A Study to Correlate Ultrasound Elastography With Histopathology to Monitor the Response of Locally Advanced Breast Cancer to Neoadjuvant Chemotherapy
Condition: Breast Cancer; Neoadjuvant Therapy
MeSH terms: Breast Neoplasms
Study type: Observational

Summary: 
      This research proposal concerns a study to monitor the effects of chemotherapy on breast
      cancer tumour and peritumour stromal cells using ultrasound (US) elastography (also known as
      strain imaging).

      Many cancer treatments currently being developed are targeted; that is they exploit
      particular biological processes in specific cancer cell types to disrupt tumour growth. Being
      able to monitor the efficacy of these typically high-cost drug therapies is essential both
      for the best patient outcome as well as offering economical benefits to the health care
      system and much needed insight into future drug development.

      Ultrasound provides a relatively inexpensive, non-invasive means for imaging cancers, and has
      been used widely in breast cancer diagnosis for many years. Its role in therapy monitoring
      has been suggested but has not been well explored. The purpose of this proposal is to explore
      this potential in more depth.

      It has been identified that significant interaction takes place between tumour and stroma
      through all stages of tumour growth; this complex relationship is an ongoing topic of
      research. Fibrotic changes occur during tumour growth and are also a quintessential process
      of healing. Indeed, fibrosis is a common after effect to chemotherapy in many forms of
      cancer. Elastography is an established imaging technique (based on ultrasound or MRI) which
      can estimate the relative stiffness of tissues in vivo and is thus well-suited to monitor
      these particular biological processes.

      This elucidates the main hypothesis of this project: fibrosis, cancer cell necrosis and
      inflammation may all contribute to a measurable response in elastography. These changes to
      the tissue composition can be imaged over a course of a patient's treatment to assess the
      response to chemo/hormonal therapy.

      The ultimate project goals are to develop a clinical tool (based on ultrasound elastography)
      to improve treatment management in addition to offering a better biological understanding of
      tumour/stroma behaviour.
    

Detailed description: 
      This research proposal concerns a study to monitor the effects of chemotherapy on breast
      cancer tumour and peritumour stromal cells using ultrasound (US) elastography (also known as
      strain imaging).

      Many cancer treatments currently being developed are targeted; that is they exploit
      particular biological processes in specific cancer cell types to disrupt tumour growth. Being
      able to monitor the efficacy of these typically high-cost drug therapies is essential both
      for the best patient outcome as well as offering economical benefits to the health care
      system and much needed insight into future drug development.

      Ultrasound provides a relatively inexpensive, non-invasive means for imaging cancers, and has
      been used widely in breast cancer diagnosis for many years. Its role in therapy monitoring
      has been suggested but has not been well explored. The purpose of this proposal is to explore
      this potential in more depth.

      It has been identified that significant interaction takes place between tumour and stroma
      through all stages of tumour growth; this complex relationship is an ongoing topic of
      research. Fibrotic changes occur during tumour growth and are also a quintessential process
      of healing. Indeed, fibrosis is a common after effect to chemotherapy in many forms of
      cancer. Elastography is an established imaging technique (based on ultrasound or MRI) which
      can estimate the relative stiffness of tissues in vivo and is thus well-suited to monitor
      these particular biological processes.

      This elucidates the main hypothesis of this project: fibrosis, cancer cell necrosis and
      inflammation may all contribute to a measurable response in elastography. These changes to
      the tissue composition can be imaged over a course of a patient's treatment to assess the
      response to chemo/hormonal therapy.

      The ultimate project goals are to develop a clinical tool (based on ultrasound elastography)
      to improve treatment management in addition to offering a better biological understanding of
      tumour/stroma behaviour.
    

Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patient will be selected from clinically diagnosed patients with breast cancer undergoing
        neoadjuvant chemotherapy. These women will be recruited through the Oxford University NHS
        Trust cancer centre and will consist primarily of women living within Oxfordshire.