Early metabolic response assessment of breast cancer liver metastases: 4-week posttreatment FDG PET predicts survival after ⁹⁰Y microsphere radioembolization

Abstract

Aim To evaluate the feasibility of early metabolic response assessment with ¹⁸F-FDG PET/CT in patients with breast cancer liver metastases 4 weeks after radioembolization with Yttrium-90 labeled microspheres.

Methods 25 patients (mean age 58y, range 40–74) with advanced stage liver metastases of breast cancer were treated with 1.9 ± 0.4 GBq of 90Y-microspheres in the salvage setting and underwent ¹⁸F-FDG PET/CT at baseline and 4 weeks post-radioembolization. 14 patients (56 %) had an excessive hepatic tumor burden (> 50 % of total liver volume), 21 patients (84 %) had extrahepatic disease. Liver lesions with the highest SUV_max were selected as target lesions and a cut-off was set at 50 % reduction to separate responders from non-responders. The predictive impact of metabolic response on overall survival (OS) was investigated along with other prognostic factors.

Results The median OS in this highly advanced metastatic cohort was 7 months (95 % CI, 5–9). All patients had a reduction in SUV_max (mean ΔSUV_max: –49 ± 26 %) at 4 weeks post-treatment. Patients with > 50 % SUV_max reduction survived longer (median OS 13 mo, 95 % CI 8–18) than the remaining patients (median OS 4 mo, 95 % CI 2–6; p = 0.001). From all investigated baseline factors including age, performance status, and presence of extra-hepatic disease, only the hepatic tumor burden had a significant impact on OS (p = 0.02).

Conclusions This is the first preliminary evidence in breast cancer that early post-radioembolization molecular response assessment of treated liver metastases – as early as 4 weeks posttreatment – may predict survival. If confirmed by larger series, FDG PET/CT could be considered for early response-adapted treatment modifications.

Zusammenfassung

Methoden n = 25 Patientinnen (Durchschnittsalter 58 Jahre, 40–74) mit fortgeschritten leberdominant metastasiertem Brustkrebs wurden mit Radioembolisation behandelt (1,9 ± 0,4 GBq). Vor und 4 Wochen nach Radioembolisation erfolgte eine ¹⁸F-FDG PET/CT Bildgebung. 14 Patientinnen (56 %) hatten eine sehr hohe hepatische Tumorlast (> 50 % des Lebervolumens), 21 (84 %) auch extrahepatische Tumormanifestationen. Als Zielläsionen wurden die Leberlmetastasen mit den höchsten SUV_max Werten ausgewählt, der Cut-off zur Unterscheidung von Respondern und Non-Respondern lag bei 50 % Reduktion des Ausgangs-SUV_max. Der prädiktive Wert des metabolischen Ansprechens auf das Gesamtüberleben (OS) wurde zusammen mit anderen prognostischen Faktoren untersucht.

Ergebnisse Das mediane Gesamtüberleben in dieser Kohorte betrug 7 Monate (95 % CI, 5–9). Bei allen Patienten konnte 4 Wochen nach Behandlung eine Reduktion des SUV_max der Zielläsionen (Mittelwert ΔSUV_max: –49 ± 26 %) festgestellt werden. Patientinnen mit > 50 % SUV_max-Reduktion überlebten länger (mOS 13 Monate; 95 % CI, 8–18) als die übrigen Patientinnen (mOS 4 Monate; 95 % CI, 2–6; p = 0,001). Von allen untersuchten Ausgangsfaktoren wie Alter, ECOG Score und extrahepat. Befall hatte nur die hepatische Tumorlast einen signifikanten Einfluss auf das Gesamtüberleben (p = 0,02).

Beurteilung Die Studie liefert den ersten Hinweis dafür, dass das metabolischen Frühansprechen von radioembolisierten Lebermetastasen beim Brutkrebs bereits 4 Wochen nach erfolgter SIRT von hoher prädiktiver Relevanz ist. Nach Bestätigung der Ergebnisse in größeren Studien sollte die frühe posttherapeutische FDG-PET/CT eine Optimierung des Patientenmanagement unter Berücksichtigung des Ansprechverhaltens nach Radioembolisation erbringen

Key words

FDG-PET/CT - breast cancer - SIRT - radioembolization - FDG - liver metastases

Schlüsselwörter

Radioembolisation - Brustkrebs - SIRT - FDG-PET/CT - Lebermetastasen

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