Total Lesion Glycolysis and the Impact of Tumor Absorbed Dose Following Radioembolization of Breast Cancer Liver Metastases

Wednesday, March 8, 2023

3:18 PM – 3:27 PM

Location: Phoenix Convention Center, 224AB

Presenting Author(s)

Debkumar Sarkar, DO

Associate Attending
Memorial Sloan Kettering Cancer Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

HM

Humberto G. Mendoza, MD

Nuclear Medicine
Memorial Sloan Kettering Cancer Center
KZ

Ken Zhao, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
Yolanda Bryce, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
Amy Deipolyi, MD, PhD

Director, IR
University of West Virginia
JB

Jackie Bromberg, MD, PhD

Attending Physician
Memorial Sloan Kettering Cancer Center
HY

Hooman Yarmohammadi, MD

Associate Attending
Memorial Sloan-Kettering Cancer Center
Constantinos T. Sofocleous, MD PhD

Professor IR
Weill Cornell Medical College Memorial Sloan-Kettering Cancer Center
SS

Stephen B. Solomon, MD

Section Chief
Memorial Sloan Kettering Cancer Center

Disclosure(s):

Debkumar Sarkar, DO: No financial relationships to disclose

Ken Zhao, MD: No financial relationships to disclose

Yolanda Bryce, MD: Boston Scientific, Inc.: Speaking and Teaching (Terminated, March 31, 2022); Hologic, Inc: Consultant (Terminated, January 30, 2022); Pfizer: Speaking and Teaching (Terminated, November 30, 2022)

Amy Deipolyi, MD, PhD: No financial relationships to disclose

Constantinos T. Sofocleous, MD PhD: No relevant disclosure to display

Stephen B. Solomon, MD: Aperture Medical: Board Membership (Ongoing), Consultant (Ongoing), Ownership Interest (Ongoing); Elesta: Research Grant Recipient (Ongoing); GE Healthcare: Consultant (Ongoing), Research Grant Recipient (Ongoing); Johnson & Johnson: Consultant (Ongoing), Ownership Interest (Ongoing); Microbot: Consultant (Ongoing); XAct Robotics: Consultant (Ongoing)

Purpose:

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.

Results:

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).

Conclusion:

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.