Integration of Pathologic Findings With Clinical-Radiologic Tumor Measurements to Quantify Response to Neoadjuvant Chemotherapy
Abstract
The aim of the project is to develop and test anew method to quantify the proportion (percent) of cancer that is residual after neoadjuvant chemotherapy using standard radiologic and/or clinical measures of tumor size that are integrated with pathologic information about the amount of cancer within each tumor We have determined that tumor cellularity significantly decreases as a result of neoadjuvant (pre-operative) chemotherapy compared to control untreated breast cancers managed by surgery alone. However, the extent and variability of reduction of cellularity is considerable, particularly in the tumors that partly respond, and this shifts the distribution of residual tumor burden closer to complete response in those cases. Overall, this distribution indicates that many breast cancers are more responsive to neoadjuvant chemotherapy than measurement of tumor diameter alone would indicate. Therefore, size alone is not a sufficient measure of the tumor response to treatment. We have combined our measure of cancer cellularity with the radiological tumor measurements with the gross and microscopic pathologic changes in the breast and axillary lymph nodes after chemotherapy to determine a measure of relative breast cancer response. This Residual Cancer Index closely correlates with T-stage and appears to organize the responses into a meaningful distribution that allows a detailed view of nonresponsive tumors and can then be wed to conduct rank order statistical analyses without dividing the distribution of responses into arbitrary categories. Using this approach we have determined that low proliferation (Ki-67 < 15%), bcl-2 overexpression, and tau overexpression significantly predict greater resistance to neoadjuvant chemotherapy with paclitaxel, 5-FU, doxorubicin, and cyclophosphamide.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jun 01, 2004
- Accession Number
- ADA433045
Entities
People
- William F. Symmans
Organizations
- The University of Texas MD Anderson Cancer Center