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Annals of Oncology Advance Access published online on July 14, 2009
Annals of Oncology, doi:10.1093/annonc/mdp262
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Circulating tumor cells and bone metastases as detected by FDG–PET/CT in patients with metastatic breast cancer

U. De Giorgi1,2,3, V. Valero1, E. Rohren4, M. Mego1,2, G. V. Doyle5, M. C. Miller5, N. T. Ueno1,6, B. C. Handy7, J. M. Reuben2, H. A. Macapinlac4, G. N. Hortobagyi1 and M. Cristofanilli1,*

1 Department of Breast Medical Oncology
2 Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
3 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
4 Department of Nuclear Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
5 Immunicon Corporation, Huntingdon Valley, PA, USA
6 Department of Stem Cell Transplantation and Cellular Therapy
7 Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

* Correspondence to: Dr M. Cristofanilli, Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1-713-792-8138; Fax: +1-713-794-1838; E-mail: mcristof{at}mdanderson.org

Background: We evaluated the relationship between the detection and prognostic significance of circulating tumor cells (CTCs) and sites of metastases detected by 2-[fluorine-18]fluoro-2-deoxy-D-glucose–positron emission tomography/computed tomography (FDG–PET/CT) in patients with metastatic breast cancer (MBC).

Patients and methods: From May 2004 to January 2008, 195 patients with relapsed/progressive MBC underwent whole-body FDG–PET/CT and provided blood samples for assessment of CTC count.

Results: Higher CTC numbers were detected in patients with bone metastases relative to those with no bone lesions (mean 65.7 versus 3.3, P = 0.0122) and in patients with multiple bone metastases relative to those with one or two bone lesions (mean 77.7 versus 2.6, P < 0.001). CTCs predicted overall survival (OS) in 108 patients with multiple sites of metastases including bone (P = 0.0008) but not in 58 without bone metastases (P = 0.4111) and in 29 with bone involvement only (P = 0.3552). All 15 patients but one with human epidermal growth factor receptor 2 (HER-2) positive tumors who were treated with trastuzumab-based regimens had <5 CTCs at progression. In multivariate analysis, CTCs, but not bone metastases, remained a significant predictor of OS.

Conclusion: Presence of extensive bone metastases as detected by FDG–PET/CT is associated with increased CTC numbers in MBC.

bone metastases, breast cancer, circulating tumor cells, FDG–PET/CT, prognosis

Received for publication March 26, 2009. Accepted for publication March 31, 2009.


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