The response to primary chemotherapy is an important prognostic factor in patients with non metastatic breast cancer. In this study we compared the assessment of response performed by clinical palpation to that performed by echography and mammography in 141 out of 157 consecutive breast cancer patients (T2-4, N0-1, M0) submitted to primary chemotherapy. A low relationship was recorded between tumor size assessed clinically and that evaluated by either mammography: Spearman R = 0.38 or echography: R = 0.24, while a greater correlation was found between the tumor dimension obtained by the two imaging techniques (R = 0.62). According to the WHO criteria, the grade of response of breast cancer to primary chemotherapy, showed by mammography and echography, was less marked than the grade of response seen at clinical examination. Residual tumor size assessed clinically depicted a stronger correlation with pathological findings (R = 0.68) than the residual disease assessed by echography (R = 0.29) and mammography (R = 0.33). Post-chemotherapy histology evaluation revealed pathological complete response in three cases (2.1%). Two of these cases were judged as complete responders by clinical palpation but only one was recognized by mammography, and none by echography. Clinical response, but not the response obtained by the two imaging techniques, was a significant predictor for longer disease free survival (p = 0.04). To conclude, physical examination measurements remain the method of choice in evaluating preoperatively the disease response in trials of primary chemotherapy. Prediction of pathological outcome is not improved by echography and mammography.
"The pathCR was confined to the cohort C (7 out of 40 cases, 17.5%), with respect to cohort B (2 out of 40 cases, 5.0%) and cohort A (1 out of 40 cases, 2.5%) (P-value for trend o0.04). As previously shown by our group (Fiorentino et al, 2001), the grade of response of breast cancer to primary chemotherapy, showed by mammography and echography (data not shown), was less marked than the grade of response seen at clinical examination. The frequency of early treatment discontinuation, resulting from disease progression and patient refusal, did not occur among the treatment cohorts. "
[Show abstract][Hide abstract] ABSTRACT: Background:
The objective of this study was to determine the optimal scheduling of 2.5 mg daily letrozole in neoadjuvant breast cancer patients to obtain pathological complete response (pathCR) and assess Ki-67 expression as an early predictor of response.
Patients and methods:
This single institution study comprised 120 oestrogen receptor (ER)-positive postmenopausal women with primary breast cancer (clinical stage ⩾T2, N0–1), from three sequential cohorts (cohort A of 40, cohort B of 40 and cohort C of 40 patients, respectively) based on different duration of the neoadjuvant letrozole. Biological markers such as ER, progesterone receptor, HER2 and Ki-67 expression were tested at diagnosis and at definitive surgery.
A total of 89 patients (75.4%) achieved an objective response with 44 (37.3%) clinical CRs and 45 (38.1%) partial responses. The clinical CRs were significantly observed in cohort C (23 out of 40 patients, 57.5%) and B (16 out of 38 patients, 42.1%) compared with cohort A (5 out of 40 patients, 12.5%) (P-value for trend <0.001). Letrozole induced a similar significant reduction in Ki-67 index after treatment in all cohorts. The pathCR rate was significantly more frequent in cohort C (7 out of 40 patients, 17.5%) than in cohort A (1 out of 40 patients, 2.5%) and B (2 out of 40 patients, 5.0%) (P-value for trend <0.04).
One-year neoadjuvant letrozole therapy leads to a higher pathCR rate and may be the optimal length of drug exposure.
British Journal of Cancer 04/2013; 108(8). DOI:10.1038/bjc.2013.151 · 4.84 Impact Factor
"Many treatments options are now available, and with in vitro methods of limited reliability in determining chemotherapeutic response , as indeed are mammography and echo , researchers have applied MRI techniques which are usually based on measures of tissue perfusion (PWI). Loo  investigated parameters associated with PWI to predict which tumours with neoadjuvant chemotherapy would achieve remission. "
[Show abstract][Hide abstract] ABSTRACT: MRI/MRS can produce information on over 40 physico-chemical parameters regarded as biomarkers of structural, functional or metabolic significance. Though of undisputed worth in the detection of macroscopic lesions or of metabolic derangements, MRI's use in prognosis and prediction has not been so extensively studied. Serial studies can be performed to show early pre-clinical changes in biomarkers caused by disease progression or therapy, such as the adverse effect on heart function of certain cancer therapies. It can utilise various haemodynamic measures to predict the evolution of stroke and so help justify certain interventions. Changes in cerebral metabolite concentrations or the volumes of brain sub-structures can be used as objective measures of drug response in psychiatric conditions. However care must be exercised as MR can sometimes be considered 'too sensitive' as it often detects real abnormalities even in asymptomatic volunteers, the actual predictive significance of which have yet to be fully assessed.
EPMA Journal, The 12/2011; 2(4):403-10. DOI:10.1007/s13167-011-0086-x
"Rational use of neoadjuvant chemotherapy requires objective evaluation of chemotherapeutic response. Response assessment also helps in determining the early termination of ineffective regimens and change in the chemotherapeutic regimen . The methods available are able to assess the response but predictability in an individual patient has not been documented. "
[Show abstract][Hide abstract] ABSTRACT: Doppler ultrasonography (US) is increasingly being utilized as an imaging modality in breast cancer. It is used to study the vascular characteristics of the tumor. Neoadjuvant chemotherapy is the standard modality of treatment in locally advanced breast cancer. Histological examination remains the gold standard to assess the chemotherapy response. However, based on the color Doppler findings, a new scoring system that could predict histological response following chemotherapy is proposed.
Fifty cases of locally advanced infiltrating duct carcinoma of the breast were studied. The mean age of the patients was 44.5 years. All patients underwent clinical, Doppler and histopathological assessment followed by three cycles of CAF (Cyclophosphamide, Adriamycin and 5-Fluorouracil) chemotherapy, repeat clinical and Doppler examination and surgery. The resected specimens were examined histopathologically and histological response was correlated with Doppler findings. The Doppler characteristics of the tumor were graded as 1-4 for <25%, 25-50%, >50% and complete disappearance of flow signals respectively. A cumulative score was calculated and compared with histopathological response. Results were analyzed using Chi square test, sensitivity, specificity, positive and negative predictive values.
The maximum Doppler score according to the proposed scoring system was twelve and minimum three. Higher scores corresponded with a more favorable histopathological response. Twenty four patients had complete response to chemotherapy. Sixteen of these 24 patients (66.7%) had a cumulative Doppler score more than nine. The sensitivity of cumulative score >5 was 91.7% and specificity was 38.5%. The area under the ROC curve of the cumulative score >9 was 0.72.
Doppler scoring can be accurately used to objectively predict the response to chemotherapy in patients with locally advanced breast cancer and it correlates well with histopathological response.
World Journal of Surgical Oncology 08/2007; 5:99. DOI:10.1186/1477-7819-5-99 · 1.41 Impact Factor
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