Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer(481 views) Ciarmiello A, Del Vecchio S, Silvestro P, Potena MI, Carriero MV, Thomas R, Botti G, D'Aiuto G, Salvatore M
Journal Of Clinical Oncology (ISSN: 0732-183x), 1998 May; 16(5): 1677-1683.
Keywords: Antineoplastic Agent, Methoxy Isobutyl Isonitrile Technetium Tc 99m, Adult, Article, Breast Cancer, Cancer Chemotherapy, Cancer Scintiscanning, Cancer Surgery, Clinical Article, Drug Clearance, Drug Efficacy, Drug Response, Human, Intravenous Drug Administration, Priority Journal, Treatment Outcome, Antibiotics, Breast Neoplasms, Adjuvant, Disease-Free Survival, Epirubicin, Female, Lymph Node Excision, Mastectomy, Modified Radical, Middle Aged, Residual, Predictive Value Of Tests, Prospective Studies, Radiopharmaceuticals, Technetium Tc 99m Sestamibi,
Affiliations: Istituto Nazionale per lo Studio e la Cura dei Tumori, Naples, Italy
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Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer
Purpose: Since we have previously shown that the efflux rate of technetium 99m (Tc-99m) sestamibi, a transport substrate of P-glycoprotein (Pgp), is directly correlated with Pgp levels in untreated breast carcinoma, we tested whether tumor clearance of Tc-99m-sestamibi may be predictive of therapeutic response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. Patients and Methods: Thirty-nine patients with stage ill disease, median tumor diameter 5.8 cm (range, 3 to 10)were enrolled onto this prospective clinical trial and underwent Tc-99m-sestamibi scan before neoadjuvant chemotherapy. Patients were injected intravenously (IV) with 740 MBq of Tc-99m-sestamibi; a 15-minute dynamic study was performed, and static planar images were obtained at 0.5, 1, 2, and 4 hours. The time to half clearance of Tc-99m-sestamibi was calculated in each patient from decoy corrected time-activity curves using a monoexponential fitting. Patients were treated with epirubicin 150 mg/m(2) IV every 2 weeks for three courses and then underwent surgery within 3 weeks from the completion of chemotherapy. Residual tumor vias assessed by pathologic examination of mastectomy specimens. Results: Seventeen of 39 patients showed a rapid tumor clearance of Tc-99m-sestamibi (time to half clearance [t(1/2)] less than or equal to 204 minutes) and 15 of these 17 (88%) showed a highly cellular macroscopic residual tumor at histology that indicated lack of tumor response to neoadjuvant chemotherapy. In contrast, only eight of 22 (36%) with prolonged retention of Tc-99m-sestamibi (t(1/2) > 204 minutes) showed residual macroscopic tumor at histology (Fisher's exact test, P < .01). Conclusion: A rapid tumor clearance of Tc-99m-sestamibi may predict lack of tumor response to neoadjuvant chemotherapy with drugs affected by the multidrug-resistant phenotype in patients with locally advanced breast carcinoma. (C) 1998 by American Society of Clinical Oncology.
Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer
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