Abstract PO3-27-01: Prediction of pathological complete response to neoadjuvant treatment in loco-regional advancedbreast cancer by using advanced PET/CT metabolic parameters
Authors: Shamya Maisun , Kagna Olga , Keidar Zohar , Palchan-Hazan Tala , Billan Salem , Abdah-Bortnyak Roxolyana 
Published: May 2024

Prediction of pathological complete response to neoadjuvant treatment in loco-regional advanced breast cancer by using advanced PET/CT metabolic parameters. Abstract: Background: The standard treatment for locally advanced breast cancer (LABC) is neoadjuvant systemic therapy followed by surgery. The usefulness of FDG PET/CT for evaluating the treatment efficacy in breast cancer is well established; however, the role of quantitative functional PET/CT parameters, such as the metabolic tumor volume (MTV) and total lesion glycolysis (TLG), remains inconclusive. The aim of this study was to determine the correlation between quantitative functional parameters derived from PET/CT in LABC patients at staging and the response to neoadjuvant therapy. Methods: Seventy-eight consecutive patients (aged 25-82 y) with confirmed LABC (stages II-III) who underwent PET/CT as a part of their staging assessment and received neoadjuvant therapy followed by surgery were retrospectively included in this study. All patients underwent an FDG PET/CT at staging; and values of SUV max, SUV mean, MTV, and TLG were determined from the PET/CT studies.

The patients were divided into two groups, based on the completeness of histopathologic response to neoadjuvant therapy, both in the primary tumor and axillary lymph nodes. Clinical, imaging and demographic data were collected from patient’s medical record. Results: A complete pathologic response (pCR) was achieved in 33/78 (42%) patients. Among patients with ER/PR positive, Her2-neu negative tumors, in 23/27 (85%) patients only partial pathologic response was reached; 91% of patients with ER/PR negative, Her2-neu positive and 43% of Triple-negative patients had complete pathological? response. For the primary breast tumor response, a higher SUV max, 10.7±5.34 for pCR vs. 7.24±4.62 for non-pCR group was measured, p-value=0.003; threshold value of 6.625. A higher SUV mean in the primary tumor resulted in a significantly higher rate of pCR, 5.95±2.36 vs 4,4±2.16, p=0.004, with a threshold value of 5.795.

Neither MTV, not TLG were predictive parameters of the primary tumor response. For lymph nodes response, SUV max and SUV mean had no role in the prediction of pCR. Statistically significant difference however, was found between pCR and non-pCR in MTV values in the involved lymph nodes, with a median =2.13 cm³ [0-7.85] in pCR group vs 5.43 cm³ [3.11-15.3] in non-pCR, p=0.01 (threshold value 2.375) as well as in TLG measurements, with a median of 4.64 [0-19.8] vs. 12.7 [3.21-23.1], p=0.047, (25-75 IQR). Conclusion: Primary breast tumor SUV max/mean values have a significant correlation with the treatment response and threshold values were found.

Low MTV and TLG measurements in lymph nodes may predict pCR. Neither MTV nor TLG had were found to have a significant role in the prediction of the primary tumor response.

Citation Format: Maisun Shamya, Olga Kagna, Zohar Keidar, Tala Palchan-Hazan, Salem Billan, Roxolyana Abdah-Bortnyak. Prediction of pathological complete response to neoadjuvant treatment in loco-regional advancedbreast cancer by using advanced PET/CT metabolic parameters [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-01.