1
|
Canali L, Costantino A, Mari G, Festa BM, Russo E, Giannitto C, Spriano G, De Virgilio A. Diffusion-Weighted MRI for Recurrent/Persistent Head and Neck Squamous-Cell Carcinoma After Radiotherapy: Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39154260 DOI: 10.1002/ohn.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 07/23/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To evaluate the accuracy of diffusion-weighted magnetic resonance imaging (DWI-MRI) in diagnosing persistent/recurrent head and neck squamous cell carcinomas (HNSCCs) after primary chemoradiotherapy (CRT). DATA SOURCES Scopus, PubMed/MEDLINE, and Cochrane Library databases were searched for relevant publications until April 18, 2023. REVIEW METHODS A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Test Accuracy statement. The search was conducted independently by 2 investigators. Methodological quality of included studies was assessed using the Quality Assessment of Diagnostic Studies-2 questionnaire. Extracted data were used to calculate the pooled DWI-MRI sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratio. RESULTS A total of 618 patients from 10 studies were included for calculation of diagnostic accuracy parameters. At the level of the primary tumor, the pooled sensitivity and specificity were, respectively, 0.96 (95% confidence interval [CI]: 0.89-1.00) and 0.81 (95% CI: 0.54-0.98) in the case of qualitative analysis, and, respectively, 0.79 (95% CI: 0.66-0.89) and 0.88 (95% CI: 0.77-0.96) for quantitative analysis. At the level of the neck, the pooled sensitivity and specificity were, respectively, 0.87 (95% CI: 0.75-0.95) and 0.84 (95% CI: 0.74-0.93) when images were analyzed qualitatively, and 0.79 (95% CI: 0.60-0.94) and 0.90 (95% CI: 0.82-0.97) when analyzed quantitatively. CONCLUSION DWI-MRI showed high diagnostic accuracy and should be considered if persistent/recurrent HNSCCs is suspected after primary CRT. No significant differences were found between qualitative and quantitative imaging assessment.
Collapse
Affiliation(s)
- Luca Canali
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Andrea Costantino
- Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida, USA
| | - Giulia Mari
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Radiology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | | |
Collapse
|
2
|
Shah R, Tyagi S, Liu C, Judson B. Extra imaging beyond NCCN surveillance guidelines is cost effective for HPV- but not HPV+ oropharyngeal cancer. Oral Oncol 2023; 146:106564. [PMID: 37672950 DOI: 10.1016/j.oraloncology.2023.106564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Rema Shah
- Yale University School of Medicine, New Haven, CT, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Sidharth Tyagi
- Yale University School of Medicine, New Haven, CT, USA; Medical Scientist Training Program, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Christina Liu
- Yale University School of Medicine, New Haven, CT, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin Judson
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
3
|
Awan M, Robbins JR. Post-treatment Imaging From the Perspective of the Head and Neck Radiation Oncologist. Semin Roentgenol 2023; 58:355-362. [PMID: 37507175 DOI: 10.1053/j.ro.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/13/2023] [Accepted: 02/26/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
| | | |
Collapse
|
4
|
Retrospective Evaluation of NI-RADS for Detecting Postsurgical Recurrence of Oral Squamous Cell Carcinoma on Surveillance CT or MRI. AJR Am J Roentgenol 2021; 217:198-206. [DOI: 10.2214/ajr.20.24209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
5
|
Brenet E, Barbe C, Hoeffel C, Dubernard X, Merol JC, Fath L, Servagi-Vernat S, Labrousse M. 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. Cancers (Basel) 2020; 12:cancers12051234. [PMID: 32422975 PMCID: PMC7281260 DOI: 10.3390/cancers12051234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
Aims: To investigate the predictive capacity of early post-treatment diffusion-weighted magnetic resonance imaging (MRI) for recurrence or tumor progression in patients with no tumor residue after chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma, and, to assess the predictive capacity of pre-treatment diffusion-weighted MRI for persistent tumor residue post-CRT. Materials and Method: A single center cohort study was performed in one French hospital. All patients with squamous cell carcinoma receiving CRT (no surgical indication) were included. Two diffusion-weighted MRI were performed: one within 8 days before CRT and one 3 months after completing CRT with determination of median tumor apparent diffusion coefficient (ADC). Main outcome: