Assessing Treatment Response in Breast Cancer with MRI

Background
Neoadjuvant chemotherapy (NACT) is now a standard of care for patients with locally advanced breast cancer. The identification of patients who have a poor response to therapy, at an early stage in the treatment process, would be beneficial as it could allow an alternative treatment strategey to be introduced at an earlier stage for these patients. This would mean they could avoid some of the unnecessary side effects associated with the ineffective treatment.

Current methods to assess response to NACT include clinical examination, mammography, ultrasound and MRI.  Of these MRI has been shown to have the highest accuracy in assessing tumour response to treatment. Conventional methods such as mammography and ultrasound only assess morphological tumour response but it is known that functional changes occur prior to structural changes. Our study aims to investigate these structural changes early on in the treatment using new advanced MR imaging techniques.

Aims of the our study
The goal of the study is to investigate whether MRI can predict treatment response in women receiving neoadjuvant chemotherapy for breast cancer.
Specifically we are evaluating the early predictive performance of ADC and FA values which are parameters derived from advanced MRI sequences. These sequences give us information about the diffusion of water molecules in cells, which has been shown to be restricted in cancer cells.
ADC values have shown potential as a marker of early treatment response in breast cancer and in other cancer studies. The importance of our study lies in its potential to differentiate patients who are responding to treatment (reflected by changes in the ADC and FA values) from those with a suboptimal response with a view to recommending alternative treatment for these patients.

What participants should expect
Patients who will be asked to take part in this study will have been diagnosed with breast cancer and scheduled for chemotherapy prior to their surgery. This study will use an advanced scan known as an MRI scan to look for changes in the cancer during treatment. An MRI scan is considered very safe and it does not expose patients to any ionizing radiation. We will examine the scan images and compare them with the patient’s final results after surgery.
Study participants will attend the MRI research centre, the National Centre for Advanced Medical Imaging at St. James’s Hospital, on four occasions to undergo a 3.0 Telsa MRI scan.
The first scan will be scheduled before treatment starts. This will give the doctors a baseline to compare future scans against. This scan will involve an injection of contrast to improve the pictures seen in the scan. This first scan will take about 40 minutes. The next scan will be performed 7-14 days after the first dose of chemotherapy and will be quicker as no contrast will be given. The third scan will take place 7-14 days after the second dose of chemotherapy. Like the second scan, it will not take as long as the first scan. The last scan will be similar to the first and will take place after the last dose of chemotherapy but before surgery.
Participants should be aware that there are no risks from the scan. Some patients experience claustrophobia in the MRI scanner but almost all patients are able to tolerate the scan. The contrast injection is a drug and like any drug there is a tiny risk of an allergic reaction.