Assessing brain volume changes in older women with breast cancer receiving adjuvant chemotherapy: a brain magnetic resonance imaging pilot study

Abstract

BackgroundCognitive decline is among the most feared treatment-related outcomes of older adults with cancer. The majority of older patients with breast cancer self-report cognitive problems during and after chemotherapy. Prior neuroimaging research has been performed mostly in younger patients with cancer. The purpose of this study was to evaluate longitudinal changes in brain volumes and cognition in older women with breast cancer receiving adjuvant chemotherapy.MethodsWomen aged ≥ 60 years with stage I–III breast cancer receiving adjuvant chemotherapy and age-matched and sex-matched healthy controls were enrolled. All participants underwent neuropsychological testing with the US National Institutes of Health (NIH) Toolbox for Cognition and brain magnetic resonance imaging (MRI) prior to chemotherapy, and again around one month after the last infusion of chemotherapy. Brain volumes were measured using Neuroreader™ software. Longitudinal changes in brain volumes and neuropsychological scores were analyzed utilizing linear mixed models.ResultsA total of 16 patients with breast cancer (mean age 67.0, SD 5.39 years) and 14 age-matched and sex-matched healthy controls (mean age 67.8, SD 5.24 years) were included: 7 patients received docetaxel and cyclophosphamide (TC) and 9 received chemotherapy regimens other than TC (non-TC). There were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group pre-chemotherapy (p > 0.05). Exploratory hypothesis generating analyses focusing on the effect of the chemotherapy regimen demonstrated that the TC group had greater volume reduction in the temporal lobe (change = − 0.26) compared to the non-TC group (change = 0.04, p for interaction = 0.02) and healthy controls (change = 0.08, p for interaction = 0.004). Similarly, the TC group had a decrease in oral reading recognition scores (change = − 6.94) compared to the non-TC group (change = − 1.21, p for interaction = 0.07) and healthy controls (change = 0.09, p for interaction = 0.02).ConclusionsThere were no significant differences in segmented brain volumes between the healthy control group and the chemotherapy group; however, exploratory analyses demonstrated a reduction in both temporal lobe volume and oral reading recognition scores among patients on the TC regimen. These results suggest that different chemotherapy regimens may have differential effects on brain volume and cognition. Future, larger studies focusing on older adults with cancer on different treatment regimens are needed to confirm these findings.Trial registrationClinicalTrials.gov, NCT01992432. Registered on 25 November 2013. Retrospectively registered.

Gray matter density reduction associated with adjuvant chemotherapy in older women with breast cancer

“…This was a longitudinal study of breast cancer patients scheduled to receive adjuvant chemotherapy and age-/sex-matched healthy controls. The details of the study have been reported previously [ 9 ]. The eligibility criteria for patients with breast cancer were the following: diagnosis of stage I–III breast cancer, age 60 years and older, scheduled to receive adjuvant chemotherapy.…”

Effects of chemotherapy on aging white matter microstructure: A longitudinal diffusion tensor imaging study

“…This research protocol also acquired additional neuroimaging data, including T1-weighted 3D, sagittal 3D fluid attenuated inversion recovery, susceptibility-weighted imaging, and resting-state functional MRI sequences, which were published previously [19][20][21][22]. However, data from DTI analysis of white matter microstructures has not yet been published.…”

“…We reported NP testing scores obtained using the NIH Toolbox Cognition Battery for both the CT and HC groups in our previous publications [19][20][21][22]. However, since our previous studies, we added three patients to the CT group (n = 19).…”

Breast cancer and aging: Standing on the shoulders of a giant

“…Another impactful line of Dr. Hurria's research examined the potential use of neuroimaging to evaluate longitudinal changes in cognition. Along with Dr. Bihong Chen at City of Hope, Dr. Hurria conducted a study looking at the longitudinal changes in cognition in older women receiving adjuvant chemotherapy as they correlated with brain magnetic resonance imaging (MRI) [10]. They enrolled 16 patients with breast cancer (mean age of 67) and 14 age/sex-matched healthy controls (mean age 67.8).…”