Early Prediction of Outcome in Advanced Head-and-Neck Cancer Based on Tumor Blood Volume Alterations During Therapy: A Prospective Study

Abstract

Purpose To assess whether alterations in tumor blood volume (BV) and flow (BF) during the early course of chemo-radiation therapy (RT) for head and neck cancer (HNC) predict treatment outcome. Methods Fourteen patients receiving concomitant chemo-RT for non-resectable, locally advanced HNC underwent dynamic-contrast enhanced (DCE) MRI scans pre-therapy and two weeks after initiation of chemo-RT. BV and BF were quantified from DCE MRI. Pre-RT BV and BF as well as their changes during RT were evaluated separately in the primary gross tumor volume (GTV) and nodal GTV for association with outcomes. Results At a median follow-up of ten months (range of 5 – 27 months), nine patients had local-regional controlled disease (LRC). One patient had regional failure (RF), three had local failures (LF) and one had local-regional failure (LRF). Reduction in tumor volume after 2 weeks of chemo-RT did not predict for local control. In contrast, the BV in the primary GTV after 2 weeks of chemo-RT was increased significantly in the LC patients compared to the LF patients (p<0.03). Conclusions Our data suggest that an increase in available primary tumor blood for oxygen extraction during the early course of RT is associated with local control, thus yielding a predictor with potential to modify treatment. These findings require validation in larger studies.

Texture analysis on parametric maps derived from dynamic contrast-enhanced magnetic resonance imaging in head and neck cancer

“…The ability of DCE-MRI to predict a patient's response to chemo-radiation treatment has been previously investigated in head and neck cancers [5,7,8] . In a study by Cao et al [7] that followed head and neck cancer patients for a median of 10 mo (range, 5-27 mo), the blood volume in the primary gross tumor volume was increased significantly in local control patients after 2 wk of chemo-radiation, compared with local failure patients (P < 0.03) [7] .…”

“…The ability of DCE-MRI to predict a patient's response to chemo-radiation treatment has been previously investigated in head and neck cancers [5,7,8] . In a study by Cao et al [7] that followed head and neck cancer patients for a median of 10 mo (range, 5-27 mo), the blood volume in the primary gross tumor volume was increased significantly in local control patients after 2 wk of chemo-radiation, compared with local failure patients (P < 0.03) [7] . In a study of 33 patients with head and neck cancer treated with neoadjuvant chemo-radiation therapy, Kim et al [8] found that the average pretreatment K trans value of a group with complete response to treatment was significantly higher than that of a group with partial response (P = 0.001) at a 6 mo follow-up.…”

“…For patients with advanced head and neck squamous cell carcinoma (HNSCC), DCE-MRI has shown potential for assessment of treatment response and outcome [4][5][6] . More specifically, measures derived from DCE-MRI, such as K trans and ve, were demonstrated to provide helpful additional information regarding characterization and prognosis of HNSCC with neck nodal metastases [7,8] . HNSCC has been shown to be heterogeneous, due to a chaotic and poorly organized tumor vasculature.…”

Prediction of Disease-Free Survival in Patients with Squamous Cell Carcinomas of the Head and Neck Using Dynamic Contrast-Enhanced MR Imaging

“…In a related study, Zima et al 7 reported that patients with higher pretreatment blood volume and blood flow measurements from the primary tumor demonstrated better response and reduction in tumor volume after induction chemotherapy. Cao et al 8 observed a significant increase in tumor blood volume during the early course of chemoradiation therapy in patients who exhibited local control but there was no change in blood volume in patients who demonstrated local failure from chemoradiation. These studies focused only on prediction of short-term local therapeutic response, and there is no evidence to support the prognostic value of DCE-MRI in predicting long-term survival in HNSCC, which may be different from the short-term response.…”

“…Patients with HNSCC with elevated tumor blood flow/ blood volume respond more favorably to chemoradiation therapy than patients with low blood flow/volume. [5][6][7][8][9] DCE-MRI studies yield a parameter called K trans , which is a measure of the first-order bidirectional volume transfer constant of contrast agent exchange between the intravascular plasma and tumor interstitium compartments. The pretreatment K trans , which reflects tumor perfusion/permeability, has been shown to predict nodal treatment response to chemoradiation therapy in patients with HNSCC.…”