MR mammography of response-control in primary chemo-brachytherapy in BCT-inoperable breast cancer

To evaluate (1) if neoadjuvant chemo-brachytherapy interferes with MR imaging, (2) if MR can predict the size of the remaining tumor after therapy and (3) if MR can give prognostic information after the onset of therapy. 14 patients enrolled in a preoperative tumor-reduction protocol (4 cycles of chemotherapy combined with interstitial radiotherapy) were examined by dynamic contrast enhanced MR mammography (1 T, temporal resolution 93 s, spatial resolution 1.9 min, 0.1 mmol/kg GdDTPA), before therapy, after the first two cycles of chemotherapy, after radiotherapy and the third cycle, and after completion of therapy. MR findings were evaluated for (1) artificial enhancement after radiotherapy, (2) correlation of enhancement after therapy with histology and (3) changes in enhancement dynamics after the first 2 cycles. (1) 54% of patients had diffuse enhancement that occurred after radiotherapy but vanished before the end of therapy. (2) 4 patients had complete histological remissions after therapy, 3 had dispersed single tumor cells, 7 had remaining nodular tumor. While MR could not differentiate between complete remission and single tumor cells, it accurately predicted the diameter of remaining nodular tumor, except for one case that showed false-positive enhancement. (3) MR dynamics after the first cycles of chemotherapy could not predict overall response. MR is an accurate tool in assessing tumor response after neoadjuvant chemobrachytherapy. Negative effects from radiotherapy are only transient.