Subhashree, C (2009) Assessment of Response to Neoadjuvant Chemotherapy by Dynamic Contrast Enhanced MR Mammogram in Locally Advanced Breast Cancer and Comparison of Result with Pathologic Results. Masters thesis, Madras Medical College, Chennai.
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Abstract
Breast Cancer Is The Leading Cancer In Women . Breast Cancer Is The Most Common Cancer In Women, Accounting For A Total Of 215,990 Cases And 39,800 Deaths Per Year In United States[18]. Worldwide, Nearly 1 Million Cases Are Seen Annually. Epidemiologists Have Calculated That A Woman Born Today In The United States Has A 1 In 8 Chance Of Developing Breast Cancer In Her Life Time And The Life Risk Of Dying From Breast Cancer Is 3.3% Or 1 In 30 Women. In India, Breast Cancer Is Second Most Common Cancer Among Women Next To Cervical Cancer. In Chennai, According To 2004 Statistics, The Most Common Cancer Among Women Is Breast Cancer 26.5%, The Next Common Is Cervical Cancer 21.2% And The Others Are Ovary, Stomach, And Oral Cancers. The Crude Ratio And Age Adjusted Ratio Per 100000 Population For Developing Breast Cancer Is 24.4 And 26.6[19]. Most Patients Presented With Locally Advanced Breast Carcinoma. Ratio Of Locally Advanced Breast Cancer (LABC) To Early Breast Cancer, In Our Centre, Is 70:30,As 0pposed To Western Statistics Where LABC Accounts To Less Than 20%. Neoadjuvantchemotherapy (Adjuvant / Basal / Induction / Primary / Preoperative Chemotherapy) Is Given Preoperatively In Labcs To Give A Tumor Size Reduction And A Better Surgical Approximation. The Role Of Imaging For Patients Treated With Neoadjuvant Therapy For Breast Cancer Is Not Only To Evaluate The Therapeutic Response In Terms Of Tumour Shrinkage, But Also To Predict The Histological Response To Chemotherapy, Which Is Correlated To Survival. Surgery And Histopathological Analysis After Neoadjuvant Therapy Allow For An Objective Assessment Of The Accuracy Of Imaging Techniques In Evaluating Response. A Complete Tumour Response To Neoadjuvant Chemotherapy Increases The Disease-Free Interval And Patient Survival. The Parameter With The Greatest Predictive Value Is The Absence Of Any Gross Residual Tumour. Limited Microscopic Residual Tumour Does Not Play Any Significant Role, And Is Found Nearly Constantly (95% Of Complete Responses). Assessing Response To Neoadjuvant Chemotherapy In Breast Cancer Is Important, Because A Nonreponsive Tumor Can Be Combatted With A Higher Or Different Set Of Chemotherapeutic Agents, Thereby Preventing Adverse Effects Of Chemotherapy Regimen And Saving Time By Timely Change Of Regimen And Getting A Response To Treatment. A Complete Tumour Response To Neoadjuvant Chemotherapy Increases The Disease-Free Interval And Patient Survival. Hence Assessing The Response Also Prognosticates The Patient’s Disease- Free Survival. Physical Examination Is Often Unsatisfactory For Assessment Of The Response Of Locally Advanced Breast Cancer To Primary Medical Treatment. Feldman Et Al. [1] Reported That 45% Of Complete Clinical Responders Had Macroscopic Tumour At Histological Examination; Inversely, 60% Of Patients Without Any Histological Gross Residual Tumour Had An Incomplete Clinical Response. In The Series Of 49 Patients Studied By Cocconi Et Al. [2]. Physical Examination Overestimated Tumour Regression In 23% Of Cases And Underestimated The Response In 9%. The Accuracy Of Physical Examination Is Mediocre Because Palpation Of A Fibrotic And Necrotic Mass May Mimic A Residual Tumour Mass. In Other Cases, The Apparent Clinical Regression Is Due To Resolution Of Post-Biopsy Phenomena Such As Haemorrhage And Oedema. Tumours In A Progressive Phase Are Difficult To Assess By Physical Examination; Regression Of Inflammatory Phenomena Is Often The Sole Objective Parameter As The Tumour Mass Itself Changes Very Little. In The Series Of Balu-Maestro Et Al. ,(3) Ultrasound Has Been Found To Be Poorly