Abstract
PurposeThe purpose of this study was to evaluate longitudinal changes in brain gray matter density (GMD) before and after adjuvant chemotherapy in older women with breast cancer.MethodsWe recruited 16 women aged ≥ 60 years with stage I–III breast cancers receiving adjuvant chemotherapy (CT) and 15 age- and sex-matched healthy controls (HC). The CT group underwent brain MRI and the NIH Toolbox for Cognition testing prior to adjuvant chemotherapy (time point 1, TP1) and within 1 month after chemotherapy (time point 2, TP2). The HC group underwent the same assessments at matched intervals. GMD was evaluated with the voxel-based morphometry.ResultsThe mean age was 67 years in the CT group and 68.5 years in the HC group. There was significant GMD reduction within the chemotherapy group from TP1 to TP2. Compared to the HC group, the CT group displayed statistically significantly greater GMD reductions from TP1 to TP2 in the brain regions involving the left anterior cingulate gyrus, right insula, and left middle temporal gyrus (pFWE(family-wise error)-corrected < 0.05). The baseline GMD in left insula was positively correlated with the baseline list-sorting working memory score in the HC group (pFWE-corrected < 0.05). No correlation was observed for the changes in GMD with the changes in cognitive testing scores from TP1 to TP2 (pFWE-corrected < 0.05).ConclusionsOur findings indicate that GMD reductions were associated with adjuvant chemotherapy in older women with breast cancer. Future studies are needed to understand the clinical significance of the neuroimaging findings. This study is registered on ClinicalTrials.gov (NCT01992432).
Highlights
Patients who are receiving adjuvant chemotherapy for breast cancer have reported cognitive changes associated with receipt of cancer therapy [1]
Neuroimaging studies have observed a decrease in gray matter density (GMD) and working memory function in younger patients with breast cancer with exposure to chemotherapy at mean age of 46.3 (SD = 6.1) years to 52.9 (SD = 8.6) years [5,6,7]
GMD was evaluated with the voxel-based morphometry (VBM) approach using the Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) Toolbox in the Statistical Parametric Mapping software version 12 (SPM 12) (Wellcome Trust Centre for Neuroimaging, London, UK)
Summary
Patients who are receiving adjuvant chemotherapy for breast cancer have reported cognitive changes associated with receipt of cancer therapy [1]. Neuroimaging studies have observed a decrease in gray matter density (GMD) and working memory function in younger patients with breast cancer with exposure to chemotherapy at mean age of 46.3 (SD = 6.1) years to 52.9 (SD = 8.6) years [5,6,7]. Longitudinal studies have shown acutely reduced GMD 1 month after treatment in younger patients with breast cancer with mean ages at early 50 years of age [6, 8]. None of these previous studies has focused on older women with breast cancer. There is a lack of assessment of neural correlates in older women with breast cancer who have had a history of exposure to chemotherapy
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