The primary endpoint was progression-free survival. Results: 59 patients were included prior to CRT and 46 (78.0%) completed CRT. A post-CRT tumor residue was found in 19/46 (41.3%) patients. In univariate analysis, initial ADC was significantly lower in patients with residue post CRT (0.56 ± 0.11 versus 0.79 ± 0.13; p < 0.001). When initial ADC was dichotomized at the median, initial ADC lower than 0.7 was significantly more frequent in patients with residue post CRT (73.7% versus 11.1%, p < 0.0001). In multivariate analysis, only initial ADC lower than 0.7 was significantly associated with tumor residue (OR = 22.6; IC [4.9–103.6], p < 0.0001). Among 26 patients without tumor residue after CRT and followed up until 12 months, 6 (23.1%) presented recurrence or progression. Only univariate analysis was performed due to a small number of events. The only factor significantly associated with disease progression or early recurrence was the delta ADC (p = 0.0009). When ADC variation was dichotomized at the median, patients with ADC variation greater than 0.7 had time of disease-free survival significantly longer than patients with ADC variation lower than 0.7 (377.5 [286–402] days versus 253 [198–370], p < 0.0001). Conclusion and relevance: Diffusion-weighted MRI could be a technique that enables differentiation of patients with high potential for early recurrence for whom intensive post-CRT monitoring is mandatory. Prospective studies with more inclusions would be necessary to validate our results.
Collapse
Affiliation(s)
- Esteban Brenet
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
- Correspondence:
| | - Coralie Barbe
- Clinical Research Unit, Robert Debré University Hospital, 51100 Reims, France;
| | - Christine Hoeffel
- Department of Radiology, Robert Debré University Hospital, 51100 Reims, France;
| | - Xavier Dubernard
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| | - Jean-Claude Merol
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| | - Léa Fath
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France;
| | | | - Marc Labrousse
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France; (X.D.); (J.-C.M.); (M.L.)
| |
Collapse
|
6
|
Lee JY, Cheng KL, Lee JH, Choi YJ, Kim HW, Sung YS, Chung SR, Ryu KH, Chung MS, Kim SY, Lee SW, Baek JH. Detection of Local Recurrence in Patients with Head and Neck Squamous Cell Carcinoma Using Voxel-Based Color Maps of Initial and Final Area under the Curve Values Derived from DCE-MRI. AJNR Am J Neuroradiol 2019; 40:1392-1401. [PMID: 31320461 DOI: 10.3174/ajnr.a6130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of local recurrence is important to increase the chance of cure because local recurrence is the main cause of treatment failure in head and neck squamous cell carcinoma. We evaluated the added value of voxel-based color maps of dynamic contrast-enhanced MR imaging compared with conventional MR imaging alone for detecting local recurrence of head and neck squamous cell carcinoma. MATERIALS AND METHODS We retrospectively enrolled 63 consecutive patients with head and neck squamous cell carcinoma after definitive treatment and posttreatment surveillance MR imaging studies that demonstrated focal enhancement at the primary site. Three independent readers assessed conventional MR imaging and a pair of color maps of initial and final 90-second time-signal intensity areas under the curve from dynamic contrast-enhanced MR imaging. The sensitivities, specificities, and accuracies of both conventional MR imaging alone and combined interpretation of conventional and dynamic contrast-enhanced MR imaging were assessed using the clinicopathologic diagnosis as the criterion standard. κ statistics were used to evaluate interreader agreement. RESULTS There were 28 patients with subsequently documented local recurrence and 35 with posttreatment change. Adding dynamic contrast-enhanced MR imaging to conventional MR imaging significantly increased the diagnostic accuracies for detecting local recurrence (48%-54% versus 87%-91%; P < .05), with excellent interreader agreement (κ = 0.8; 95% CI, 0.67-0.92 to κ = 0.81; 95% CI, 0.69-0.93). By all 3 readers, the specificities were also significantly improved by adding dynamic contrast-enhanced MR imaging to conventional MR imaging (22%-43% versus 87%-91%; P < .001) without sacrificing the sensitivities (68%-82% versus 86%-89%; P > .05). CONCLUSIONS Adding voxel-based color maps of initial and final 90-second time-signal intensity areas under the curve from dynamic contrast-enhanced MR imaging to conventional MR imaging increases the diagnostic accuracy to detect local recurrence in head and neck squamous cell carcinoma by improving the specificity without sacrificing the sensitivity.
