HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Partridge, S. C. Articles by Hylton, N. M. Search for Related Content PubMed PubMed Citation Articles by Partridge, S. C. Articles by Hylton, N. M. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

MRI Measurements of Breast Tumor Volume Predict Response to Neoadjuvant Chemotherapy and Recurrence-Free Survival

¹ Department of Radiology, University of California, San Francisco, San Francisco, CA 94143.
³ Department of Surgery, University of California, San Francisco, San Francisco, CA 94143.
⁴ Department of Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390.
⁵ Department of Oncology, University of California, San Francisco, San Francisco, CA 94143.

View larger version (16K): [in a new window]   Fig. 1. —Recurrence-free survival (RFS) curve for study population. The 2-year RFS rate was 83% for group of patients studied (n = 58). Median time to recurrence was 10 months (n = 13), and median follow-up time was 32.5 months in patients who were disease-free (n = 45).

View larger version (52K): [in a new window]   Fig. 2A. —50-year-old woman with invasive ductal carcinoma, grade III, studied while undergoing neoadjuvant chemotherapy treatment. MRI was performed using contrast-enhanced 3D fast gradient-recalled echo pulse sequence (TR/TE, 8/4.2; flip angle, 20°; 18-cm field of view, 2-mm slice thickness, 256 x 192 acquisition matrix). Patient presented with 22 cm3 (4.7-cm diameter) tumor. Significant reduction in MRI tumor volume was evident after one cycle of chemotherapy (30% decrease) and by end of treatment (88% decrease). Patient had 2.2 cm of residual disease and one involved lymph node at surgery and continues to be disease-free 20 months after surgery. Maximum intensity projection (top) with corresponding tumor volume segmentation for representative sagittal slice (bottom) acquired before initiation of chemotherapy

View larger version (48K): [in a new window]   Fig. 2B. —50-year-old woman with invasive ductal carcinoma, grade III, studied while undergoing neoadjuvant chemotherapy treatment. MRI was performed using contrast-enhanced 3D fast gradient-recalled echo pulse sequence (TR/TE, 8/4.2; flip angle, 20°; 18-cm field of view, 2-mm slice thickness, 256 x 192 acquisition matrix). Patient presented with 22 cm3 (4.7-cm diameter) tumor. Significant reduction in MRI tumor volume was evident after one cycle of chemotherapy (30% decrease) and by end of treatment (88% decrease). Patient had 2.2 cm of residual disease and one involved lymph node at surgery and continues to be disease-free 20 months after surgery. Maximum intensity projection (top) with corresponding tumor volume segmentation for representative sagittal slice (bottom) acquired after one cycle of chemotherapy.

View larger version (52K): [in a new window]   Fig. 2C. —50-year-old woman with invasive ductal carcinoma, grade III, studied while undergoing neoadjuvant chemotherapy treatment. MRI was performed using contrast-enhanced 3D fast gradient-recalled echo pulse sequence (TR/TE, 8/4.2; flip angle, 20°; 18-cm field of view, 2-mm slice thickness, 256 x 192 acquisition matrix). Patient presented with 22 cm3 (4.7-cm diameter) tumor. Significant reduction in MRI tumor volume was evident after one cycle of chemotherapy (30% decrease) and by end of treatment (88% decrease). Patient had 2.2 cm of residual disease and one involved lymph node at surgery and continues to be disease-free 20 months after surgery. Maximum intensity projection (top) with corresponding tumor volume segmentation for representative sagittal slice (bottom) acquired after completion of four cycles of chemotherapy.

