Tissue oxygen saturation predicts response to breast cancer neoadjuvant chemotherapy within 10 days of treatment.

David R Busch,Zheng Zhang,Peter A Kaufman,Arjun G Yodh,Bradley S Snyder,Jeffrey M Cochran,Shudong Jiang,Bruce J Tromberg,Thomas D O’Sullivan,Darren Roblyer,Stefan A Carp,Anaïs Leproux,Albert E Cerussi,Steven J Isakoff,Philip M Carpenter,Keith D Paulsen,Rita S Mehta,Mitchell D Schnall ,Brian W Pogue ,Nola M Hylton ,Sukmin Chung ,David A Mankoff ,Wei Tse Yang

doi:10.1117/1.jbo.24.2.021202

Abstract

.Ideally, neoadjuvant chemotherapy (NAC) assessment should predict pathologic complete response (pCR), a surrogate clinical endpoint for 5-year survival, as early as possible during typical 3- to 6-month breast cancer treatments. We introduce and demonstrate an approach for predicting pCR within 10 days of initiating NAC. The method uses a bedside diffuse optical spectroscopic imaging (DOSI) technology and logistic regression modeling. Tumor and normal tissue physiological properties were measured longitudinally throughout the course of NAC in 33 patients enrolled in the American College of Radiology Imaging Network multicenter breast cancer DOSI trial (ACRIN-6691). An image analysis scheme, employing -score normalization to healthy tissue, produced models with robust predictions. Notably, logistic regression based on -score normalization using only tissue oxygen saturation () measured within 10 days of the initial therapy dose was found to be a significant predictor of pCR (; 95% CI: 0.82 to 1). This observation suggests that patients who show rapid convergence of tumor tissue to surrounding tissue are more likely to achieve pCR. This early predictor of pCR occurs prior to reductions in tumor size and could enable dynamic feedback for optimization of chemotherapy strategies in breast cancer.

Highlights

Neoadjuvant chemotherapy (NAC) is a widely used treatment method for breast cancer that permits increased conservation of breast tissue during tumor resection and limits the need for axillary node treatment and surgery.[1]
We recently reported the first results of ACRIN-6691, an American College of Radiology Imaging Network (ACRIN) multicenter clinical trial of patients monitored longitudinally by diffuse optical spectroscopic imaging (DOSI) throughout their NAC regimen.[13]
By application of a logistic regression model using z-score normalized DOSI measurements, we derived a robust predictor of response (AUC 1⁄4 0.92; 95% CI: 0.82 to 1) within the first 10 days after a subject’s initial chemotherapy dose

Summary

Introduction

Neoadjuvant chemotherapy (NAC) is a widely used treatment method for breast cancer that permits increased conservation of breast tissue during tumor resection and limits the need for axillary node treatment and surgery.[1] In addition, pathologic complete response (pCR) to NAC, defined as no residual invasive carcinoma, has been correlated with improved survival compared to incomplete response.[2,3] this assessment occurs after the completion of NAC. The. NAC response is typically evaluated with physical exams and radiologic imaging in current clinical practice. NAC response is typically evaluated with physical exams and radiologic imaging in current clinical practice These methods are inadequate predictors of pCR.[4,5,6] Magnetic resonance imaging (MRI) provides better correlation with pathology than mammography or ultrasound.[7] Broadly, functional monitoring techniques offer significantly improved correlation with response relative to structural imaging modalities. Magnetic resonance spectroscopy (MRS),[8] contrast-enhanced

Results

Discussion

Conclusion