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Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy

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Abstract

Neoadjuvant chemotherapy has become the standard treatment for patients with locally advanced breast cancer; however a technique that can accurately differentiate responders from non-responders at an early time point during treatment has still to be identified. The purpose of this work was to evaluate the ability of pharmacokinetically modelled dynamic contrast-enhanced MRI data to predict and monitor response of patients diagnosed with locally advanced breast cancer to neoadjuvant chemotherapy, at an early time point during treatment. Sixty-eight patients with histology proven breast cancer underwent MRI examination prior to treatment, early during treatment and following the final cycle of chemotherapy. A two compartment pharmacokinetic model provided the kinetic parameters transfer constant (Ktrans), rate constant (Kep) and extracellular extravascular space (Ve) for a region of interest encompassing the whole lesion (ROIwhole) and a 3 × 3 pixel ‘hot-spot’ showing the greatest mean maximum percentage enhancement from within that region (ROIhs). Following treatment 48 patients were classified as responders and 20 as non-responders based on total tumour volume reduction. Tumour volume changes between the pre-treatment and early treatment time points demonstrated differences between responders and non-responders with percentage change revealing the most significant result (p < 0.001). Analysis based on ROIhsprovided more statistically significant differences between responders and non-responders then ROIwhole analysis. ROIhs analysis demonstrated differences between responders and non-responders both prior to and early during treatment. A highly significant reduction in both Ktrans and Kep (p < 0.001) was noted for responders between the pre-treatment and early treatment time points, while Ve significantly increased during the same time period for non-responders (p < 0.001). Quantification of dynamic contrast enhancement parameters provides a potential means for differentiating responders from non-responders early during their treatment, thereby allowing a prompt change in treatment if necessary.

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Authors and Affiliations

  1. Post-graduate Medical School, Division of Cancer, Centre for Magnetic Resonance Investigations, University of Hull, UK

    Martin D. Pickles, Martin Lowry, David J. Manton, Peter Gibbs & Lindsay W. Turnbull

  2. Centre for Magnetic Resonance Investigations, Hull Royal Infirmary, Anlaby Road, Hull, UK, HU3 2JZ

    Martin D. Pickles

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  1. Martin D. Pickles
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  2. Martin Lowry
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Correspondence to Martin D. Pickles.

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Pickles, M.D., Lowry, M., Manton, D.J. et al. Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy. Breast Cancer Res Treat 91, 1–10 (2005). https://doi.org/10.1007/s10549-004-5819-2

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