-- Researchers at the Indiana University Melvin and Bren
Simon Cancer Center have published the first report
using imaging to show that changes in brain tissue can
occur in breast cancer patients undergoing chemotherapy.
The cognitive effects of chemotherapy, often referred
to as "chemobrain," have been known for years.
However, the IU research is the first to use brain
imaging to study women with breast cancer before and
after treatment, showing that chemotherapy can affect
gray matter. The researchers reported their findings in
the October 2010 edition of Breast Cancer Research
"This is the first prospective study," said Andrew
Saykin, Psy.D., director of the
Indiana University Center for Neuroimaging and a
researcher at the IU
Simon Cancer Center. "These analyses, led by Brenna
McDonald, suggest an anatomic basis for the cognitive
complaints and performance changes seen in patients.
Memory and executive functions like multi-tasking and
processing speed are the most typically affected
functions and these are handled by the brain regions
where we detected gray matter changes."
Dr. Saykin, who is Raymond C. Beeler Professor of
Radiology at the IU School of Medicine,
and colleagues studied structural MRI scans of
the brain obtained on breast cancer patients and healthy
controls. The scans were taken after surgery, but before
radiation or chemotherapy, to give the researchers a
baseline. Scans were then repeated one month and one
year after chemotherapy was completed.
The researchers found gray matter changes were most
prominent in the areas of the brain that are consistent
with cognitive dysfunction during and shortly after
chemotherapy. Gray matter density in most women improved
a year after chemotherapy ended.
For many patients, Dr. Saykin said, the effects are
subtle. However, they can be more pronounced for
others. Although relatively rare, some patients -- often
middle-aged women -- are so affected that they are never
able to return to work. More commonly, women will still
be able to work and multi-task, but it may be more
difficult to do so.
The study focused on 17 breast cancer patients treated
with chemotherapy after surgery, 12 women with breast
cancer who did not undergo chemotherapy after surgery,
and 18 women without breast cancer.
"We hope there will be more prospective studies to
follow so that the cause of these changes in cancer
patients can be better understood," Dr. Saykin said.
Dr. Saykin and his colleagues started their research at
Dartmouth Medical School before finishing the data
analyses at IU. A new, independent sample is now being
studied at the IU Simon Cancer Center to replicate and
further investigate this problem affecting many cancer
Other researchers included lead author Brenna McDonald,
Psy.D., M.B.A., assistant professor, Department of
Radiology and Imaging Sciences, IU School of Medicine;
Susan Conroy, M.D., Ph.D. student; Tim Ahles, Ph.D.,
professor of psychiatry, Memorial Sloan-Kettering Cancer
Center, N.Y.; and John West, M.S., an imaging researcher
at the IU Center for Neuroimaging.
The study was supported by a grant from the Office of
Cancer Survivorship of the National Cancer Institute,
National Institutes of Health and the Indiana Economic