Comparison of FDG-PET/CT and contrast-enhanced CT for monitoring therapy response in patients with metastatic breast cancer

Abstract

Purpose The aim of this study was to compare fluorodeoxyglucose positron emission tomography (FDG PET/CT) and contrast-enhanced computed tomography (CE-CT) for the prediction of progression-free survival (PFS) and disease-specific survival (DSS) in patients with stage IV breast cancer undergoing systemic therapy. Methods Sixty-five patients with metastatic breast cancer treated with first- or second-line systemic therapy in prospective clinical trials were included. Response to treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 for CE-CT and by PET response criteria in solid tumors (PERCIST), respectively. Results All responders by RECIST (n=22) were also responders by PERCIST, but 40% (17/43) of non-responders by RECIST were responders by PERCIST. Responses according to RECIST and PERCIST both correlated with PFS, but PERCIST showed a significantly higher predictive accuracy (concordance index for PFS: 0.70 vs. 0.60). One-year PFS for responders vs. non-responders by RECIST was 59% vs. 27%, compared to 63% vs. 0% by PERCIST. Four-year DSS of responders and non-responders by RECIST were 50% and 38%, respectively (p=0.2, concordance index: 0.55) as compared to 58% vs. 18% for PERCIST (p<0.001, concordance index: 0.65). Response on PET/CT was also a significantly better predictor for DSS than disease control on CE-CT. Conclusions In patients with metastatic breast cancer, tumor response on PET/CT appears to be a superior predictor of PFS and DSS than response on CE-CT. Monitoring tumor response by PET/CT may increase the power of clinical trials using tumor response as an endpoint, and may improve patient management in clinical routine.

18F-FDG PET/CT for Monitoring of Ipilimumab Therapy in Patients with Metastatic Melanoma

“…However, patients with SMD showed almost the same poor survival as patients with PMD. A similar observation has been made in patients with breast cancer treated with chemotherapy (23). This contrasts with response assessment by CT and RECIST, because stable disease on CT is generally associated with better prognosis than progressive disease.…”

18F-FES PET/CT Influences the Staging and Management of Patients with Newly Diagnosed Estrogen Receptor-Positive Breast Cancer: A Retrospective Comparative Study with 18F-FDG PET/CT

“…Increasing evidence in the literature suggests that positron emission tomography (PET)/computed tomography (CT) has a higher sensitivity and specificity in the staging of many cancers compared with other imaging methods . 18 F‐fluoro‐2‐deoxy‐D‐glucose ( 18 F‐FDG) is the most commonly used PET tracer in routine clinical practice for diagnosis and monitoring responses to therapy in oncology . In breast cancer, 18 F‐FDG PET‐CT is commonly required for metastatic examination, management response, and suspected recurrence of locally advanced cancer ; however, 18 F‐FDG is not a cancer‐specific tracer, and benign diseases related to infection or inflammation can also show false‐positive intense 18 F‐FDG uptake, which causes difficulty in distinguishing benign disorders from malignant diseases .…”

Prognostic Value of Dual-Time-Point 18F-Fluorodeoxyglucose PET/CT in Metastatic Breast Cancer: An Exploratory Study of Quantitative Measures

“…FDG-PET/CT is even more accurate compared to conventional imaging in the detection of bone metastases (bone being one of the most probable sites of metastases in breast cancer) [4]. FDG-PET/CT has also proved superior to conventional imaging for predicting treatment response in patients treated for metastatic breast cancer (MBC) [5,6].…”