18F-FDG PET-Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer
Journal of Nuclear Medicine
Previous studies have suggested that early changes in blood flow (BF) in response to neoadjuvant chemotherapy and evaluated with 15 O-water are a surrogate biomarker of outcome in women with breast cancer. This study investigates, in the triple-negative breast cancer subtype, the prognostic relevance of tumor BF changes (DBF) in response to chemotherapy, assessed using a short dynamic 18 F-FDG PET acquisition. Methods: Forty-six consecutive women with triple-negative breast cancer and an
... ion for neoadjuvant chemotherapy were prospectively included. Women benefited from a baseline 18 F-FDG PET examination with a 2-min chest-centered dynamic acquisition, started at the time of 18 F-FDG injection. Breast tumor perfusion was calculated from this short dynamic image using a first-pass model. This dynamic PET acquisition was repeated after the first cycle of chemotherapy to measure early DBF. Delayed static PET acquisitions were also performed (90 min after 18 F-FDG injection) to measure changes in tumor glucose metabolism (DSUV max ). The association between tumor BF, clinicopathologic characteristics, and patients' overall survival (OS) was evaluated. Results: Median baseline tumor BF was 21 mL/min/100 g (range, 6-46 mL/min/100 g) and did not significantly differ according to tumor size, Scarf-Bloom-Richardson grade, or Ki-67 expression. Median tumor ΔBF was −30%, with highly scattered values (range, −93% to 1118%). A weak correlation was observed between DBF and ΔSUV max (r 5 10.40, P 5 0.01). The median follow-up was 30 mo (range, 6-73 mo). Eight women developed recurrent disease, 7 of whom died. Low OS was associated with menopausal history (P 5 0.03), persistent or increased tumor vascularization on the interim PET (DBF cutoff 5 −30%; P 5 0.03), non-breast-conserving surgery (P 5 0.04), and the absence of a pathologic complete response (pCR) (P 5 0.01). DBF and pCR provided incremental prognostic stratification: 3-y OS was 100% in pCR women, 87% in no-pCR women but achieving an early tumor BF response, and only 48% in no-pCR/no-BF-response women (DBF cutoff 5 −30%, P , 0.001). Conclusion: This study suggests the clinical usefulness of an early user-and patient-friendly 2-min dynamic acquisition to monitor breast tumor DBF to neoadjuvant chemotherapy using 18 F-FDG PET/CT. Monitoring tumor perfusion and angiogenesis response to treatment seems to be a promising target for PET tracers.