Comparing the performances of Magnetic Resonance Imaging size versus pharmacokinetic parameters to predict response to neoadjuvant chemotherapy and survival in breast cancer patients

Publication date: Available online 28 March 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Basak Dogan, Qing Yuan, Roland Bassett, Inanc Guvenc, Edward F. Jackson, Massimo Cristofanilli, Gary J. Whitman
PurposeTo compare the value of dynamic contrast-enhanced MRI (DCE-MRI)-pharmacokinetic (PK) parameters versus tumor volume in predicting breast cancer neoadjuvant chemotherapy response (NACR) and patient survival.Subjects and MethodsSixty-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 post-chemotherapy 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 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.ResultsHigher 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 pathological 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.ConclusionChanges in PK and DCE-MRI kinetic parameters may have a role in predicting NACR in breast tumors. While 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.



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