Collapse
Affiliation(s)
- J Y Lee
- From the Department of Radiology (J.Y.L.), Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - K L Cheng
- Department of Medical Imaging (K.L.C.)
- School of Medical Imaging and Radiological Sciences (K.L.C.), Chung Shan Medical University, Taichung, Taiwan
- Department of Veterinary Medicine (K.L.C.), National Chung Hsing University, Taichung, Taiwan
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - J H Lee
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - Y J Choi
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - H W Kim
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - Y S Sung
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - S R Chung
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| | - K H Ryu
- Department of Radiology (K.H.R.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - M S Chung
- Department of Radiology (M.S.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - S Y Kim
- Departments of Otolaryngology (S.Y.K.)
| | - S-W Lee
- Radiation Oncology (S.-W.L), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J H Baek
- Department of Radiology and Research Institute of Radiology (J.Y.L., K.L.C., J.H.L., Y.J.C., H.W.K., Y.S.S., S.R.C., J.H.B.)
| |
Collapse
|
7
|
Timing and Impact of Posttreatment PET/CT After First 6 Months on Patient Management and Outcomes in Oropharyngeal Squamous Cell Carcinoma. AJR Am J Roentgenol 2019; 212:1142-1147. [PMID: 30835513 DOI: 10.2214/ajr.18.20619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The objective of this study was to investigate the impact of PET/CT on patient management and outcomes of oropharyngeal squamous cell carcinoma (OPSCC) after the first 6 months following treatment. MATERIALS AND METHODS. We retrospectively identified patients with OPSCC who underwent chemoradiation therapy and had at least 2 years of posttreatment follow-up. Patients were grouped on the basis of whether they underwent PET/CT, as a result of clinical suspicion of recurrence or routine follow-up, in the last 18 months of the 2-year posttreatment period (experimental group) or not (control group). Association between PET/CT use and change in management was tested using chi-square analysis. Survival analyses were performed with Cox and Kaplan-Meier analyses. RESULTS. In total, 149 patients underwent 294 PET/CT studies in the 2-year follow-up period. Eighty-three patients (55.7%) underwent PET/CT in the last 18 months of the 2 years. This group underwent 223 PET/CT studies, 22 (9.9%) of which were positive. Sixteen of the 22 (72.7%) changed management. Sixty-six patients (44.3%) did not undergo PET/CT in the last 18 months. This group underwent 71 PET/CT studies, six (8.5%) of which were positive. Two of the six studies (33.3%) changed management. Of first-time positive PET/CT studies in the last 18 months, five of nine (55.6%) were performed 6-12 months after treatment. PET/CT in the last 18 months was positively associated with change in management (odds ratio, 4.88; p = 0.02). Patients with positive PET/CT findings had worse overall survival (hazard ratio [HR], 31.6; p < 0.0001) and progression-free survival (HR, 40.8; p < 0.0001). CONCLUSION. PET/CT in the last 18 months of the 2-year posttreatment period impacted patient management. Most first-time positive PET/CT studies in the last 18 months of the 2 years were performed 6-12 months after treatment.
