The Effectiveness of Radiological Methods in Predicting Pathological Complete Response After Neoadjuvant Therapy in Locally Advanced Breast Cancer Patients

Abstract

Abstract Aim: The current innovations in breast cancer treatment have led to an increased utilization of neoadjuvant therapy. Pathological complete response following neoadjuvant therapy is a crucial prognostic factor for predicting survival. The objective of this study is to demonstrate the efficacy of radiological methods in predicting patholojical complete response in our patients with locally advanced breast cancer. Material and Methods: The medical records of patients who received treatment for breast cancer at our hospital between January 2017 and January 2022 were retrospectively reviewed. The study included female patients over the age of 18 with locally advanced unifocal breast cancer who underwent neoadjuvant chemotherapy. Demographic information, menopausal status, molecular subtypes, radiological results, disease stage, treatment and surgical methods, and pathology results were recorded. Results: A total of 4474 patients were treated for breast cancer out of which 94 patients met the criteria for this study. The mean age of the patients was 49.9 ± 11.06 years. Ultrasonography was performed on all patients, while FDG-PetCT was performed on 47 (50%) patients and magnetic resonance imaging (MRI) was performed on 31 (33%) patients for radiological response evaluation. The radiological complete response was highest in the FDG-petCT group (39.4%). The rate of pathological complete response was 35.1%. Conclusion: Although FDG-PETCT has high sensitivity in predicting pathological complete response after neoadjuvant chemotherapy in locally advanced breast cancers, the common use of ultrasonography, FDG-PETCT, and magnetic resonance imaging is more advantageous due to their different benefits.

Keywords

• breast
• beast cancer
• neoadjuvant therapy

Lokal İleri Meme Kanseri Hastalarında Neoadjuvan Tedavi Sonrası Patolojik Tam Yanıtı Tahmin Etmede Radyolojik Yöntemlerin Etkinliği

Öz

Öz Amaç: Meme kanseri tedavisindeki güncel yenilikler, neoadjuvan tedavinin kullanımının artmasına neden olmuştur. Neoadjuvan tedaviyi takiben patolojik tam yanıt , sağkalımı tahmin etmek için çok önemli bir prognostik faktördür. Bu çalışmanın amacı, lokal ileri meme kanserli hastalarımızda radyolojik yöntemlerin patolojik tam yanıtı öngörmedeki etkinliğini göstermektir. Materyal ve Metod: Hastanemizde Ocak 2017-Ocak 2022 tarihleri arasında meme kanseri tedavisi gören hastaların tıbbi kayıtları retrospektif olarak incelendi. Çalışmaya, neoadjuvan kemoterapi uygulanan, lokal ileri tek odaklı meme kanserli 18 yaş üstü kadın hastalar dahil edildi. Hastaların demografik bilgileri, menopoz durumu, moleküler alt tipleri, radyolojik sonuçları, hastalık evresi, tedavi ve cerrahi yöntemleri, patoloji sonuçları kaydedildi. Bulgular: Toplam 4474 hasta meme kanseri tedavisi gördü ve bunların 94'ü bu çalışmanın kriterlerini karşıladı. Hastaların yaş ortalaması 49,9 ± 11,06 idi. Radyolojik yanıt değerlendirmesi için tüm hastalara ultrasonografi, 47 (%50) hastaya FDG-PetCT ve 31 (%33) hastaya manyetik rezonans görüntüleme (MRG) yapıldı. Radyolojik tam yanıt FDG-petCT grubunda (%39.4) en yüksekti. Patolojik tam yanıt oranı %35.1 idi. Sonuç: FDG-PETCT'nin lokal ileri meme kanserlerinde neoadjuvan kemoterapi sonrası patolojik tam yanıtı öngörmede yüksek duyarlılığı olmasına rağmen, ultrasonografi, FDG-PETCT ve manyetik rezonans görüntülemenin ortak kullanımı, farklı yararları nedeniyle daha avantajlıdır.

