Abstract
Breast cancer is the most common cancer among women worldwide. Adjuvant chemotherapy has significantly reduced mortality but increased cognitive impairments, including attention function, making quality of life issues a crucial concern. This study enrolled nineteen breast cancer patients who were treated with standard chemotherapy within 6 months and 20 sex-matched healthy controls to investigate the brain effects of chemotherapy. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) with mean fractional amplitude of low-frequency fluctuation (mfALFF) analysis and were correlated with neuropsychological tests, including the Mini-Mental State Examination (MMSE), the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), and the Impact of Event Scale-Revised (IES-R), to explore the possible underlying mechanism of cognitive alternations. We found increased mfALFF over the frontoparietal lobe and decreased mfALFF over the occipital lobe in the cancer patients compared with the healthy controls; the altered brain regions may be associated with the dorsal attention network (DAN) and may be explained by a compensatory mechanism. Both MMSE and CAMS-R scores showed a positive correlation with mfALFF in the occipital lobe but a negative correlation in the frontoparietal lobe. By contrast, IES-R scores showed a positive correlation with mfALFF in the frontoparietal lobe but a negative correlation in the occipital lobe. These alterations are potentially related to the effects of both chemotherapy and psychological distress. Future research involving a larger sample size of patients with breast cancer is recommended.
Highlights
Breast cancer is the most common cancer among women worldwide, and according to the American Cancer Society, it accounts for 25% of all new cancer diagnoses in women globally
By using diffusion tensor imaging (DTI) analysis, a noninvasive method that provides unique microstructural information of the brain white matter tissue, Deprez et al found significantly decreased brain fractional anisotropy (FA) in the frontal, parietal, and occipital white matter tracts, which correlated with attention and verbal memory performance changes in patients with breast cancer 3 to 4 months after chemotherapy treatment when compared with the baseline[24]
By using task-based functional MRI (fMRI), McDonald et al found decreased working memory-related activation in the frontal lobe in patients with breast cancer 1 month after chemotherapy that partially recovered at 1 year[32]
Summary
Breast cancer is the most common cancer among women worldwide, and according to the American Cancer Society, it accounts for 25% of all new cancer diagnoses in women globally. Wefel et al reviewed 53 published cross-sectional and prospective neuropsychological studies that provided mixed evidence of chemotherapy-related cognitive dysfunction in women treated for breast cancer and found that attention, memory, processing speed, and executive function were the most commonly affected cognitive domains[12] These effects appear to be more pronounced in the short term; Koppelmans et al recently revealed that breast cancer survivors exhibited a poorer performance in neuropsychological tests 20 years after they had undergone chemotherapy than their matched healthy controls. By using rs-fMRI with seed-based correlation analysis (SCA), Miao et al revealed decreased functional connectivity in the dorsal medial prefrontal cortex and medial temporal lobe subsystems and may be associated with the attention function of breast cancer patients 1 month after chemotherapy[39]. It may thereby provide a useful complement to approaches, such as interregional coherencies between multiple BOLD signals[42]
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