Heterogeneity of bone metastases as an important prognostic factor in patients affected by oestrogen receptor-positive breast cancer. The role of combined [18F]Fluoroestradiol PET/CT and [18F]Fluorodeoxyglucose PET/CT

• DOI: 10.1016/j.ejrad.2021.109821
• Publication Date: 2021-06-10T01:57:17Z
• Authors: Gianluca Bottoni; Arnoldo Piccardo; Francesco Fiz; Giacomo Siri; Federica Matteucci; Andrea Rocca; Oriana Nanni; Manuela Monti; Etienne Brain; Jean Louis Alberini; Bassam Dib; Gian Mauro Sacchetti; Chiara Saggia; Valentina Rossi; Nadia Harbeck; Rachel Wuerstlein; Tom Degenhardt; Andrea DeCensi; Gian Andrea Rollandi; Alessandra Gennari
• Keywords: 570; Oestrogen receptor; Prognosi; 610; (18)F-FES; Breast Neoplasms; 03 medical and health sciences; Breast cancer; 0302 clinical medicine; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Humans; (18)F-FDG; [PHYS.PHYS.PHYS-BIO-PH] Physics [physics]/Physics [physics]/Biological Physics [physics.bio-ph]; (18)F-FDG; (18)F-FES; Bone metastases; Breast cancer; Heterogeneity; Oestrogen receptor; Female; Fluorodeoxyglucose F18; Humans; Prognosis; Radiopharmaceuticals; Receptors, Estrogen; Breast Neoplasms; Positron Emission Tomography Computed Tomography; Prognosis; 3. Good health; Bone metastase; Receptors, Estrogen; Radiopharmaceutical; Female; Heterogeneity; Radiopharmaceuticals; Breast Neoplasm; Human

To assess the prognostic role of different inter and intralesional expression (heterogeneity) of oestrogen receptor (ER) in bone metastases, as identified by the combined use of [18F]FES PET/CT and [18F]FDG PET/CT in patients with oestrogen receptor-positive (ER+) metastatic breast cancer (BC).We analysed patients with a new diagnosis of bone metastases who were candidates for first-line systemic endocrine therapy. Before starting therapy, patients underwent baseline [18F]FES PET/CT and [18]FDG PET/CT. Semi-quantitative evaluation of whole-body bone metabolic burden (WB-B-MB) was performed on [18F]FES and [18F]FDG PET/CT in order to evaluate disease extent, tumour metabolism and ER heterogeneity. We used time-to-event analyses (Kaplan-Meier and Cox proportional-hazards methods) to estimate progression-free (PFS) and overall survival (OS), in order to assess the independent prognostic value of [18F]FES PET/CT and [18F]FDG PET/CT, alone and in combination.According to our criteria, we enrolled 49 patients. Over a median follow-up of 44.7 months, 35 patients suffered disease progression (71.4 %) and 15 died of disease (30.6 %). When the risk of disease progression was calculated by means of the Cox model, only [18F]FDG WB-B-MB was independently and directly associated to PFS (p = 0.02). On analysing the association between all prognostic parameters and survival, the Cox model showed that the only parameter associated with OS was the WB-B-MB FES/FDG ratio (p = 0.01).The combined use of [18F]FES-PET/CT and [18F]FDG-PET/CT can identify ER heterogeneity in BC bone metastases. This heterogeneity is significantly associated with survival. Moreover, the extension of the FDG-avid component correlates with the risk of disease progression.