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.