Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy
Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy
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DOI：
10.1007/s10549-004-5819-2
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发表时间：
2005-05-01
影响因子：
3.8
通讯作者：
Turnbull, LW
中科院分区：
文献类型：
--
作者：
Pickles, MD;Lowry, M;Turnbull, LW
新辅助化疗已成为局部晚期乳腺癌患者的标准治疗方法;然而，一种可以在治疗期间的早期时间点准确区分有反应者和无反应者的技术仍有待确定。这项工作的目的是评价药物动力学建模的动态对比增强MRI数据预测和监测诊断为局部晚期乳腺癌的患者在治疗期间的早期时间点对新辅助化疗的反应的能力。68例经组织学证实的乳腺癌患者在治疗前、治疗早期和最后一个化疗周期后接受了MRI检查。一个两室药代动力学模型提供了动力学参数传递常数（K-transs），速率常数（K-ep）和细胞外血管外空间（V-e）的一个区域的利益，包括整个病变（ROI整体）和一个3 - 3像素的Cyhot-spot显示最大的平均最大百分比增强从该区域（ROIhs）。治疗后，根据总肿瘤体积减少，48例患者被归类为应答者，20例患者被归类为非应答者。治疗前和早期治疗时间点之间的肿瘤体积变化证明了应答者和非应答者之间的差异，其中百分比变化揭示了最显著的结果（p <0.001）。基于ROI（hs）的分析提供了应答者和非应答者之间的统计学显著差异，然后ROI整体分析。ROIhs分析显示了治疗前和治疗早期应答者和非应答者之间的差异。在治疗前和早期治疗时间点之间，观察到应答者的K-transs和K-ep均显著降低（p <0.001），而在同一时间段内，无应答者的V-e显著增加（p <0.001）。动态对比度增强参数的量化提供了一种在治疗早期区分应答者和非应答者的潜在方法，从而允许在必要时迅速改变治疗。
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 (K-trans), rate constant (K-ep) and extracellular extravascular space (V-e) for a region of interest encompassing the whole lesion (ROIwhole) and a 3 3 pixel Cyhot-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 ROI(hs)provided 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 K-trans and K-ep (p < 0.001) was noted for responders between the pre-treatment and early treatment time points, while V-e 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.