Collapse
|
8
|
Zhao X, Rao S. Surveillance imaging following treatment of head and neck cancer. Semin Oncol 2017; 44:323-329. [DOI: 10.1053/j.seminoncol.2018.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 11/11/2022]
|
9
|
Noij DP, Jagesar VA, de Graaf P, de Jong MC, Hoekstra OS, de Bree R, Castelijns JA. Detection of residual head and neck squamous cell carcinoma after (chemo)radiotherapy: a pilot study assessing the value of diffusion-weighted magnetic resonance imaging as an adjunct to PET-CT using 18 F-FDG. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:296-305.e2. [DOI: 10.1016/j.oooo.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/08/2017] [Accepted: 04/15/2017] [Indexed: 02/06/2023]
|
10
|
Helsen N, Roothans D, Van Den Heuvel B, Van den Wyngaert T, Van den Weyngaert D, Carp L, Stroobants S. 18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy. PLoS One 2017; 12:e0182350. [PMID: 28771540 PMCID: PMC5542639 DOI: 10.1371/journal.pone.0182350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/17/2017] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study is to evaluate the diagnostic performance of FDG-PET/CT for the detection of residual disease after (chemo)radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and to evaluate the prognostic value of the FDG-PET/CT findings. Methods Patients with HNSCC who underwent FDG-PET/CT after (chemo)radiotherapy were studied retrospectively. Results 104 FDG-PET/CT-scans were performed at a median of 13.2 weeks post-treatment (5.4–19.0 weeks). The diagnostic performance was time dependent with decreasing sensitivity and slightly increasing specificity over time. Sensitivity, specificity, PPV and NPV at 9 months after imaging were 91%, 87%, 77% and 95%, respectively. In a logistic regression model, the odds of a correct FDG-PET/CT increased with 33% every additional week after end of therapy (p = 0.01) and accuracy plateaued after 11 weeks (97%; p<0.001). A complete response on FDG-PET/CT was associated with an overall survival benefit (50.7 versus 10.3 months; p<0.001). Residual disease on FDG-PET/CT increased the risk of death 8-fold (p<0.001). Conclusion FDG-PET/CT is able to detect residual disease after (chemo)radiotherapy, with an optimal time point for scanning between 11–12 weeks after therapy. However, a reevaluation is probably necessary 10–12 months after the FDG-PET/CT to detect late recurrences. In addition, FDG-PET/CT can guide decisions about neck dissection and identifies patients with poor prognosis.
Collapse
Affiliation(s)
- Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
- * E-mail:
| | - Dessie Roothans
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Bert Van Den Heuvel
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | | | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| |
Collapse
|
11
|
van Ginkel JH, Huibers MMH, van Es RJJ, de Bree R, Willems SM. Droplet digital PCR for detection and quantification of circulating tumor DNA in plasma of head and neck cancer patients. BMC Cancer 2017. [PMID: 28629339 PMCID: PMC5477260 DOI: 10.1186/s12885-017-3424-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background During posttreatment surveillance of head and neck cancer patients, imaging is insufficiently accurate for the early detection of relapsing disease. Free circulating tumor DNA (ctDNA) may serve as a novel biomarker for monitoring tumor burden during posttreatment surveillance of these patients. In this exploratory study, we investigated whether low level ctDNA in plasma of head and neck cancer patients can be detected using Droplet Digital PCR (ddPCR). Methods TP53 mutations were determined in surgically resected primary tumor samples from six patients with high stage (II-IV), moderate to poorly differentiated head and neck squamous cell carcinoma (HNSCC). Subsequently, mutation specific ddPCR assays were designed. Pretreatment plasma samples from these patients were examined on the presence of ctDNA by ddPCR using the mutation-specific assays. The ddPCR results were evaluated alongside clinicopathological data. Results In all cases, plasma samples were found positive for targeted TP53 mutations in varying degrees (absolute quantification of 2.2–422 mutational copies/ml plasma). Mutations were detected in wild-type TP53 background templates of 7667–156,667 copies/ml plasma, yielding fractional abundances of down to 0.01%. Conclusions Our results show that detection of tumor specific TP53 mutations in low level ctDNA from HNSCC patients using ddPCR is technically feasible and provide ground for future research on ctDNA quantification for the use of diagnostic biomarkers in the posttreatment surveillance of HNSCC patients. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3424-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joost H van Ginkel
