Originally published as JCO Early Release 10.1200/JCO.2005.04.6326 on May 22 2006

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Powerful Prognostic Stratification By [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography in Patients With Metastatic Breast Cancer Treated With High-Dose Chemotherapy

Florent Cachin, H. Miles Prince, Annette Hogg, Robert E. Ware, Rodney J. Hicks

From the Centre for Molecular Imaging; Division of Haematology and Medical Oncology, the Peter MacCallum Cancer Centre, Melbourne; the University of Melbourne, Parkville, Victoria, Australia; and the Nuclear Medicine Department, Cancer Center Jean Perrin, Clermont Ferrand, France

Address reprint requests to Rodney Hicks, MD, Centre for Molecular Imaging, The Peter MacCallum Cancer Centre, 12 Cathedral Place, East Melbourne, VIC 3002, Australia; e-mail: rod.hicks{at}petermac.org

PURPOSE: This study examines the use of [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the evaluation of the therapeutic response for patients treated with high-dose chemotherapy (HDC) with autologous stem cell transplantation for metastatic breast cancer (MBC) focusing on prognostic stratification.

PATIENTS AND METHODS: Forty-seven patients with MBC were treated with a maximum of three cycles of HDC. Therapeutic response was assessed with conventional imaging (CImg; including a computed tomography in all cases and ultrasound, mammography, and bone scanning as clinically indicated) and by FDG-PET study performed after the last cycle of HDC. Parameters analyzed for predicting survival were FDG-PET and CImg results, pattern of disease, prior treatment, and HDC regimen.

RESULTS: Complete responses were observed in 16 patients (37%) with CImg and 34 patients (72%) with FDG-PET. The FDG-PET result was the most powerful and independent predictor of survival; patients with a negative post-treatment FDG-PET had a longer median survival than patients with a positive FDG-PET (24 months v 10 months; P < .001). By multivariate analysis the relative risk (RR) of death was higher in patients with FDG-PET-positive disease (RR, 5.3), prior anthracycline treatment (RR, 3.3), or with visceral metastasis (RR, 2.4).

CONCLUSION: A single FDG-PET study performed after completion of HDC for MBC can powerfully stratify for survival. This may have implications for how we should assess outcome after conventional-dose therapy for MBC and warrants additional study.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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