Potential of Reduction in Total Tumor Volume Measured with 3D‐MRI as a Prognostic Factor for Locally‐Advanced Breast Cancer Patients Treated with Primary Chemotherapy

Abstract:  For accurate assessment of the response to primary chemotherapy (PCT) for locally advanced breast cancer, we measured reduction in total tumor volume (TTV) by using three‐dimensional magnetic resonance imaging (3D MRI), and examined the relationship between this reduction and patient prognosis. Fifty‐one patients with locally advanced breast cancer were treated with four cycles of docetaxel (60 mg/m2) before surgery. Tumor size was measured with calipers, ultrasonography (US) and conventional two‐dimensional (2D) MRI before and after chemotherapy. TTV was measured with 3D MRI. These and other clinicopathological parameters were statistically analyzed to determine the prognosis for the patients. Median follow‐up time was 46 months (1–64 months). Of the 51 patients, 25 developed distant recurrences. Patients whose TTV decreased by 75% or more after PCT showed significantly better prognosis than others, while tumor size measured with calipers, US and 2D MRI showed no significant relationship with patient prognosis. Of the clinicopathological parameters, only reduction in TTV and histological grade showed a significant association with distant recurrence‐free survival (p = 0.03 and 0.02, log‐rank test), while stepwise multivariate Cox’s proportional hazards analysis identified TTV as the strongest independent prognostic factor. Reduction in TTV measured with 3D MRI can be a useful prognostic factor for patients with locally advanced breast cancer treated with PCT.

[1]  A. Brufsky,et al.  Phase II study of neoadjuvant docetaxel/ vinorelbine followed by surgery and adjuvant doxorubicin/cyclophosphamide in women with stage II/III breast cancer. , 2006, Clinical breast cancer.

[2]  B. Overmoyer,et al.  Phase II study of dose-dense sequential doxorubicin and docetaxel for patients with advanced operable and inoperable breast cancer , 2006, Breast Cancer Research and Treatment.

[3]  G. Hortobagyi,et al.  Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. , 1997, Clinical cancer research : an official journal of the American Association for Cancer Research.

[4]  E. Winer,et al.  Efficacy of pegfilgrastim and darbepoetin alfa as hematopoietic support for dose-dense every-2-week adjuvant breast cancer chemotherapy. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  D. Venzon,et al.  A Pilot Study of Dose Intense Doxorubicin and Cyclophosphamide Followed by Infusional Paclitaxel in High-Risk Primary Breast Cancer , 2003, Breast Cancer Research and Treatment.

[6]  L. Esserman,et al.  MRI measurements of breast tumor volume predict response to neoadjuvant chemotherapy and recurrence-free survival. , 2005, AJR. American journal of roentgenology.

[7]  J. Blohmer,et al.  Dose-dense biweekly doxorubicin/docetaxel versus sequential neoadjuvant chemotherapy with doxorubicin/cyclophosphamide/docetaxel in operable breast cancer: second interim analysis. , 2002, Clinical breast cancer.

[8]  G. Cocconi,et al.  Problems in evaluating response of primary breast cancer to systemic therapy , 2005, Breast Cancer Research and Treatment.

[9]  S. Delorme,et al.  Locally advanced breast carcinoma: evaluation of mammography in the prediction of residual disease after induction chemotherapy. , 2000, Anticancer research.

[10]  Anna L. Brown,et al.  Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  K S Panageas,et al.  Weekly trastuzumab and paclitaxel therapy for metastatic breast cancer with analysis of efficacy by HER2 immunophenotype and gene amplification. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  D. Wickerham,et al.  Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  T. Aas,et al.  Predictive value of tumour cell proliferation in locally advanced breast cancer treated with neoadjuvant chemotherapy. , 2003, European journal of cancer.

[14]  William J. Gradishar,et al.  Evidence-Based Use of Neoadjuvant Taxane in Operable and Inoperable Breast Cancer , 2004, Clinical Cancer Research.

[15]  V. Valero,et al.  Neoadjuvant systemic therapy for breast cancer: an overview and review of recent clinical trials , 2005, Expert opinion on pharmacotherapy.

[16]  Ying Lu,et al.  Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. , 2002, AJR. American journal of roentgenology.

[17]  Yoshinobu Sato,et al.  Preoperative Evaluation of Residual Tumor Extent by Three‐Dimensional Magnetic Resonance Imaging in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy , 2006, The breast journal.

[18]  J E Husband,et al.  Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. , 1996, Radiology.

[19]  M. Helvie,et al.  Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. , 1996, Radiology.

[20]  V. Ozmen,et al.  Breast Conserving Surgery after Primary Chemotherapy in Locally Advanced Breast Cancer , 2005, Acta chirurgica Belgica.

[21]  B. Asselain,et al.  Breast tumour response to primary chemotherapy predicts local and distant control as well as survival. , 1995, European journal of cancer.