Adherence to pretreatment and intratreatment imaging of head and neck squamous cell carcinoma patients undergoing (chemo) radiotherapy in a research setting

Abstract

The emerge of improved personalized treatment adaptations and outcome prediction is accompanied with increasing non-invasive assessments in early treatment phase, leading to increased patient burden. This study assessed the adherence of patients with head and neck squamous cell carcinoma (HNSCC) to undergo pretreatment and research-related intratreatment imaging, and assessed which factors caused drop-out. Method: Between 2013 and 2019, advanced-staged HNSCC patients were prospectively included, underwent (chemo) radiotherapy with curative intent and planned for both pre-treatment and intratreatment sequential 18F-FDG-PET/CT, 18F-FDG-PET/MRI and thereafter MRI (including DWI/DCE). Drop-out-factors were described as healthcare-related (logistics and imaging-system defects) and patient-related (psychological, physical, not-specified). Common Toxicity Criteria (CTC) were routinely scored by radiation/medical oncologists throughout the first 3 weeks, and compared between patient drop-outs and who complete imaging. Results: Ninety-seven patients (mean age 61 ± 6.8 years) were included; 95 patients (97.9%) underwent pretreatment imaging and 63 (64.9%) intratreatment imaging. For 18F-FDG-PET/CT, 18F-FDG-PET/MRI and MRI pretreatment drop-outs were 2, 10 and 3 patients and for intratreatment drop-outs were 34, 39 and 35 patients, respectively. Patient-related drop-out-factors were physical (n = 16, e.g. dysphagia), psychological (n = 6, e.g. claustrophobia) and non-specified (n = 12). Healthcare-related drop-out-factors were logistics (n = 6) and 18F-FDG-PET/CT-/MRI-system defects (n = 2). The CTC mucosal toxicity was significantly higher (p = 0.023) at week 2 of (chemo)radiotherapy in patient drop-outs than with complete imaging. Conclusions: The drop-out frequency of advanced-staged HNSCC patients for imaging during (chemo)radiotherapy in a research-setting was high and mainly patient-related. Treatment of patient-related inconveniences, communication of rationale and healthcare-related imaging protocol efficiency improvements may contribute to improved adherence.

Early Response Prediction of Multiparametric Functional MRI and 18F-FDG-PET in Patients with Head and Neck Squamous Cell Carcinoma Treated with (Chemo)Radiation

“…The exclusion criteria were: nasopharyngeal tumors, age < 18 and inadequate image quality (this will be discussed in a later Section of the paper). The adherence of all patients to have pretreatment and intratreatment imaging has been previously reported [ 13 ], whereas, in this paper, we report on the early tumoral changes and prognosis. Within five weeks after baseline imaging, treatment was initiated consisting of pre-determined radiotherapy (7 weeks, 70 Gy in 35 fractions) with/without concomitant chemotherapy (3 weekly 100 mg/m 2 cisplatin), or weekly cetuximab (400 mg/m 2 loading dose, followed by 7 weekly infusions of 250 mg/m 2 ).…”

“…Between 2013 and 2019, 97 histological-proven HNSCC patients were recruited [ 13 ], of which 63 patients were recruited with complete functional imaging ( Figure 2 ).…”

Photobiomodulation therapy for the prevention of acute radiation dermatitis in head and neck cancer patients (DERMISHEAD trial)

“…Furthermore, other factors played a role in the attrition rate ranging from forgetting PBM sessions or the fact that patients did not experience skin problems at the start of the trial [31]. Previous clinical trials with HNC patients already described this low adherence rate [32][33][34][35]. However, our trial also has many advantages, including the randomised and multicentric design, the blinding of patients and assessor, well-defined PBM parameters, and the usage of validated grading tools and questionnaires.…”

Current Role of Delta Radiomics in Head and Neck Oncology

“…One non-technical but, nevertheless, important challenge in implementing delta radiomics is patient adherence to imaging timelines. Patient non-compliance with follow-up protocols can lead to a lack of the necessary information for adequate delta-radiomic analysis [40].…”