Anahtar Kelimeler

• meme
• meme kanseri
• neoadjuvan tedavi

Kaynakça

1. 1.Asoğlu O, Müslanoğlu M, Igçi A, et al. Breast protective surgery after primary chemotherapy for locally advanced breast cancer. Acta Chir Belg. 2005;105: 62-8. https://doi.org/10.1080/00015458.2005.11679668
2. 2.Escobar PF, Patrick RJ, Rybicki LA, et al. The 2003 revised TNM staging system for breast cancer: the results of stage decateration on survival and future comparisons between stage groups. Ann Surg Oncol. 2007; 14: 143-7. https://doi.org/10.1245/s10434-006-9147-0
3. 3.Silva OE, Zurida S. Stage III disease in Breast Cancer. A Practical Guide 3. edition, Elsevier Saunders, Toronto, 2005: 230-37.
4. 4.Burstein HJ, Harris JR, Morrow M. Malignant Tumors of the Breast. In: DeVita VT, Lawrence Tu, Rosenberg SA, editors. Principles of Cancer and Oncology Practice. 8. pressing. Philadelphia: Lippincott Williams and Wilkins, 2008: 1606-45.
5. 5.Sadetzki S, Oberman B, Zipple D, et al. Protection of the breast after neoadjuvant chemotherapy. Ann Surg Oncol. 2005; 12: 480-7. https://doi.org/10.1245/ASO.2005.07.021
6. 6.Rastogi P, Anderson SJ, Bear HD, et al. Chemotherapy before surgery: National Surgical updates Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008; 26: 778-85. https://doi.org/10.1200/JCO.2007.15.0235
7. 7.Schwartz GF, Hortobagyi GN.Proceedings of the consensus conference on neoadjuvant chemotherapy in breast carcinoma, April 26-28, 2003, Philadelphia, Pennsylvania. Cancer. 2004; 100: 2512-32. https://doi.org/10.1002/cncr.20298
8. 8.Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumors: revised Registration guide (version 1.1). Eur J Cancer. 2009; 45: 228-47. https://doi.org/10.1016/j.ejca.2008.10.026

