Impact of 18 F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Versus Conventional Staging in Patients With Locally Advanced Breast Cancer.

Autor:	Dayes IS; Department of Oncology, McMaster University, Hamilton, ON, Canada.; Juravinski Cancer Centre-Hamilton Health Sciences, Hamilton, ON, Canada.; Ontario Clinical Oncology Group, Hamilton, ON, Canada.; Escarpment Cancer Research Institute, Hamilton, ON, Canada., Metser U; Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.; University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada., Hodgson N; Department of Surgery, McMaster University, Hamilton, ON, Canada., Parpia S; Department of Oncology, McMaster University, Hamilton, ON, Canada.; Ontario Clinical Oncology Group, Hamilton, ON, Canada.; Escarpment Cancer Research Institute, Hamilton, ON, Canada., Eisen AF; Department of Medicine, University of Toronto, Toronto, ON, Canada.; Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada.; Ontario Health, Toronto, ON, Canada., George R; Department of Surgery, University of Toronto, Toronto, ON, Canada.; St Michael's Hospital, Toronto, ON, Canada., Blanchette P; Department of Oncology, Western University, London, ON, Canada.; London Health Sciences Regional Cancer Program, London, ON, Canada., Cil TD; University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada.; Department of Surgery, University of Toronto, Toronto, ON, Canada., Arnaout A; Department of Surgery, Ottawa University, Ottawa, ON, Canada.; Ottawa Hospital Cancer Centre, Ottawa, ON, Canada., Chan A; Northern Ontario School of Medicine, Thunder Bay ON, Canada.; Thunder Bay Regional Health Sciences Cancer Centre, Thunder Bay, ON, Canada., Levine MN; Department of Oncology, McMaster University, Hamilton, ON, Canada.; Juravinski Cancer Centre-Hamilton Health Sciences, Hamilton, ON, Canada.; Ontario Clinical Oncology Group, Hamilton, ON, Canada.; Escarpment Cancer Research Institute, Hamilton, ON, Canada.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2023 Aug 10; Vol. 41 (23), pp. 3909-3916. Date of Electronic Publication: 2023 May 26.
DOI:	10.1200/JCO.23.00249
Abstrakt:	Purpose: Patients with locally advanced breast cancer (LABC) typically undergo staging tests at presentation. If staging does not detect metastases, treatment consists of curative intent combined modality therapy (neoadjuvant chemotherapy, surgery, and regional radiation). Positron emission tomography-computed tomography (PET-CT) may detect more asymptomatic distant metastases, but the evidence is based on uncontrolled studies. Methods: For inclusion, patients had histological evidence of invasive ductal carcinoma of the breast and TNM stage III or IIb (T3N0, but not T2N1). Consenting patients from six regional cancer centers in Ontario were randomly assigned to 18 F-labeled fluorodeoxyglucose PET-CT or conventional staging (bone scan, CT of the chest/abdomen and pelvis). The primary end point was upstaging to stage IV. A key secondary outcome was receiving curative intent combined modality therapy (ClinicalTrials.gov identifier: NCT02751710). Results: Between December 2016 and April 2022, 184 patients were randomly assigned to whole-body PET-CT and 185 patients to conventional staging. Forty-three (23%) PET-CT patients were upstaged to stage IV compared with 21 (11%) conventional staged patients (absolute difference, 12.3% [95% CI, 3.9 to 19.9]; P = .002). Consequently, treatment was changed in 35 (81.3%) of 43 upstaged PET-CT patients and 20 (95.2%) of the 21 upstaged conventional patients. Subsequently, 149 (81%) patients in the PET-CT group received combined modality treatment versus 165 (89.2%) patients in the conventional staging group (absolute difference, 8.2% [95% CI, 0.1 to 15.4]; P = .03). Conclusion: In patients with LABC, PET-CT detected more distant metastases than conventional staging, and fewer PET-CT patients received combined modality therapy. Our randomized trial demonstrates the utility of the PET-CT staging strategy.
Databáze:	MEDLINE
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