Contrast enhanced magnetic resonance imaging underestimates residual disease following neoadjuvant docetaxel based chemotherapy for breast cancer
Introduction
Neoadjuvant chemotherapy is used to treat women with locally advanced breast carcinoma. It allows conservative treatment in half of patients, and may be associated with better outcome for responders.1, 2, 3 New drugs such as taxanes are often used alone or in association in this situation and seem to enhance response rate and conservative surgical treatment.4 Recent studies suggest that docetaxel may have an anti-angiogenic activity which would explain, in part, its anti-tumoural effect by reducting the synthesis of pro-angiogenic molecules (such as bFGF and VEGF) by tumour cells.5
Contrast-enhanced magnetic resonance imaging (MRI) is used to measure tumour shrinkage following neoadjuvant chemotherapy.6 Visualization of tumour by contrast-enhanced MRI is allowed by tumour vascularization. However, some studies reported that anti-angiogenic treatment may lead to vascular changes assessed by Doppler sonography7 or MRI.8, 9
Contrast enhancement may be affected by both cytotoxic and potential anti-angiogenic effects of drugs such as docetaxel, leading to over or underestimate residual tumour size, and to mislead preoperative tumour response assessment. No comparison of the accuracy of MRI for measuring residual tumour according to chemotherapy regimen has been performed yet.
This prospective study was undertaken to compare the ability of MRI to measure residual breast cancer between patients treated with or without docetaxel-based.
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Patients and treatment
Between September 2001 and March 2004, 40 patients with histologically confirmed locally advanced breast carcinoma were treated with intravenous neoadjuvant chemotherapy. Patients with inflammatory breast cancer or synchronous metastasis were excluded. No previous treatment had been performed before chemotherapy. Twelve patients (mean age 47 years old, range 32–58) received 5 fluoro uracyl (500 mg/m2)-epirubicin (Farmorubicin® 100 mg/m2, Pharmacia and Upjohn Co)-cyclophosphamide (FEC group) and
Tumour response rates according to treatment arm
Clinical objective response rate was 82% in DXL group and 58% in FEC group (p=0.13). Radiological and histological response were also not statistically significant (p=0.45 and p=0.15, respectively) Table 1.
Tumour measurements
There were one patient with multifocal lesions in FEC group and two in DXL. Tumour MRI measurements after neoadjuvant chemotherapy were compared with histologic size for each of the 40 patients (Table 2). The average tumour size predicted by MRI was 20.3 mm (SD=17.0 mm, range 0–65 mm) compared
MRI accuracy and neoadjuvant chemotherapy
We prospectively compared accuracy of MRI to pathology to measure residual breast cancer after FEC or docetaxel preoperative chemotherapy in a homogeneous population of patient. We found a significant over/underestimation rate of tumour size by preoperative MRI and specific pathologic features were observed after docetaxel-based chemotherapy.
Neoadjuvant chemotherapy is administered to patients especially to allow breast conservation surgery in locally advanced breast cancer.1 Although, the
References (24)
- et al.
In vivo quantitation of tumour vascularization assessed by doppler sonography in rat mammary tumours
Ultrasound in Med Biol
(2002) - et al.
Primary chemotherapy to avoid mastectomy in tumors with diamaters of three centimetres or more
J Natl Cancer Inst
(1990) - et al.
Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18
J Natl Cancer Inst
(2001) - et al.
Preoperative chemotherapy in primary operable breast cancer: results from European Organization for Research and Treatment of Cancer trial 10902
J Clin Oncol
(2001) - et al.
Aberdeen Breast Group. Neoadjuvant docetaxel in locally advanced breast cancer
Breast Cancer Res Treat
(2003) - et al.
Inhibitory effects of docetaxel on expression of VEGF, bFGF and MMPs of LS174T cell
World J Gastroenterol
(2003) - et al.
Accuracy of MRI in the detection of residual breast cancer after neo-adjuvant chemotherapy
Am J Roentgenol
(2003) - et al.
Changes in tumor vascularization following irradiation, anthracyclin or anti-angiogenic treatment in autochthonous rat mammary tumors
Clinical Cancer Res
(2003) - et al.
Dynamic contrast-enhanced magnetic resonance imaging as a biomarker for the pharmacological response of PTK787, an inhibitor of the VEGF receptor tyrosine kinases, in patients with colorectal cancer and liver metastases: results from two phase 1 studies
J Clin Oncol
(2003) - et al.
Reduction of vascular and permeable regions in solid tumors detected by macromolecular contrast magnetic resonance imaging after treatment with anti-angiogenic agent TNP-470
Clin Cancer Res
(2003)