Purpose: To estimate the accuracy of predicting response to neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer using MR spectroscopy (MRS) measurements made very early in treatment. Materials and Methods: This prospective Health Insurance Portability and Accountability Act (HIPAA)–compliant protocol was approved by the American College of Radiology and local-site institutional review boards. One hundred nineteen women with invasive breast cancer of ≥3 cm undergoing NACT were enrolled between September 2007 and April 2010. MRS measurements of the concentration of choline-containing compounds ([tCho]) were performed before the first chemotherapy regimen (time point 1, TP1) and 20–96 h after the first cycle of treatment (TP2). The change in [tCho] was assessed for its ability to predict pathologic complete response (pCR) and radiologic response using the area under the receiver operating characteristic curve (AUC) and logistic regression models. Results: Of the 119 subjects enrolled, only 29 cases (24%) with eight pCRs provided usable data for the primary analysis. Technical challenges in acquiring quantitative MRS data in a multi-site trial setting limited the capture of usable data. In this limited data set, the decrease in tCho from TP1 to TP2 had poor ability to predict either pCR (AUC = 0.53, 95% confidence interval [CI]: 0.27–0.79) or radiologic response (AUC = 0.51, 95% CI: 0.27–0.75). Conclusion: The technical difficulty of acquiring quantitative MRS data in a multi-site clinical trial setting led to a low yield of analyzable data, which was insufficient to accurately measure the ability of early MRS measurements to predict response to NACT. Level of Evidence: 1. Technical Efficacy: Stage 2. J. MAGN. RESON. IMAGING 2017;46:290–302.
Bibliographical noteFunding Information:
The authors acknowledge those individuals who have contributed substantially to the work reported in the manuscript, including the ACRIN 6657 Trial Team, the I-SPY TRIAL Investigators Network, the patients who participated in the study, and the staff members who contributed to the conduct of the study at the University of California at San Francisco, the University of Minnesota, the University of Pennsylvania, the University of North Carolina at Chapel Hill, Georgetown University, Memorial Sloan-Kettering Cancer Center, the University of Texas Southwestern Medical Center, the University of Washington, and the University of Chicago. The authors also gratefully acknowledge Ralph Noeske at General Electric and Marcus Alley at Stanford University for their assistance and software. This trial was supported by the National Cancer Institute's grants to ACRIN, ECOG-ACRIN, and CALGB/ISPY.
© 2016 International Society for Magnetic Resonance in Medicine
- breast cancer
- magnetic resonance spectroscopy
- treatment response