Diffusion Weighted Imaging in Predicting Progression Free Survival in Patients with Squamous Cell Carcinomas of the Head and Neck Treated with Induction Chemotherapy

Abstract

Background To assess the role of diffusion weighted imaging (DWI) in predicting progression-free survival in patients with squamous cell carcinomas of head and neck (HNSCC) treated with induction chemotherapy. Methods Eighteen patients with HNSCC underwent DWI studies prior to treatment and within 3-weeks after completion of induction chemotherapy. Median apparent diffusion coefficient (ADC) values were computed from the largest cervical metastatic lymph node. Percentage (%) changes in ADC values from pre-treatment to post-treatment time points were compared between alive and dead patients using Mann-Whitney test. Probability (p) value of less-than 0.05 was considered significant. Results A 22% increase in ADC was observed after induction chemotherapy in alive patients (n=15), while patients who died from HNSCC (n=3) demonstrated a 33% decrease in ADC. The difference in % change in ADC between alive and dead patients was significant (p=0.039). Conclusions ADC may be a useful marker in predicting progression-free survival in HNSCC patients undergoing induction chemotherapy.

Squamous Cell Carcinoma of the Head and Neck: Comparison of Diffusion-weighted MRI at b-values of 1,000 and 2,000 s/mm² to Predict Response to Induction Chemotherapy

“…16 This result might be in line with the findings of Kim and associates of significant difference between complete and partial responders to chemoradiation therapy of pretreatment ADC values with b-values of 1,000 s/mm 2 20 and results of Kato's team showing an inverse correlation between tumor regression rate and ADC values. 19 However, King's group could not corroborate these positive results using a b-value of 500 s/mm 2 21,22 nor could Vandecaveye's team 23 using a b-value of 1,000 s/mm 2 .…”

“…19 Berrak and colleagues showed significant difference in the percentage of change of ADC values of metastatic nodes before and after induction chemotherapy between live patients and patients who died of HNSCC, but they did not show any potential of pretreatment ADC values to predict outcome. 16 In this regard, our study showed the potential of pretreatment ADC values to reflect the treatment response to induction chemotherapy, which was not revealed in standard b-value DWI.…”

“…[16][17][18][19][20][21][22][23] However, the results regarding pretreatment prediction have been inconsistent.…”

“…With regard to neoadjuvant chemotherapy, 2 studies have related DWI parameters (b-value of 1,000 s/mm 2 ) with tumor response to induction chemotherapy. 16,19 Kato and associates demonstrated positive correlation between the rate of tumor regression and signal intensities on DWI and inverse correlation between the rate of tumor regression and ADC values. 19 Berrak and colleagues showed significant difference in the percentage of change of ADC values of metastatic nodes before and after induction chemotherapy between live patients and patients who died of HNSCC, but they did not show any potential of pretreatment ADC values to predict outcome.…”

“…Therefore, in recent years, DWI has been considered a good candidate as a noninvasive biomarker for predicting and monitoring treatment responses. Consequently, many studies have assessed DWI parameters (ADC values) with tumor response to chemoradiation therapy, [16][17][18][19][20][21][22][23][24] 2 ) has been applied successfully to HNSCC for tumor grading and work-up for recurrence following treatment. [25][26][27] In addition, a histogram-based approach with ADC maps has been used in neuro-oncologic imaging to differentiate tumor progression from pseudoprogession and to evaluate tumor grades and even gene mutations.…”