Reliable, Evaluating The Size Of Residual Tumour After Chemotherapy Only In 43% Of Cases. In Other Series Ultrasound Was Found To Be Superior To Physical Examination And Mammography Especially When The Tumour Was Hypoechoic. Modification Of Tumoral Echogenicity Induced By Chemotherapy Limits The Reproducibility Of The Measurements After Treatment. During The Treatment The Tumoral Density Decreases On Successive Mammograms. This Density Diminution Cannot Be Measured And May Even Interfere With The Measurements Because Of The Decreased Contrast Ratio Between Tumoral And Normal Tissue. Ultrasound May Then Be More Reliable. When The Tumour Is Fractionated, Plurifocal, Or When It Is Larger Than The Field Of The Probe, The Ultrasound Measurements Are Not So Reliable. In Multifocal Disease, The Advantage Of Ultrasound Is Controversial. Infra-Clinical Or Infra-Mammographic Lesions May Be Found That Will Change The Therapeutic Strategy But Will Not Be Characterized With Certainty By This Method. Ultrasound Is Able To Measure The Skin Thickness And Oedema And To Follow Their Evolution. Ultrasound Is The Best Modality For Examining Lymph Nodes (Sensitivity 72%–84%, Specificity Up To 97% With High Frequencies Probes) [5,6]. Controversial Results About Ultrasound In The Literature Emphasize The Importance Of Parameters That Interfere With The Accuracy Of The Method. The Main One Is Operator Dependence. However, The Technique Is Changing And Must Not Remain Only Morphological Especially In Monitoring Treatment Of Cancers. An Early Decrease Or Disappearance Of Tumour Vascularity Evaluated By Doppler Ultrasonography May Reflect The Efficiency Of Chemotherapy Before Any Decrease In Tumour Volume. On The Contrary, An Increase In Tumour Vascularity Reflects Tumour Progression. MRI Allows Morphological Analysis Of Tumours And Kinetic Study Of The Contrast Enhancement Reflecting The Richness Of The Vascularization. It Is The Most Reliable Method For Appreciating Multifocality. Its Role Is Essential In Pre-Therapeutic Staging And In The Assessment Of Chemotherapy Efficacy. Most Authors Find An Excellent Correlation Between The Macroscopic Tumour Size And The Tumour Established By MRI. In The Series Of Abraham Et Al. [8], In 97% Of The Cases, The Results Of MRI After Treatment Correlated With The Pathological Findings. During Or After Neoadjuvant Chemotherapy, Role Of MRI Is To (A) Monitor Early Response To Treatment (B)Identify Possible Residual Disease. To Avoid Harm And Costs Due To Inefficient Treatment It Is Desirable To Predict Response To Neoadjuvant Chemotherapy As Early As Possible, Ideally Immediately After The First Cycle. Imaging At This Stage Is Aimed At Demonstrating A Metabolic Response To Treatment ,Like Change In Contrast Enhancement And Time Activity Curve ,Rather Than Change In Tumor Size. Since Assessing Response To Chemotherapy Shall Have Substantial Impact On Clinical Decision –Making, It May Emerge As One Of The Important Indications Of Breast MRI.[17]. To Obtain More And Higher Level Evidence For This Indication The American College Of Radiology Imaging Network(ACRIN) Has Sponsored A Multiinstitutional Prospective Trial (ACRIN 6657) To Evaluate The Role Of MR In Predicting Response To Treatment.[17] In Our Study We Have Studied The Response Of Neoadjuvant Chemotherapy To Locally Advanced Breast Cancer By Dynamic Contrast Enhanced MR Mammogram And Compared Its Efficacy With Post Surgical Histopathology Results.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Assessment Response; Neoadjuvant ; Chemotherapy Dynamic Contrast Enhanced ; MR Mammogram ; Locally Advanced Breast Cancer ; Comparison Result ; Pathologic Results. |
| Subjects: | MEDICAL > Radio Diagnosis |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Jun 2017 12:18 |
| Last Modified: | 30 Jun 2017 12:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/735 |
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