View larger version (51K): [in a new window]   Fig. 3A. —41-year-old patient with invasive ductal carcinoma, grade III, studied while undergoing neoadjuvant chemotherapy treatment. MRI was performed using contrast-enhanced 3D fast gradient-recalled echo pulse sequence (TR/TE, 8/4.2; flip angle, 20°; 18-cm field of view, 2-mm slice thickness, 256 x 192 acquisition matrix). Patient presented with 71 cm3 (6.2-cm diameter) tumor and experienced increase in MRI tumor volume throughout treatment (28% overall increase). At surgery, 8 cm of residual disease and nine involved lymph nodes were identified. Patient experienced disease recurrence 8 months after surgery. Maximum intensity projection (top) with corresponding tumor volume segmentation for representative sagittal slice (bottom) acquired before initiation of chemotherapy

View larger version (45K): [in a new window]   Fig. 3B. —41-year-old patient with invasive ductal carcinoma, grade III, studied while undergoing neoadjuvant chemotherapy treatment. MRI was performed using contrast-enhanced 3D fast gradient-recalled echo pulse sequence (TR/TE, 8/4.2; flip angle, 20°; 18-cm field of view, 2-mm slice thickness, 256 x 192 acquisition matrix). Patient presented with 71 cm3 (6.2-cm diameter) tumor and experienced increase in MRI tumor volume throughout treatment (28% overall increase). At surgery, 8 cm of residual disease and nine involved lymph nodes were identified. Patient experienced disease recurrence 8 months after surgery. Maximum intensity projection (top) with corresponding tumor volume segmentation for representative sagittal slice (bottom) acquired after one cycle of chemotherapy.

View larger version (49K): [in a new window]   Fig. 3C. —41-year-old patient with invasive ductal carcinoma, grade III, studied while undergoing neoadjuvant chemotherapy treatment. MRI was performed using contrast-enhanced 3D fast gradient-recalled echo pulse sequence (TR/TE, 8/4.2; flip angle, 20°; 18-cm field of view, 2-mm slice thickness, 256 x 192 acquisition matrix). Patient presented with 71 cm3 (6.2-cm diameter) tumor and experienced increase in MRI tumor volume throughout treatment (28% overall increase). At surgery, 8 cm of residual disease and nine involved lymph nodes were identified. Patient experienced disease recurrence 8 months after surgery. Maximum intensity projection (top) with corresponding tumor volume segmentation for representative sagittal slice (bottom) acquired after completion of four cycles of chemotherapy. In this subject, several large blood vessels visible on maximum intensity projections were omitted from analyses, as described in Subjects and Methods, to avoid contributions to tumor volume calculations.

View larger version (20K): [in a new window]   Fig. 4A. —Illustration of final Cox model using Kaplan-Meier curves for length of recurrence-free survival (RFS). Resulting model from stepwise Cox analysis showed initial MRI tumor volume (p = 0.0051) and final change in MRI tumor volume (p = 0.0028) to be most significant independent predictors. Vol = volume decrease. Patients divided based on initial MRI volume of their tumors showed significant differences in RFS (p = 0.042, Wilcoxon's test). The 2-year RFS rate was 93% for patients with smaller tumor volumes of 33 cm3 or less (n = 30) compared with 70% for those with larger tumors (n = 28).

View larger version (20K): [in a new window]   Fig. 4B. —Illustration of final Cox model using Kaplan-Meier curves for length of recurrence-free survival (RFS). Resulting model from stepwise Cox analysis showed initial MRI tumor volume (p = 0.0051) and final change in MRI tumor volume (p = 0.0028) to be most significant independent predictors. Vol = volume decrease. Patients divided based on amount of volumetric tumor shrinkage experienced during treatment also showed significant differences in RFS (p = 0.012, Wilcoxon's test). The 2-year RFS rate was 87% for patients with 50% or greater reduction in tumor volume (n = 47) compared with 64% for those with less than 50% tumor shrinkage (n = 11) during treatment.

View larger version (24K): [in a new window]   Fig. 4C. —Illustration of final Cox model using Kaplan-Meier curves for length of recurrence-free survival (RFS). Resulting model from stepwise Cox analysis showed initial MRI tumor volume (p = 0.0051) and final change in MRI tumor volume (p = 0.0028) to be most significant independent predictors. Vol = volume decrease. Significantly longer RFS was observed in group of patients with initial tumor volumes less than 33 cm3 and at least 50% reduction in tumor volume during treatment (96% 2-year RFS, n = 23) compared with other patients (60% 2-year RFS, n = 35; p = 0.032, Wilcoxon's test).

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati