Comparison of FDG-PET/CT and contrast-enhanced CT for monitoring therapy response in patients with metastatic breast cancer

Christopher C. Riedl, Katja Pinker, Gary A. Ulaner, Leonard T. Ong, Pascal Baltzer, Maxine S. Jochelson, Heather L. McArthur, Mithat Gönen, Maura Dickler, Wolfgang A. Weber

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Purpose: The aim of this study was to compare fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and contrast-enhanced computed tomography (CE-CT) for the prediction of progression-free survival (PFS) and disease-specific survival (DSS) in patients with stage IV breast cancer undergoing systemic therapy. Methods: Sixty-five patients with metastatic breast cancer treated with first- or second-line systemic therapy in prospective clinical trials were included. Response to treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 for CE-CT and by PET Response Criteria in Solid Tumors (PERCIST), respectively. Results: All responders by RECIST (n = 22) were also responders by PERCIST, but 40% (17/43) of non-responders by RECIST were responders by PERCIST. Responses according to RECIST and PERCIST both correlated with PFS, but PERCIST showed a significantly higher predictive accuracy (concordance index for PFS: 0.70 vs. 0.60). One-year PFS for responders vs. non-responders by RECIST was 59% vs. 27%, compared to 63% vs. 0% by PERCIST. Four-year DSS of responders and non-responders by RECIST was 50% and 38%, respectively (p = 0.2, concordance index: 0.55) as compared to 58% vs. 18% for PERCIST (p < 0.001, concordance index: 0.65). Response on PET/CT was also a significantly better predictor for DSS than disease control on CE-CT. Conclusions: In patients with metastatic breast cancer, tumor response on PET/CT appears to be a superior predictor of PFS and DSS than response on CE-CT. Monitoring tumor response by PET/CT may increase the power of clinical trials using tumor response as an endpoint, and may improve patient management in clinical routine.

Original languageEnglish (US)
Pages (from-to)1428-1437
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number9
StatePublished - Aug 1 2017
Externally publishedYes


  • Breast cancer
  • FDG
  • PET/CT
  • Survival
  • Treatment response

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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