Prognostic role of diffusion weighted and dynamic contrast-enhanced MRI in loco-regionally advanced head and neck cancer treated with concomitant chemoradiotherapy

Abstract

Background In the study, the value of pre-treatment dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI-derived parameters as well as their changes early during treatment was evaluated for predicting disease-free survival (DFS) and overall survival (OS) in patients with locoregionally advanced head and neck squamous carcinoma (HNSCC) treated with concomitant chemoradiotherapy (cCRT) with cisplatin. Patients and methods MRI scans were performed in 20 patients with locoregionally advanced HNSCC at baseline and after 10 Grays (Gy) of cCRT. Tumour apparent diffusion coefficient (ADC) and DCE parameters (volume transfer constant [Ktrans], extracellular extravascular volume fraction [ve], and plasma volume fraction [Vp]) were measured. Relative changes in parameters from baseline to 10 Gy were calculated. Univariate and multivariate Cox regression analysis were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify parameters with the best diagnostic performance. Results None of the parameters was identified to predict for DFS. On univariate analysis of OS, lower pre-treatment ADC (p = 0.012), higher pre-treatment Ktrans (p = 0.026), and higher reduction in Ktrans (p = 0.014) from baseline to 10 Gy were identified as significant predictors. Multivariate analysis identified only higher pre-treatment Ktrans (p = 0.026; 95% CI: 0.000–0.132) as an independent predictor of OS. At ROC curve analysis, pre-treatment Ktrans yielded an excellent diagnostic accuracy (area under curve [AUC] = 0.95, sensitivity 93.3%; specificity 80 %). Conclusions In our group of HNSCC patients treated with cisplatin-based cCRT, pre-treatment Ktrans was found to be a good predictor of OS.

Predictive Value of Early Post-Treatment Diffusion-Weighted MRI for Recurrence or Tumor Progression of Head and Neck Squamous Cell Carcinoma Treated with Chemo-Radiotherapy

“…Furthermore, our study demonstrates that ADC1 values of less than 0.7 also predict post-CRT tumor residue, thus indicating treatment failure, contrary to ADC1 above this threshold that significantly predicts a positive response. This second point is indeed in accordance with the existing literature [37].…”

“…Usually, malignant tumors have lower values in comparison to benign lesions [31][32][33]. Several studies have suggested that the characteristics of tumors on magnetic resonance imaging (MRI)/DWI, especially ADC values, commonly correlate with histologic characteristics known as poor prognosis in HNSCC as well as in rectal, pelvic, cerebral and breast tumors [29,32,[34][35][36], and thus predict both long-term survival and resistance to CRT [37]. Other studies have suggested that MRI/DWI is a potentially valuable tool for early detection of responders to chemotherapy, thus enabling rapid adjustment to the therapeutic strategy of non-responders during treatment [38,39].…”

A Nomogram for Pretreatment Prediction of Response to Induction Chemotherapy in Locally Advanced Hypopharyngeal Carcinoma

“…Oh et al find that radiomic features derived from 18-fluorodeoxyglucose ( 1 8 F-FDG) positron emission tomography (PET) images of hypopharyngeal carcinoma patients could evaluate their response to IC (8). Emerging evidence suggests that diffusion-weighted imaging (DWI) MRI improves tissue characterization, staging, and response to therapy in those with head and neck carcinoma (9)(10)(11)(12)(13)(14). Noij et al compare the efficacy of FDG-PET/CT and DWI MRI in evaluating the IC response of the primary tumor and find that the FDG-PET/CT had better performance with a specificity of 86.5% and sensitivity of 85.7% (15).…”

MRI Dynamic Contrast Imaging of Oral Cavity and Oropharyngeal Tumors

“…2 and 3). Garbajs et al 69 showed in HNSCC patients (n ¼ 20) treated with cisplatin-based concurrent chemoradiotherapy, pretreatment K trans was a good predictor of OS.…”