Overall survival after recurrence of HNSCC is influenced by the HNSCC subsite and human papillomavirus or p16 status, as well surgical and systemic interventions. An oligometastatic phenotype characterizes patients with solitary metastasis after chemoradiotherapy. These findings have important implications for clinical trial designs for HNSCC in the recurrent and oligometastatic setting.
PurposeCharacterize and monitor treatment response in human papillomavirus (HPV) head and neck squamous cell carcinoma (HNSCC) using intra‐treatment (intra‐TX) imaging metrics derived from intravoxel incoherent motion (IVIM) diffusion‐weighted magnetic resonance imaging (DW‐MRI).Materials and MethodsThirty‐four (30 HPV positive [+] and 4 HPV negative [‐]) HNSCC patients underwent a total of 136 MRI including multi‐b value DW‐MRI (pretreatment [pre‐TX] and intra‐TX weeks 1, 2, and 3) at 3.0 Tesla. All patients were treated with chemo‐radiation therapy. Monoexponential (yielding apparent diffusion coefficient [ADC]) and bi‐exponential (yielding perfusion fraction [f], diffusion [D], and pseudo‐diffusion [D*] coefficients) fits were performed on a region of interest and voxel‐by‐voxel basis, on metastatic neck nodes. Response was assessed using RECISTv1.1. The relative percentage change in D, f, and D* between the pre‐ and intra‐TX weeks were used for hierarchical clustering. A Wilcoxon rank‐sum test was performed to assess the difference in metrics within and between the complete response (CR) and non‐CR groups.ResultsThe delta (Δ) change in volume (V)1wk‐0wk for the CR group differed significantly (P = 0.016) from the non‐CR group, while not for V2wk‐0wk and V3wk‐0wk (P > 0.05). The mean increase in ΔD3wk‐0wk for the CR group was significantly higher (P = 0.017) than the non‐CR group. ADC and D showed an increasing trend at each intra‐TX week when compared with pre‐TX in CR group (P < 0.003). Hierarchical clustering demonstrated the existence of clusters in HPV + patients.ConclusionAfter appropriate validation in a larger population, these IVIM imaging metrics may be useful for individualized treatment in HNSCC patients.
Level of Evidence: 2J. Magn. Reson. Imaging 2017;45:1013–1023
OS by smoking status: !10PY (n Z 21)-92.9% and <10PY (n Z 44)-87.0% (no significant difference; P>0.05). There was no significant difference in any outcome between the low-and intermediate-risk groups in this limited cohort. T-stage correlated to lower OS and NR!10% correlated with lower LRC (both P<0.05). Conclusion: This data supports TORS/TLM & ART in HPV+OPSCC. Those in the low-risk group had excellent outcomes, supporting ongoing dose de-intensification trials in this population. Based on inferior performance in RTOG 0129, it has been postulated that the intermediate-risk cohort may be less radio-sensitive and benefit from definitive TORS/TLM followed by ART. Our results demonstrate that patients do well with this approach, with equivalent outcomes to the low-risk group. Both definitive CRT and TORS/TLM followed by adjuvant treatment are reasonable treatment options for low and intermediate risk HPV+OPSCC.
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