The ability of post-chemoradiotherapy DWI ADCmean and 18F-FDG SUVmax to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status

Abstract

Objectives To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADCmean) and 18F-FDG PET maximum standardized uptake value (SUVmax) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status. Methods This prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADCmean (pre-treatment, 6- and 12-weeks post-CRT) and SUVmax (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann–Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS. Results Absolute post-CRT ADCmean values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADCmean at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUVmax did not predict DFS. Conclusion Absolute post-CRT ADCmean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADCmean were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes.

MRI for Differentiation between HPV-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma: A Systematic Review

“…Twenty-eight studies with a total of 2634 patients (1571 HPV+ cases, 899 HPV− cases), conducted between 2014 and 2022, were included in this review. Fourteen out of twenty-eight studies used MRI to find differences between HPV+ and HPV− patients ( Table 1 ) [ 2 , 19 , 20 , 25 , 28 , 29 , 35 , 38 , 39 , 41 , 43 , 47 , 49 , 50 ], the other studies aimed to predict HPV status using MRI ( Table 2 ) [ 21 , 22 , 23 , 26 , 27 , 31 , 32 , 37 , 40 , 42 , 44 , 45 , 46 , 48 ]. The main findings from each feature category are summarized in Table 3 .…”

“…The main findings from each feature category are summarized in Table 3 . Twenty-one studies had a retrospective cohort study design [ 2 , 19 , 20 , 21 , 22 , 25 , 26 , 28 , 29 , 31 , 32 , 35 , 37 , 38 , 39 , 42 , 44 , 45 , 47 , 48 , 49 ], and seven studies had a prospective cohort study design [ 23 , 27 , 40 , 41 , 43 , 46 , 50 ]. Of the twenty-eight included papers, five papers focused on structural MRI sequences that were used in routine clinical examinations [ 19 , 20 , 21 , 22 , 23 ], nineteen focused on DWI sequences [ 2 , 25 , 27 , 28 , 29 , 31 , 32 , 35 , 36 , 38 , 39 , 41 , 42 , 44 , 45 , 46 , 47 ,…”

“…Eleven studies used 1.5T MRI scanners [19,25,27,28,38,43,[45][46][47]49,50], nine studies used 3.0T MRI scanners [20,22,26,29,32,37,40,41,44], and eight studies used a combination of 1.5T and 3.0T MRI scanners [2,21,23,31,35,39,42,48]. Of the twenty-eight studies, nineteen investigated OPSCC exclusively [19][20][21][22][23]27,29,31,32,37,38,40,42,[44][45][46][47][48][49], three studies investigated oral cavity (OC)SCC as well as OPSCC [2,26,28], and ...…”

Imaging of human papilloma virus associated oropharyngeal squamous cell carcinoma and its impact on diagnosis, prognostication, and response assessment

“… 97,111,157,158 For example, Connor et al found HNSCC patients with higher post-treatment ADC mean values 6 and 12 weeks following RT were associated with increased 2 year disease free survival rates. 158 At 6 weeks, an optimum threshold of 1405 10 –6 mm 2 /s was derived (with a sensitivity of 83%, specificity of 80%, PPV of 39% and NPV of 97%) and at 12 weeks an optimum threshold of 1840 10 –6 mm 2 /s was derived (with a sensitivity of 83%, specificity of 57%, PPV of 22% and NPV of 96%). 158 …”

“… 158 At 6 weeks, an optimum threshold of 1405 10 –6 mm 2 /s was derived (with a sensitivity of 83%, specificity of 80%, PPV of 39% and NPV of 97%) and at 12 weeks an optimum threshold of 1840 10 –6 mm 2 /s was derived (with a sensitivity of 83%, specificity of 57%, PPV of 22% and NPV of 96%). 158 …”