Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging.

BACKGROUND: The implementation of new treatment protocols for locally advanced breast cancer is currently limited by inaccurate evaluation of response to neoadjuvant chemotherapy. A recently developed dedicated breast magnetic resonance imaging (MRI) method (RODEO MRI) was evaluated as a tool for determining tumor response and extent of residual disease after neoadjuvant chemotherapy. METHODS: Thirty-nine patients with Stage II, III, or IV breast carcinoma were prospectively evaluated prior to and following neoadjuvant chemotherapy by MRI, physical examination, and mammography. Assessment of response determined by the three methods was compared. In addition, detailed pathologic correlation of residual disease was determined by serial sectioning of 31 mastectomy specimens from 30 patients. Nine patients had breast conservation, and were included in the response evaluation only. Estimates of tumor response were made by both surgical and medical oncologists. Independent interpretations of MRI studies without knowledge of clinical response were made by three radiologists. RESULTS: The surgical oncologists assessed complete response (CR), partial response (PR), and no response (NR) in 11, 22, and 7 cases, respectively. The medical oncologists assessed CR, PR, and NR in 12, 21, and 7 cases, respectively. The surgical and medical oncologists' clinical assessment of response agreed with the results of MRI in 52% and 55% of cases, respectively, and with each other in 30 of 40 cases (75%). Mammography correlated with MRI response in only 52% of cases. However, MRI accurately predicted the pathologic determination of residual disease in 30 of 31 cases (97%). There was no disagreement in the assessments of residual disease or response among the three radiologists. CONCLUSIONS: RODEO breast MRI accurately estimates residual disease after induction chemotherapy. It assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination or mammography. The information obtained from this MRI technique may be used as an objective tool during clinical trials, and to select patients better for breast conservation after neoadjuvant chemotherapy for locally advanced disease.

Enhancement of fetal rat limb bone resorption by phorbol ester (PMA) and ionophore A-23187.

The present investigation was undertaken to determine if an interaction affecting 45Ca release from prelabeled fetal rat long bones could be elicited by the Ca2+ ionophore, A-23187, and the phorbol ester, 12-myristate 13-acetate (PMA). Treatment with either A-23187 at a concentration of 0.3 microM or PMA at concentrations of 10(-6) M, 10(-7) M, and 10(-8) M produced significant 45Ca mobilization. When A-23187 and PMA were combined, enhanced 45Ca release was observed on days 1 and 2 of culture. The stimulation of calcium mobilization noted on day 1 occurred when neither ionophore nor 10(-6) M PMA treatments alone produced significant 45Ca release. On day 2, cumulative 45Ca release elicited by the combination of A-23187 plus 10(-6) M PMA was slightly more than additive (15.9% for combination treatment vs. 13.7% for the sum of the individual treatments). Moreover, when A-23187 was combined with 10(-7) M PMA on day 2, an enhancement of 45Ca release was observed which was clearly more than additive (14.5% for combination treatment vs. 8.8% for the individual treatments), suggesting the possibility of a synergistic interaction between the two agents. These results were in marked contrast to those obtained with the inactive phorbol ester analog, phorbol 13-monoacetate. No stimulation of 45Ca release was observed with 10(-6) M and 10(-7) M phorbol 13-monoacetate alone nor was enhanced 45Ca release noted when the analog was combined with 0.3 microM A-23187.(ABSTRACT TRUNCATED AT 250 WORDS)