Originally published as JCO Early Release 10.1200/JCO.2006.05.7406 on November 6 2006

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Monitoring of Early Response to Neoadjuvant Chemotherapy in Stage II and III Breast Cancer by [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography

Caroline Rousseau, Anne Devillers, Christine Sagan, Ludovic Ferrer, Boumédiène Bridji, Loïc Campion, Myriam Ricaud, Emmanuelle Bourbouloux, Isabelle Doutriaux, Martine Clouet, Dominique Berton-Rigaud, Catherine Bouriel, Valérie Delecroix, Etienne Garin, Sophie Rouquette, Isabelle Resche, Pierre Kerbrat, Jean François Chatal, Mario Campone

From the Nuclear Medicine, Pathology, Radiophysics, Statistics, Radiology, and Medical Oncology Units, René Gauducheau Cancer Center; Research Cancer Center, Nantes University, Inserm U601, Nantes, France; Nuclear Medicine, Radiology, and Medical Oncology Units, Eugène Marquis Cancer Center; and Gynecologic Surgery Unit, University Hospital Pontchaillou, Rennes, France

Address reprint requests to Caroline Rousseau, Service de Médecine Nucléaire, Centre René Gauducheau, Blvd Monod, 44805 Saint Herblain Cedex, France; e-mail: c-rousseau{at}nantes.fnclcc.fr

PURPOSE: This study aimed to assess prospectively the efficacy of sequential [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG PET) to evaluate early response to neoadjuvant chemotherapy in stage II and III breast cancer patients.

PATIENTS AND METHODS: Images were acquired with a PET/computed tomography scanner in 64 patients after administration of FDG (5 MBq/kg) at baseline and after the first, second, third, and sixth course of chemotherapy. Ultrasound and mammography were used to assess tumor size. Decrease in the standardized uptake value (SUV) with PET was compared with the pathologic response.

RESULTS: Surgery was performed after six courses of chemotherapy and pathologic analysis revealed gross residual disease in 28 patients and minimal residual disease in 36 patients. Although SUV data did not vary much in nonresponders (based on pathology findings), they decreased markedly to background levels in 94% (34 of 36) of responders. When using 60% of SUV at baseline as the cutoff value, the sensitivity, specificity, and negative predictive value of FDG PET were 61%, 96%, and 68% after one course of chemotherapy, 89%, 95%, and 85% after two courses, and 88%, 73%, and 83% after three courses, respectively. The same parameters with ultrasound (US) and mammography were 64%, 43%, and 55%, and 31%, 56%, and 45%, respectively. Assessment of tumor response with US or mammography was never significant whatever the cutoff.

CONCLUSION: Pathologic response to neoadjuvant chemotherapy in stage II and III breast cancer can be predicted accurately by FDG PET after two courses of chemotherapy.

published online ahead of print at www.jco.orgon November 6, 2006.

Supported by Conseil Régional des Pays de Loire.

Presented in poster format at the 41st Annual Meeting of the American Society of Clinical Oncology, May 13-17, 2005, Orlando, FL; and at the 52nd Annual Meeting of the Society of Nuclear Medicine, June 17-23, 2005, Toronto, Canada.

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

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