Total Lesion Glycolysis and Sequential 90Y-Selective Internal Radiation Therapy in Breast Cancer Liver Metastases: Preliminary Results

To assess the prognostic role of total lesion glycolysis (TLG) in patients with breast cancer liver metastases (BCLM) after sequential lobar Y-90-radioembolization (Y-90-RE). Seventeen patients with bilobar BCLM underwent FDG PET/CT and TLG calculation before Y-90-RE. The hepatic lobe with the highest TLG was treated in the first session. PET was performed 6 weeks postprocedure and decrease in TLG (TLG) in the treated lobe was calculated before the second Y-90 administration. Subjects were divided in two groups (group 1: TLG >50%, group 2: TLG <50%). After the two consecutive Y-90-therapies, patients underwent follow-up until death. Statistical analysis was performed to identify prognostic factors on overall survival (OS). After the first Y-90 administration, 10 cases showed a TLG >50% and seven had a TLG value <50%. After the two consecutive procedures, the mean OS for all patients was 13.5 +/- 0.8 months. Subjects with a TLG >50% and TLG <50% had a mean OS of 16.4 +/- 0.6 and 10.3 +/- 0.4 months, respectively (p<0.001). Cox regression analysis demonstrated hepatic tumor load (p=0.048) and TLG as the only significant (p=0.005) predictors of survival. TLG after the first Y-90 administration agrees with final outcome in BCLM patients after separate sequential lobar Y-90-RE.