SAN ANTONIO — Contrast-enhanced MRI shows promise as a predictive tool for deciding a priori whether neoadjuvant therapy is going to work in patients with locally advanced breast cancer, Oana I. Craciunescu, Ph.D., said at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.
The predictive power of this technique stems from the fact that pretreatment gadolinium-enhanced MRI is capable of extracting information about tumor vascularity, permeability, and cellularity that correlates with response to neoadjuvant chemotherapy and hyperthermia, explained Dr. Craciunescu of Duke University, Durham, N.C.
The novel imaging modality takes 30 minutes after bolus injection of the contrast agent. During that time, tumor gadolinium uptake and washout rates are assessed to generate morphophysiologic maps of the malignancy, that are converted into predicted treatment response scores.
Studying actual neoadjuvant therapy outcomes in 20 patients with locally advanced breast cancer who were in a clinical trial in which they underwent four cycles of neoadjuvant chemotherapy and hyperthermia, followed by surgery, the MRI-based scoring system had 91% sensitivity and 89% specificity for predicting neoadjuvant treatment response. Nine of 11 patients with a score of 2-5 were responders, compared with 1 of 9 patients having a score of 0-1 in the study sponsored by the National Cancer Institute.