Original articlePredictive value of DCE-MRI for early evaluation of pathological complete response to neoadjuvant chemotherapy in resectable primary breast cancer: A single-center prospective study
Introduction
Neoadjuvant chemotherapy (NAC) for breast cancer has been widely promoted in recent years, and NAC has been made a necessary step for operable patients with breast cancer according to NCCN guidelines [1]. NAC can effectively control the potential metastases at the earliest time and reduce the size and stage of tumor, which to the greatest extent enables breast-conserving surgery, and therefore improves the life quality of breast cancer patients [2].
Several studies proved that patients achieving pathological complete response (pCR) after NAC presented significantly better survival outcomes that those not achieving pCR [3], [4], [5], [6]. Thus, pCR is regarded as a surrogate endpoint for improved survival in breast cancer patients with NAC.
Preoperative accurate prediction of pCR status enables timely regimen adjustment, which is especially crucial when a patient is resistant to NAC. The earlier the pCR status could be predicted, the more clinical benefit would be obtained. Presently, MRI is usually applied in preoperative evaluation of therapeutic response to NAC [7], [8], [9]. Researchers considered several MRI parameters, such as size, apparent diffusion coefficient (ADC), transfer constant (Ktrans), rate constant (Kep) and relative blood volume (rBV) for predicting pCR. However, most of present studies were of small sample size, and used complexly calculated MRI parameters.
Thus we proposed this prospective study to investigate the value of dynamic enhanced MRI (DCE-MRI) for predicting pCR at the end of the first NAC cycle, based on the findings to establish a multi-parameter MRI model for early prediction of pCR.
Section snippets
Patients
This study was approved by the Medical Ethics Committee of Peking University Cancer Hospital. Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We enrolled consecutive patients from December 2005
Patients
We enrolled 191 consecutive patients who were scheduled to receive NAC followed by surgery from December 2005 to December 2007. We excluded 6 patients with distant metastasis, 2 patients combined with other tumor, 3 patients with uncontrolled adverse conditions, 3 patients who didn't complete the NAC, 2 patients who received primary surgery, 2 patients with MR contraindication and 3 patients withdrew. Finally 170 patients were included in this study, with their characteristics listed in Table 1
Discussion
The ultimate goal of oncology is to improve the overall survival of patients. Generally it takes more than ten years or even decades of follow-up to acquire survival outcomes, thus in recent years, pCR often serves as an early marker of long-term survival for breast cancer patients with NAC [3], [4], [5], [6].
It is still argued if other regimen should be added when a patient doesn't achieve pCR. GBG 44-GeparQuinto trial [10] showed the neoadjuvant use of bevacizumab or everolimus in addition to
Conflict of interest statement
The authors have declared that no competing interests exist.
Acknowledgements
This work was supported by the National Natural Science Foundation of China (Grant No. 81471640, YSS), the National Basic Research Program of China (973 Program) (Grant No. 2011CB707705, YSS), Beijing Health System High Level Health Technical Personnel Training Plan (No. 2013-3-083, YSS).
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Ying-Shi Sun and Ying-Jian He contributed equally to this work.