Prognostic Role of Early and End-of-Neoadjuvant Treatment 18F-FDG PET/CT in Patients With Breast Cancer

Vicente, Ana María García; Amo-Salas, Mariano; Calatayud, Fernanda Relea; Sánchez, María del Carmen; Pardo, Francisco José Pena; Londoño, G.A. Jiménez; Cabellos, R. Alvarez; Aunión, Ruth Espinosa; Castrejón, Á. Soriano

doi:10.1097/rlu.0000000000001191

Cited by 15 publications

(13 citation statements)

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“…Six studies presented a moderate risk of confounding bias as no adjustment for potential confounders was performed [ 12 , 18 , 20 , 21 , 24 , 28 ]. With regard to statistical analysis domains, five studies had a moderate risk of bias as it was unclear which variables were incorporated into the multivariate analyses, or too many variables were included in the multivariate analyses considering the number of patients in the study population [ 13 , 15 , 17 , 19 , 30 ]. One study had a high risk of bias in the statistical analyses due to possible selective reporting, as the results of survival analysis were provided for only a subset of the study population, and not the whole population [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of note, %ΔSUVmax is defined as (SUVmax at baseline PET − SUVmax at interim or post-treatment PET) / SUVmax at baseline PET × 100%. The CMR in the included studies was defined as negative FDG uptake [ 21 ], or according to the European Organisation for Research and Treatment of Cancer (EORTC) or Positron Emission Tomography Response Criteria in Solid Tumours (PERCIST) criteria [ 17 , 26 , 30 ]. Regarding the timing of interim assessment, PET or PET/CT were performed after two cycles of NAC in five studies [ 17 – 19 , 30 , 32 ], one cycle in four [ 20 , 21 , 28 , 31 ], and three cycles in two studies [ 13 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

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Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Han

Choi

2020

Breast Cancer Res

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Background We performed a systematic review and meta-analysis to evaluate the prognostic significance of 18F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of 18F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model. Results Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14–0.32) for interim PET scans and 0.31 (95% CI, 0.21–0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09–0.44) and 0.26 (95% CI, 0.14–0.51), respectively. Conclusions The currently available literature suggests that the use of 18F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Han

Choi

2020

Breast Cancer Res

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“…We agree with this proposal until a valid combined variable has been established. Only a few studies have described the metabolic response in breast and axilla separately and its respective association with pCR breast and pCR axilla within the same cohort [7, 34]. These studies did not evaluate the correlation between the metabolic response in both locations.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, detection of changes in tumour glucose metabolism in response to treatment enables early response monitoring [5]. Optimal long-term outcome is seen after pathologic complete response in breast and axilla (pCR total) [6] but the sensitivity to NST may differ between both sites [7, 8]. Nevertheless, most previous neoadjuvant PET/CT studies focussed on the metabolic response of the breast alone [9–15].…”

Section: Introductionmentioning

confidence: 99%

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Additional value of 18F-FDG PET/CT response evaluation in axillary nodes during neoadjuvant therapy for triple-negative and HER2-positive breast cancer

et al. 2017

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Background 18F-FDG PET/CT can monitor metabolic activity in early breast cancer during neoadjuvant systemic therapy (NST), but it is unknown if the metabolic breast and axillary response differ. We evaluated the correlation between metabolic breast and axillary response at various time points during NST. Furthermore, we analysed if the combined metabolic response improves pathologic complete response (pCR) prediction compared to using the metabolic breast response alone.Methods 18F-FDG PET/CT was performed at baseline (PET1), 2–3 weeks (PET2), and 6–8 weeks (PET3) of NST in patients with triple-negative (TN) and HER2-positive node-positive breast cancer. SUVmax and ∆SUVmax were determined separately for breast and axilla. Spearman’s correlation coefficients (r) between both localisations were calculated. The accuracy of pCR total (ypT0/is,ypN0) prediction using the metabolic response in breast, axilla or both was examined using logistic regression analysis.ResultsHundred-five patients were included: 45 TN and 60 HER2-positive tumours. The metabolic response in breast and axilla correlated moderately in TN tumours (r = 0.57) using ∆SUVmax between PET1-PET3 and poorly in HER2-positive tumours (r = 0.49) using SUVmax at PET2. In TN tumours, metabolic breast response predicted pCR well without improvement after adding axillary response (c-index 0.82 versus 0.85, p = 0.63). In HER2-positive tumours, metabolic breast response predicted pCR poorly with improvement after adding axillary response (c-index 0.64 versus 0.72, p = 0.06).Conclusions 18F-FDG PET/CT response during NST differs between breast and axilla. In TN tumours, pCR total prediction can be made independent of metabolic axillary response. In HER2-positive tumours, axillary response may improve pCR total prediction. These findings may help guide PET/CT-response-based changes during NST.Trial registration NTR NTR1797. Registered 29 May 2009, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-017-0117-5) contains supplementary material, which is available to authorized users.

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The accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis and systematic review

et al. 2017

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Prognostic Role of Early and End-of-Neoadjuvant Treatment 18F-FDG PET/CT in Patients With Breast Cancer

Abstract: End-of-treatment F-FDG PET/CT was a predictor of lymph node response and prognosis. Most of metabolic response variables related to histopathological response showed association with the prognosis.

Cited by 15 publications

References 49 publications

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Additional value of 18F-FDG PET/CT response evaluation in axillary nodes during neoadjuvant therapy for triple-negative and HER2-positive breast cancer

The accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis and systematic review

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