Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer

A. Ciarmiello, S. Del Vecchio, P. Silvestro, M. I. Potena, M. V. Carriera, R. Thomas, G. Botti, G. D'Aiuto, M. Salvatore

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Abstract

Purpose: Since we have previously shown that the efflux rate of technetium 99m (99mTc) sestamibi, a transport substrate of P-glycoprotein (Pgp), is directly correlated with Pgp levels in untreated breast carcinoma, we tested whether tumor clearance of 99mTc-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 III disease, median tumor diameter 5.8 cm (range, 3 to 10) were enrolled onto this prospective clinical trial and underwent 99mTc-sestamibi scan before neoadjuvant chemotherapy. Patients were injected intravenously (IV) with 740 MBq of 99mTc-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 99mTc-sestamibi was calculated in each patient from decay corrected time-activity curves using a monoexponential fitting. Patients were treated with epirubicin 150 mg/m2 IV every 2 weeks for three courses and then underwent surgery within 3 weeks from the completion of chemotherapy. Residual tumor was assessed by pathologic examination of mastectomy specimens. Results: Seventeen of 39 patients showed a rapid tumor clearance of 99mTc-sestamibi (time to half clearance [t( 1/4 )] ≤ 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 99mTc-sestamibi (t( 1/4 ) > 204 minutes) showed residual macroscopic tumor at histology (Fisher's exact test, P <.01). Conclusion: A rapid tumor clearance of 99mTc-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.

Original languageEnglish
Pages (from-to)1677-1683
Number of pages7
JournalJournal of Clinical Oncology
Volume16
Issue number5
Publication statusPublished - May 1998

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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    Ciarmiello, A., Del Vecchio, S., Silvestro, P., Potena, M. I., Carriera, M. V., Thomas, R., Botti, G., D'Aiuto, G., & Salvatore, M. (1998). Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer. Journal of Clinical Oncology, 16(5), 1677-1683.