Debkumar Sarkar, DO
Memorial Sloan Kettering Cancer Center
Disclosure(s): No financial relationships to disclose
Constantinos T. Sofocleous, MD PhD
Weill Cornell Medical College Memorial Sloan-Kettering Cancer Center
To assess the prognostic value of total lesion glycolysis (TLG) and to assess for a relationship between tumor absorbed dose (TAD) and change in total lesion glycolysis (∆TLG) in patients with breast cancer liver metastases undergoing radioembolization.
Materials and Methods:
This is an IRB approved retrospective study. From January 2015 to April 2018 a total of 15 female patients with breast cancer liver metastases (ages 37-72 years, mean 54.8) underwent ytrium-90 radioembolization using glass microspheres. Pre-treatment and post-treatment PET/CT were evaluated to determine metabolic tumor volume (MTV), SUVmean, SUVmax, and TLG using Aquarius iNtuition. ∆TLG was subsequently calculated. Treatment response was assessed using PERCIST. Post y90 bremsstrahlung SPECT/CT was evaluated to determine TAD with MIRD partition model using HERMES. The relationship between TAD and ∆TLG was analyzed using Spearman correlation coefficients. Univariable analysis of Overall Survival (OS) was performed through Kaplan-Meier survival curves and log-rank tests.
Median OS was 18.8 months. 1, 2 and 3year survival was 75%, 26.7% and 13.3% respectively. Patients with low TLG (TLG< 1000) compared with those with high TLG had significantly improved survival (46.7 months vs 14.8 months p=0.014). There was a statistically significant difference in OS when TAD in the target lesion was >200 Gy (38.9 months vs 12.5 months p < 0.05). ∆TLG greater than 70% was associated with statistically significant improved survival (42.1months vs 11.4 months p< 0.05). Finally, there is a positive correlation between the TAD and ∆TLG (p< 0.05).
Pretreatment TLG appears to be a prognostic factor influencing OS in patients with metastatic breast cancer. Higher tumor absorbed doses lead to improved outcomes with higher ∆TLG and improved OS. ∆TLG may be an effective method to quantify and monitor post-treatment response for radioembolization.