Comparing the Performances of Magnetic Resonance Imaging Size vs Pharmacokinetic Parameters to Predict Response to Neoadjuvant Chemotherapy and Survival in Patients With Breast Cancer.

PURPOSE To compare the value of dynamic contrast-enhanced magnetic resonance imaging-pharmacokinetic (PK) parameters vs tumor volume in predicting breast cancer neoadjuvant chemotherapy response (NACR) and patient survival. SUBJECTS AND METHODS Sixty-six patients with locally advanced breast cancer who underwent breast MRI monitoring of NACR were retrospectively analyzed. We compared baseline transfer constant (Ktrans), reflux rate contrast (kep), and extracellular extravascular volume fraction (ve) with the same parameters obtained at early postchemotherapy MRI, and examined model-independent changes in time-intensity curves (maximum slope, contrast enhancement ratio, and IAUC90). Tumor size changes (tumor volume, single dimension, and Response Evaluation Criteria in Solid Tumors [RECIST]) were also analyzed. The Spearman correlation test was used to assess the association between size and PK parameters, and regression analysis to assess the association with 5-year disease-free survival. RESULTS Higher ve values at baseline were associated with greater decreases in tumor size (P = 0.008). Changes in Ktrans and IAUC90 were the strongest predictors of NACR. Changes in IAUC90 (P = 0.04) and RECIST (P = 0.003) were independently associated with pathologic response. The only parameter significantly associated with 5-year survival was change in RECIST (P = 0.001). However, there was a trend toward statistical significance for changes in ve and Ktrans, with greater changes associated with longer survival. CONCLUSION Changes in PK and dynamic contrast-enhanced magnetic resonance imaging kinetic parameters may have a role in predicting NACR in breast tumors. Although changes in Ktrans and IAUC90 are helpful in predicting NACR, they do not show significant association with survival. Early RECIST size change measured by MRI remains the strongest predictor of overall patient survival.

[1]  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.

[2]  M. Bani,et al.  Neoadjuvant chemotherapy in breast cancer: which diagnostic procedures can be used? , 2005, Anticancer research.

[3]  Mevlüt Türe,et al.  Prognostic value DCE-MRI parameters in predicting factor disease free survival and overall survival for breast cancer patients. , 2012, European journal of radiology.

[4]  T. Powles,et al.  Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. , 1995, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  Woo Kyung Moon,et al.  Early Prediction of Response to Neoadjuvant Chemotherapy Using Parametric Response , 2015 .

[6]  L. Esserman,et al.  Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL. , 2012, Radiology.

[7]  G. Hortobagyi,et al.  Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  Orhan Nalcioglu,et al.  MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy , 2008, Cancer.

[9]  A. Tutt,et al.  Recommendations from an International Consensus Conference on the Current Status and Future of Neoadjuvant Systemic Therapy in Primary Breast Cancer , 2012, Annals of Surgical Oncology.

[10]  D. Drost,et al.  Simultaneous MRI measurement of blood flow, blood volume, and capillary permeability in mammary tumors using two different contrast agents , 2000, Journal of magnetic resonance imaging : JMRI.

[11]  J. Wildberger,et al.  Pre-treatment differences and early response monitoring of neoadjuvant chemotherapy in breast cancer patients using magnetic resonance imaging: a systematic review , 2012, European Radiology.

[12]  Carmel Hayes,et al.  Prediction of clinicopathologic response of breast cancer to primary chemotherapy at contrast-enhanced MR imaging: initial clinical results. , 2006, Radiology.

[13]  R. Schulz-Wendtland.  Neoadjuvant chemotherapy--monitoring: clinical examination, ultrasound, mammography, MRI, elastography: only one, only few or all? , 2012, European journal of radiology.

[14]  L. Schwartz,et al.  New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). , 2009, European journal of cancer.

[15]  P. Tofts.  Modeling tracer kinetics in dynamic Gd‐DTPA MR imaging , 1997, Journal of magnetic resonance imaging : JMRI.

[16]  Andreas Makris,et al.  Early Changes in Functional Dynamic Magnetic Resonance Imaging Predict for Pathologic Response to Neoadjuvant Chemotherapy in Primary Breast Cancer , 2008, Clinical Cancer Research.

[17]  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.

[18]  L. Turnbull,et al.  Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy , 2005, Breast Cancer Research and Treatment.

[19]  P. Spanheimer,et al.  The response to neoadjuvant chemotherapy predicts clinical outcome and increases breast conservation in advanced breast cancer. , 2013, American journal of surgery.

[20]  L. Turnbull,et al.  Prognostic value of pre-treatment DCE-MRI parameters in predicting disease free and overall survival for breast cancer patients undergoing neoadjuvant chemotherapy. , 2009, European journal of radiology.