¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Abstract

90 Y radioembolization (selective internal radiation therapy [SIRT]) has emerged as a valuable therapeutic option in unresectable, chemotherapy-refractory hepatic metastases from breast cancer. The objective of the present study was to evaluate 18 F-FDG PET/ CT for predicting survival in these patients. Methods: Fifty-eight consecutive patients with hepatic metastases from breast cancer were treated with SIRT. Before therapy, all patients underwent MRI of the liver. 18 F-FDG PET/CT was performed at baseline and 3 mo after SIRT to calculate percentage changes in maximum 18 F-FDG standardized uptake value (SUV max ) relative to baseline. A decrease of more than 30% in the follow-up scan, compared with the baseline examination, indicated therapy response. Treatment response at 3 mo was also assessed in 43 patients using contrastenhanced MRI and CT on the basis of the Response Evaluation Criteria in Solid Tumors. All patients were followed to complete survival data. Results: Overall median survival after SIRT was 47 wk. Response as assessed with SUV max correlated significantly with survival after radioembolization, with responders having significantly longer survival (65 wk) than nonresponders (43 wk; P , 0.05). In multivariate analysis the change in SUV max was identified as the only independent predictor of survival (hazard ratio, 0.23; P , 0.005). Furthermore, a high pretherapeutic SUV max (.20) was associated with a significantly shorter median survival than was an SUV max of 20 or less (21 vs. 52 wk; P , 0.005). The presence of extrahepatic metastases (mean survival in both groups, 47 wk; P 5 0.92), hormone receptor status (estrogen, P 5 0.53; progesterone, P 5 0.79; Her-2/neu, P 5 0.49), and MRI/CT response (P 5 0.91) did not predict survival. Conclusion: The change in SUV max as assessed by 18 F-FDG PET/CT before and 3 mo after SIRT was identified as the only independent predictor of survival in patients with hepatic metastases of breast cancer. Breastcanceri s the most common malignancy affecting women in developed countries. Despite advances in adjuvant treatment, about 20% of patients with initially local disease will still develop metastases (1), frequently involving the liver. In most patients, curative surgical resection of liver metastases is not an option because of the presence of extrahepatic disease or multisegmental involvement of the liver. Other local therapies, such as radiofrequency ablation, are feasible in only a limited number of patients exhibiting only a few, small hepatic metastases. Despite significant advances in chemotherapeutic options in metastatic breast cancer, the presence of liver metastases limits survival in up to 60% of patients. Median survival in women exhibiting liver metastases of breast cancer has been estimated at about 18 mo (2).More recently, radioembolization using 90 Y-microspheres (selective internal radiation therapy [SIRT]) has emerged as a palliative treatment for hepatic metastases of various tumors (3-6). In hepatic metastases of breast cancer (7-9), reported...

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

“…Given the manifold options for local or systemic treatment of metastatic pancreatic cancer, it is crucial to identify those patients at high risk for tumor progression in order to optimally adapt their consequent treatment. In several studies of liver metastases from sources other than the pancreas, changes in tumor glycolytic rate by PET with the glucose analog 18 F-FDG proved to be predictive of response to radioembolization (6)(7)(8)(9)(10). Indeed, 18 F-FDG PET provided accuracy superior to CT in monitoring response and predicting survival in various solid tumors (11,12).…”

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

“…Assessment of early responses with [ 18 F]FDG PET/CT has been found to be superior to assessment based on the RECIST criteria and changes in tumor density evaluated with CT. Furthermore, PET is the strongest predictor of progression-free survival in patients with liver metastases, demonstrating a correlation with tumor markers [56][57][58].…”

18F-FDG PET-derived parameters as prognostic indices in hepatic malignancies after 90Y radioembolization: is there a role?

“…The previously cited reports [12,13,18] Y RE by performing FDG PET 6-8 weeks after the procedure [17]. A significant correlation was found between the decrease of SUV max and patients' progression-free survival.…”

“…Furthermore, PET Response Criteria in Solid Tumors (PERCIST) criteria have been recently introduced to more accurately define the metabolic response of tumours to the therapies [11]. Haug and colleagues published research on the role of FDG PET in predicting survival after 90 Y RE in a cohort of 58 patients with hepatic metastases from breast cancer [12]. FDG PETwas performed at baseline and 3 months after the procedure.…”