FDG PET-CT of chemobrain: An SPM analysis in patients with breast cancer before and after neoadjuvant chemotherapy

초록

Objectives The aim of this study was to investigate the chemotherapy related brain metabolic change by means of FDG PET-CT. Methods We enrolled 27 patients with breast cancer who underwent FDG PET-CT for initial staging work up (base line study) and had follow up studies for response monitoring of neoadjuvant chemotherapy. We analysed the region of brain from the whole body PET-CT. We had 24 recent (less than 30 days) follow up data, and 5 remote (more than 1yr) follow up data. Comparison between base-line study and post chemotherapy study were analysed by paired T-test using SPM5. And we also determined the difference between 19 pairs of FDG PET-CT of base line and age matched normal control. Results Compared to base-line studies, recent post-chemo studies showed significantly decreased glucose metabolism in left temporal lobe (BA 21, 13, 41), left superior and middle frontal lobe (BA 6,8) insula (BA 13), postcentral gyrus of left parietal lobe (BA 2) and right medial frontal gyrus (BA 2). In remote post chemotherapy study, glucose metabolism in fusiform gyrus of left temporal lobe (BA 20) and precentral gyrus of left frontal lobe (BA 44) was significant decrease as compared with base-line study. In comparison between normal control vs baseline study of cancer patients, glucose metabolism significantly decreased in left inferior temporal (BA 20), right precentral gyrus (BA 44) and right middle frontal gyrus (BA 11) in base-line study of cancer patients. Conclusions The present study showed that chemotherapy induced significant brain change in both of recent and remote state after neoadjuvant chemotherapy in breast cancer. And another important finding was that the significantly decreased glucose metabolism was also found in breast cancer patients before chemotherapy as compared with the age matched normal control group. It seems, therefore, that cancer-related as well as chemotherapy-induced brain metabolic changes may be present