9. 9.Kitajima K, Miyoshi Y, Yamano T, et al. Evaluation of tumor response to neoadjuvant chemotherapy in breast cancer patients using MRI and Sag-PET/CT-RECIST 1.1 versus PERCIST 1.0. Nagoya J Medical Science. 2018; 80(2): 183-97.
10. 10.Liu SV, Melstrom L, Yao K, et al. Neoadjuvant therapy for breast cancer. J Surg Oncol. 2010; 101: 283-91. https://doi.org/10.1002/jso.21446
11. 11.Kaufmann M, von Minckwitz G, Mamounas EP, et al. Recommendations from an International Consensus Conference on the Current Status and Future of Neoadjuvant Systemic Therapy in Primary Breast Cancer. Ann Surg Oncol. 2012; 19: 1508-16. https://doi.org/10.1245/s10434-011-2108-2
12. 12.Von Waldenfels G, Loibl S, Furlanetto J, et al. Outcome after neoadjuvant chemotherapy in elderly breast cancer patients - a pooled analysis of individual patient data from eight prospectively randomized controlled trials. A target. 2018; 9(20): 15168-79. https://doi.org/10.1055/s-0038-1671612
13. 13.Caiyun Nie, Huifang Lv, Liangyu Bie, et al. The expression of hypoxia-causing factor 1-alpha is associated with the response to neoadjuvant chemotherapy in women with breast cancer. Medicine (Baltimore) 2018; 97 (51): e13551. https://doi.org/10.1097/MD.0000000000013551
14. 14.Akoz G, Diniz G, Ekmekci S, et al. Evaluation of human epididymal secretory protein 4 expression according to molecular subtypes of breast cancer (luminal A, luminal B, human epidermal growth factor receptor 2 positive, triple negative). Indian J Pathology Microbiol. 2018;61(3): 323-9. https://doi.org/10.4103/IJPM.IJPM_465_17
15. 15.Chu KC, Anderson WF, Fritz A, et al. Frequency distributions of breast cancer characteristics classified by estrogen receptor and progesterone receptor status for eight racial/ethnic groups. Cancer. 2001; 92(1): 37-45. https://doi.org/10.1002/1097-0142(20010701)92:1<37::AID-CNCR1289>3.0.CO;2-F
16. 16.Haque W, Verma V, Hatch S, et al. Response rates and pathological complete response according to the molecular subtype of breast cancer following neoadjuvant chemotherapy. Treatment of Breast Cancer. 2018; 170(3): 559-67. https://doi.org/10.1007/s10549-018-4801-3
17. 17.Houssami N, Macaskill P, von Minckwitz G, et al. Meta-analysis of the association of pathological complete response to neoadjuvant chemotherapy with breast cancer subtype. Eur J Cancer. 2012; 48(18): 3342-54. https://doi.org/10.1016/j.ejca.2012.05.023
18. 18.Boughey JC, McCall LM, Ballman KV, et al. Tumor biology is associated with breast protective surgery rates and pathological complete response after neoadjuvant chemotherapy for breast cancer: Findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surgery. 2014; 260(4): 608-16. https://doi.org/10.1097/SLA.0000000000000924
19. 19.Agarwal R, Unnikrishnan UG, Keechilat P, et al. Pathological Complete Response in Locally Advanced Breast Cancer After Neoadjuvant Chemotherapy: Survival Outcome and Its Importance as a Surrogate Endpoint. South Asian J Cancer. 2020; 9(3): 136-40. https://doi.org/10.1055/s-0040-1721238
20. 20.Müller C, Schmidt G, Juhasz-Böss I, et al. Effects on pathological complete response in breast cancer patients after neoadjuvant chemotherapy. Belt Gynecol Obstet. 2021; 304(4): 1065-71. https://doi.org/10.1007/s00404-021-06018-6
21. 21.Gajdos C, Tartter PI, Estabrook A, et al. The relationship between clinical and pathological response to neoadjuvant chemotherapy and the outcome of locally advanced breast cancer. Dec. Surgeon Oncol. 2002; 80 (1):4-11. https://doi.org/10.1002/jso.10090
22. 22.Bonadonna G, Veronesi U, Brambilla C, et al. The first belt treatment to avoid mastectomy in all those with a diameter of three centimeters or more. J Natl Cancer Institute. 1990; 82 (19): 1539-45. https://doi.org/10.1093/jnci/82.19.1539
23. 23.Lobbes MB, Prevos R, Smidt M, et al. The role of magnetic resonance imaging in the evaluation of residual disease and pathological complete response in breast cancer patients receiving neoadjuvant chemotherapy: A systematic review. Viewing Insights. 2013; 4: 163-75. https://doi.org/10.1007/s13244-013-0219-y
24. 24.Tateishi U, Miyake M, Nagaoka T, et al. Neoadjuvant chemotherapy in breast cancer: prediction of pathological response with PET / CT and dynamic contrast MRI imaging - prospective evaluation. Radiology. 2012; 263: 53-63. https://doi.org/10.1148/radiol.12111177
25. 25.A YY, Kim SH, Kang BJ, et al. The Usefulness of MRI and PET / CT Imaging Parameters for Evaluating the Response to Treatment of Breast Cancer After Neoadjuvant Chemotherapy. J Korean Medical Science. 2015;30(6):808-15. https://doi.org/10.3346/jkms.2015.30.6.808
26. 26.Evans A, Whelehan P, Thompson A, et al. Determination of pathological complete response after neoadjuvant chemotherapy for breast cancer: comparison of grayscale ultrasound, shear wave elastography and MRI. Clin Radiol. 2018; 73(10):910.e1-910.e6. https://doi.org/10.1016/j.crad.2018.05.030
27. 27.Sheyhbahaei S, Trahan TJ, Xiao J, et al. FDG-PET/CT and MRI for the Evaluation of Pathological Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer: A Meta-Analysis of Diagnostic Accuracy Studies. Oncologist. 2016; 21(8): 931-39. https://doi.org/10.1634/theoncologist.2015-0353
28. 28.You, Kang DK, Jung YS, A YS,et al. Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of the diagnostic performance of ultrasound, MRI and 1⁸F-FDG PET / CT. BRJ Radiol. 2015; 88(1052): 20150143. https://doi.org/10.1259/bjr.20150143
29. 29.Chen L, Yang Q, Bao J, et al. Direct comparison of PET/CT and MRI to predict pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Science Representative. 2017; 7 (1):8479. https://doi.org/10.1038/s41598-017-08852-8
30. 30.Li H, Yao L, Jin P, et al. MRI and PET / CT for the evaluation of pathological response to neoadjuvant chemotherapy in breast cancer: A systematic review and meta-analysis. Breast. 2018; 40: 106-15. https://doi.org/10.1016/j.breast.2018.04.018
31. 31.Von Minckwitz G, Untch M, Blohmer JU, et al. Definition and effect of pathological complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012; 30: 1796-804. https://doi.org/10.1200/JCO.2011.38.8595
32. 32.Ignatiadis M, Singhal SK, Desmedt C, et al. Gene modules and response to neoadjuvant chemotherapy in breast cancer subtypes: a pooled analysis. J Clin Oncol. 2012; 30: 1996-2004. https://doi.org/10.1200/JCO.2011.39.5624