Enida Bufi, Abstract Co-Author: Nothing to Disclose

marialuisa di matteo, Abstract Co-Author: Nothing to Disclose

Daniela Distefano MD, MD, Abstract Co-Author: Nothing to Disclose

Melania Costantini MD, Abstract Co-Author: Nothing to Disclose

Pierluigi Rinaldi MD, Abstract Co-Author: Nothing to Disclose

Paolo Belli MD, Presenter: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

We address the diagnostic performance of breast MRI and the efficacy of the neoadjuvant radio-chemotherapy treatment (MADD protocol) compared with conventional neoadjuvant chemotherapy in patients with locally advanced breast cancer.

The MADD protocol consists in 6 doxorubicin/docetaxel cycles coupled with low-dose radiotherapy. Breast MRI was performed at baseline, after the third and the last therapy cycle. Using a propensity-matching technique (1:2 ratio) we selected 18 patients undergoing the MADD protocol and 36 patients submitted to neoadjuvant chemotherapy (NAC).

In the MADD group, there was a prevalence of ductal invasive carcinomas (67%), grade 3 tumor (67%) and 2B stage (77.8%). The groups were comparable with respect to the baseline characteristics. Among patients receiving the MADD protocol, we observed a reduction in tumor dimension after the third and the last cycle compared with baseline (p<0.001 both). In fact, the RECIST class displayed a direct correlation with the TRG class after the third cycle (tau=0.43, p=0.05); such correlation became stronger after the last cycle (tau=0.77, p<0.001). Patients receiving the MADD protocol displayed a higher frequency of complete/partial response at the end of treatment compared with NAC patients (p=0.048). Persisting type of dynamic curves and higher apparent diffusion coefficient values are statistically associated with favourable response to treatment in both groups. The intergroup difference in TRG class was not statistically meaningful (p=0.12), but it may imply a clinical significance given the higher percentage of TRG 1 and 2 classes in the MADD group. Fourteen out of 18 patients (77%) could avoid radical mastectomy. 

The MADD treatment seems to be associated with superior oncologic results in locally advanced breast cancer compared with NAC. The pathological response is reliably predicted by MRI performed after the third cycle.

Morphofunctional breast MRI well predicts the response to neoadjuvant treatment in locally advanced breast cancer. The MADD protocol yields superior oncologic results than conventional treatment.

Bufi, E, di matteo, m, Distefano, D, Costantini, M, Rinaldi, P, Belli, P, Bonomo, L, Breast MRI Evaluation of the Efficacy of Neoadjuvant Radio-Chemotherapy Treatment Compared with Conventional Protocols.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014372.html