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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: 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). Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish
Article number109821
JournalEuropean Journal of Radiology
Volume141
DOIs
Publication statusPublished - Aug 2021

Keywords

  • Bone metastases
  • Breast cancer
  • F-FDG
  • F-FES
  • Heterogeneity
  • Oestrogen receptor

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