Pretreatment and early intratreatment prediction of clinicopathologic response of head and neck cancer to chemoradiotherapy using ¹H‐MRS

Abstract

Purpose: To determine if choline (cho) identified by proton magnetic resonance spectroscopy ( 1 H-MRS) performed pretreatment and early in the course of treatment predicts clinicopathologic response of head and neck squamous cell carcinoma (HNSCC). Materials and Methods:In all, 60 patients with HNSCC scheduled to undergo concurrent chemoradiotherapy or radiotherapy alone were recruited. 1 H-MRS was performed pretreatment and early intratreatment (2 weeks after start of treatment). Cho:creatine and cho:water ratios at each timepoint and change in the ratios between the two timepoints were correlated with locoregional failure, distant metastases, overall survival, and cancerrelated death. Statistical analysis was performed using logistic regression and chi-square and a P-value of < 0.05 was considered statistically significant.Results: Cho was identified in 47/49 successful pretreatment spectra and 42 of these 47 underwent successful 1 H-MRS early intratreatment, of which 21 showed persistent cho. Locoregional failure occurred in 15, distant metastases in 6, and death in 15 patients; the follow-up period in survivors ranged from 13-64 months (mean, 39 months). No statistically significant correlation was found between 1 H-MRS parameters and clinical endpoints. Conclusion:The pretreatment cho and change in cho early during a course of treatment did not predict clinical outcome.

Biologic Imaging of Head and Neck Cancer: The Present and the Future

“…18 F-FMISO is reduced and bound to cell constituents under hypoxic conditions with the level of hypoxia depicted by 18 F-FMISO before treatment, correlating with locoregional failure and the absence of hypoxia associated with a low risk of locoregional failure. 58,61,62 Treating patients with hypoxic primary tumors with additional cytotoxin resulted in significantly fewer local failures than treating patients with chemotherapy alone, thus showing that hypoxia identification by using biologic imaging can be crucial for prognostication.…”

“…60 Hence, there is growing interest in diagnosing hypoxic HNC before therapy in the hope of applying novel treatment strategies that may overcome resistance to conventional chemoradiation. 60 Potential tumor hypoxia imaging agents include 18 F-FMISO and copper 60 (II)-diacetyl-bis(N4-methylthiosemicarbazone).…”

“…In this biologic imaging array, we include proton MR spectroscopy, CTP, perfusion-weighted MR imaging, DWI, and 18 F-FDG-PET. We also address issues of tumor hypoxia and neoangiogenesis and discuss potential ways of imaging these entities.…”

“…While an earlier study published in 2005 17 showed that MR spectroscopy had the potential to predict response to therapy (patients with poor tumor response showed elevated Cho/Cr ratios and 1.3:0.9 ppm spectral intensity ratios [signal intensity due to lipid or lactic acid] with 83% sensitivity and 82% specificity in predicting treatment failure), a later study has shown that the pretreatment Cho and change in Cho early during a course of treatment did not predict clinical outcome. 18 To summarize, while MR spectroscopy is a good technique for evaluating abnormal metabolite fractions in lesions and characterizing them as benign or malignant, there is still work to be done in applying it during HNC therapy to monitor or predict response.…”

Meta‑analysis of diffusion‑weighted imaging for predicting locoregional failure of chemoradiotherapy in patients with head and neck squamous cell carcinoma

“…Currently, in addition to DWI, multiple imaging modalities, including dynamic contrast-enhanced MRI (21), phosphorous MR spectroscopy (22), and fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (23) have been used to predict and monitor treatment efficacy in HNSCC patients. The notable advantages of DWI over these other imaging modalities are its simplicity and the fact that the use of contrast agents is not required.…”