contrast Media; D056831:Coordination Complexes; D005710:Gallium Radioisotopes; D009842:Oligopeptides; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D043823:Taxoids; D019788:Fluorodeoxyglucose F18; D000077143:Docetaxel; C090600:gadobutrol; D015251:Epirubicin; D004317:Doxorubicin; D003520:Cyclophosphamide