title: Predicting survival and early clinical response to primary chemotherapy for patients with locally advanced breast cancer using DCE-MRI.
abstract: OBJECTIVE
  To evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a tool for early prediction of response to neoadjuvant chemotherapy (NAC) and 5-year survival in patients with locally advanced breast cancer.
  
  
  METHODS
  DCE-MRI was performed in patients scheduled for NAC (n = 24) before and after the first treatment cycle. Clinical response was evaluated after completed NAC. Relative signal intensity (RSI) and area under the curve (AUC) were calculated from the DCE-curves and compared to clinical treatment response. Kohonen and probabilistic neural network (KNN and PNN) analysis were used to predict 5-year survival.
  
  
  RESULTS
  RSI and AUC were reduced after only one cycle of NAC in patients with clinical treatment response (P = 0.02 and P = 0.08). The mean and 10th percentile RSI values before NAC were significantly lower in patients surviving more than 5 years compared to nonsurvivors (P = 0.05 and 0.02). This relationship was confirmed using KNN, which demonstrated that patients who remained alive clustered in separate regions from those that died. Calibration of contrast enhancement curves by PNN for patient survival at 5 years yielded sensitivity and specificity for training and testing ranging from 80%-92%.
  
  
  CONCLUSIONS
  DCE-MRI in locally advanced breast cancer has the potential to predict 5-year survival in a small patient cohort. In addition, changes in tumor vascularization after one cycle of NAC can be assessed.
authors.affiliation: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Roar
authors.initials: R
authors.lastname: Johansen
authors.forename: Line R
authors.initials: LR
authors.lastname: Jensen
authors.forename: Jana
authors.initials: J
authors.lastname: Rydland
authors.forename: Pål E
authors.initials: PE
authors.lastname: Goa
authors.forename: Kjell A
authors.initials: KA
authors.lastname: Kvistad
authors.forename: Tone F
authors.initials: TF
authors.lastname: Bathen
authors.forename: David E
authors.initials: DE
authors.lastname: Axelson
authors.forename: Steinar
authors.initials: S
authors.lastname: Lundgren
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Gribbestad
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003287:Contrast Media; D018592:Cross-Over Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016571:Neural Networks, Computer; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA