MRI Characteristics of Cardiotoxicity and Neurotoxicity in Patients with Breast Cancer Treated with Neoadjuvant Chemotherapy: Dynamic Changes and Interrelationships.

RATIONALE AND

OBJECTIVES

To investigate the changes in cardiotoxicity and neurotoxicity characteristics in patients with breast cancer (BC) undergoing neoadjuvant chemotherapy (NAC) and their interrelationships.

MATERIALS AND

METHODS

Pre- and post-NAC heart-brain MRI parameters and cognitive function were assessed. Paired t-tests and Wilcoxon signed-rank tests were used to assess longitudinal changes and the delta values (Δ = post-NAC - pre-NAC) in heart, brain, and cognition. Principal component analysis was performed to extract a cardiotoxicity factor (FAC), and linear regression models assessed the relationship between FAC and neurotoxicity, with FDR correction (p < 0.05).

RESULTS

Sixty-seven BC patients were in the non-cancer therapy-related cardiac dysfunction (CTRCD) group, and 18 patients were in the CTRCD group. Compared to non-CTRCD patients, CTRCD patients exhibited significant differences in the FAC (0.342 ± 0.742 vs. -1.349 ± 0.704, p < 0.001), as well as in neurotoxicity traits, including total brain volume (ΔTBV, -0.613 ± 10.377 vs. -15.706 ± 11.421, p < 0.001), gray matter volume (ΔGMV, -4.308 ± 12.098 vs. 14.439 ± 14.232, p = 0.004), and white matter volume (ΔWMV, -0.928 ± 7.958 vs. -6.724 ± 7.097, p = 0.008). In the CTRCD group, lower FAC was significantly associated with high ΔTBV (β = -0.792, p < 0.001), ΔGMV (β = -0.752, p = 0.001), and ΔWMV (β = -0.773, p < 0.001).

CONCLUSION

Our study found severe changes in heart function, brain structure, and the interrelated comorbidity of cardiotoxicity and neurotoxicity in BC patients with CTRCD.