乳癌治療後照護的重要性為目前新興的研究領域，乳癌治癒者(手術與化療)相關的創傷 已開始被研究。在乳癌診斷與治療過程中引發的癌症創傷經驗為多種與慢性的壓力，不同於 其他類型的創傷性事件。雖然過去有研究證明在部分乳癌創傷後個體的海馬迴、杏仁核、前 額葉皮層會萎縮，而化療後亦會造成額葉、顳葉萎縮與認知功能下降，但是目前在癌症相關 的創傷和化療的倖存者中仍然缺乏神經造影研究。所以我們提出這項前瞻性的神經影像學研 究，其目的是評估乳癌患者於診斷後與治療後之大腦結構與功能的變化。 這項研究將包括 70 名確診一個月內乳癌成人和 35 名正常對照組。乳癌婦女中 35 位將接 受化療，而另外 35 位將進行手術治療（無化療）。而參與者將於三個時間點接受磁振造影與 心理測驗評估，包含基線、化療後一個月與化療後一年。而大腦結構和功能的分析將包含擴 散磁振造影、功能連結與基於體素的形態測量學。 過去與癌症相關創傷的大腦結構變化與化療後腦功能改變的研究，為基於橫斷設計且結 果具有爭議。我們研究的優勢包括：1、以縱向研究設計評估乳癌確診後一年內大腦結構和功 能的改變；2、分析其他乳癌相關的創傷事件和化療與大腦的結構和功能改變的相關係性，預 計在乳癌患者之海馬迴、杏仁核、前額葉皮層體積減小，而前額葉皮層等部分腦區功能反應 減少。希望我們的結果可以提供乳癌患者的大腦結構和功能改變的證據，並凸顯乳癌相關的 創傷與化療對乳癌患者造成影響的重要性。 Recent advance in primary treatment of breast cancer marks the importance of the post-treatment care. Cancer-related trauma (after operation and chemotherapy) have been widely reported by breast cancer survivors. Given that the cancer traumatic experience contains multiple and chronic stressors during diagnosis and treatment courses, it differs from other kind of traumatic event. Although previous research has demonstrated smaller hippocampus, amygdala, and prefrontal cortex in individuals with post-traumatic stress disorder, and smaller frontal, temporal lobe as well as decreased cognitive function in individuals after chemotherapy, there remains a paucity of neuro-imaging studies in cancer-related trauma and chemotherapy survivors. The aim of this prospective neuroimaging study is to assess the longitudinal changes of brain structure and function following diagnosis of breast cancer. The study will include 70 adults with breast cancer being diagnosed within one month and 35 normal controls. 35 of the women with breast cancer will be treated with chemotherapy and 35 of them will be treated with surgery (without chemotherapy). Magnetic resonance imaging scans and psychometric testing will be used to assess the participants at three time points which are baseline, one month and one year after chemotherapy. Diffusion MRI, functional connectivity, and voxel-based morphometry will be used to analyze the longitudinal alternations of brain structure and function during the two investigations. Previous studies on structural brain changes in cancer-related trauma and functional brain changes in chemotherapy were based on cross-sectional design and demonstrated controversial results. The strengths of our study include: 1. longitudinal study design to survey brain structure and function alteration within one year after diagnosis; 2. analysis of the relation of brain structure and function changes to other breast cancer-related traumatic events and chemotherapy. Reduced volume of hippocampus, amygdala, and prefrontal cortex and function alteration are expected in the breast cancer group. Hopefully, the results can provide the evidence of brain structural and functional changes in women with breast cancer and highlight the importance of the breast cancer-related trauma and chemotherapy.
