Predicting Breast Tumor Response to Neoadjuvant Chemotherapy with Diffuse Optical Spectroscopic Tomography prior to Treatment

Abstract

Purpose Determine if pre-treatment biomarkers obtained from Diffuse Optical Spectroscopic Tomographic (DOST) imaging predict breast tumor response to Neoadjuvant Chemotherapy (NAC), which would have value to potentially eliminate delays in prescribing definitive local regional therapy that may occur from a standard complete 6–8 months course of NAC. Experimental design Nineteen patients undergoing NAC were imaged with DOST before, during and after treatment. The DOST images of total hemoglobin concentration (HbT), tissue oxygen saturation (StO2), and water (H2O) fraction at different time points have been used for testing the abilities of differentiating patients having pathologic complete response (pCR) vs. pathologic incomplete response (pIR). Results Significant differences (P-value<0.001, AUC=1.0) were found between pCR patients vs. pIR in outcome, based on the percentage change in tumor HbT within the first cycle of treatment. In addition, pre-treatment tumor HbT (Pre-TxHbT) relative to the contralateral breast was statistically significant (p-value=0.01, AUC=0.92) in differentiating pCR from pIR. Conclusions This is the first clinical evidence that DOST HbT may differentiate the two groups with predictive significance based on data acquired before NAC even begins. The study also demonstrates the potential of accelerating the validation of optimal NAC regimens through future randomized clinical trials by reducing the number of patients required and the length of time they need to be followed by using a validated imaging surrogate as an outcome measure.

A Comparison of Near-Infrared Diffuse Optical Imaging and 18F-FDG PET/CT for the Early Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy

“…A clinical study using the tomographic DOSI showed that the AUC to differentiate pCR from non-pCR patients was 1.0, based on the percentage change in tumor to hemoglobin within the first cycle of treatment. In addition, this study showed the first clinical evidence that tumor total hemoglobin estimated from diffuse optical spectroscopic images differentiates women with locally advanced breast cancer who have a pCR with NAC from those who do not with predictive significance based on image data acquired before the initiation of therapy (6).…”

Portable, parallel 9-wavelength near-infrared spectral tomography (NIRST) system for efficient characterization of breast cancer within the clinical oncology infusion suite

“…Here, three FD wavelengths and six CW wavelengths provided coverage in the range of 661 -1064nm. While several studies [20][21][22][23][24] have focused on hemodynamic changes throughout the treatment period, dynamic changes during a single infusion procedure are also of interest. Thus, we adapted the system design to acquire nine FD and CW wavelengths simultaneously, which significantly reduced imaging time.…”

“…Relative HbT has been shown to be an indicator of tissue malignancy, widely used to assess changes in tumor physiology during neoadjuvant chemotherapy [22][23][24]. StO 2 may also be an important index for predicting tumor responses, since hypoxic tumors have been found to be more resistant to chemotherapy [45].…”

“…Pilot studies have shown that NIRST monitors tumor response during treatment and can yield prognostic information [9, [18][19][20][21][22][23]. In a previous study [24], breast cancer patients undergoing NAC were imaged with NIRST before, during and after treatment. Significant differences were found between pathologic complete response (pCR) and pathologic incomplete response (pIR) groups, based on the relative change in tumor HbT within the first cycle of treatment.…”

Multiobjective guided priors improve the accuracy of near-infrared spectral tomography for breast imaging

“…1,2 However, most studies indicate that NIRST alone may not be capable of providing the quantitative accuracy required for clinical applications because of spatial resolution limitations. 3 High-spatial resolution guidance from structural images, such as x-ray or MRI, has improved the quantitative accuracy of NIRST.…”