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Manon M H Huibers
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
12
|
Yu Y, Mabray M, Silveira W, Shen PY, Ryan WR, Uzelac A, Yom SS. Earlier and more specific detection of persistent neck disease with diffusion‐weighted MRI versus subsequent PET/CT after definitive chemoradiation for oropharyngeal squamous cell carcinoma. Head Neck 2016; 39:432-438. [DOI: 10.1002/hed.24606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/28/2016] [Accepted: 08/22/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yao Yu
- Department of Radiation OncologyUniversity of California – San FranciscoSan Francisco California
| | - Marc Mabray
- Department of RadiologyUniversity of California – San FranciscoSan Francisco California
| | - William Silveira
- Department of Radiation OncologyUniversity of California – San FranciscoSan Francisco California
| | - Peter Y. Shen
- Department of RadiologyUniversity of California – San FranciscoSan Francisco California
| | - William R. Ryan
- Department of Otolaryngology, Head and Neck Surgery, Division of Head and Neck Oncologic SurgeryUniversity of California – San FranciscoSan Francisco California
| | - Alina Uzelac
- Department of RadiologyUniversity of California – San FranciscoSan Francisco California
| | - Sue S. Yom
- Department of Radiation OncologyUniversity of California – San FranciscoSan Francisco California
- Department of Otolaryngology, Head and Neck Surgery, Division of Head and Neck Oncologic SurgeryUniversity of California – San FranciscoSan Francisco California
| |
Collapse
|
13
|
Richey LM, Shores CG, George J, Lee S, Couch MJ, Sutton DK, Weissler MC. The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngol Head Neck Surg 2016; 136:98-103. [PMID: 17210342 DOI: 10.1016/j.otohns.2006.06.1267] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 06/30/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE: To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage. STUDY DESIGN AND SETTING: Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center. RESULTS: Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease ( P = 0.0115). Overall surgical morbidity was 24 percent. CONCLUSION/SIGNIFICANCE: The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well informed about the realistic chances of cure and potential morbidity of surgery. © 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
Collapse
Affiliation(s)
- Luke M Richey
- General Clinical Research Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA
| | | | | | | | | | | | | |
Collapse
|
14
|
Choi YJ, Lee JH, Sung YS, Yoon RG, Park JE, Nam SY, Baek JH. Value of Dynamic Contrast-Enhanced MRI to Detect Local Tumor Recurrence in Primary Head and Neck Cancer Patients. Medicine (Baltimore) 2016; 95:e3698. [PMID: 27175712 PMCID: PMC4902554 DOI: 10.1097/md.0000000000003698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment failures in head and neck cancer patients are mainly related to locoregional tumor recurrence. The objective of the present study was to evaluate the diagnostic accuracy of model-free dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to detect local recurrence during the surveillance of head and neck cancer patients.Our retrospective study enrolled 24 patients with primary head and neck cancer who had undergone definitive treatment. Patients were grouped into local recurrence (n = 12) or posttreatment change (n = 12) groups according to the results of biopsy or clinicoradiologic follow-up. The types of time-signal intensity (TSI) curves were classified as follows: "progressive increment" as type I, "plateau" as type II, and "washout" as type III. TSI curve types and their parameters (i.e., wash-in, Emax, Tmax, area under the curve [AUC]60, AUC90, and AUC120) were compared between the 2 study groups.The distributions of TSI curve types for local recurrence versus posttreatment change were statistically significant (P < 0.001) (i.e., 0% vs 83.3% for type I, 58.3% vs 16.7% for type II, and 41.7% vs 0% for type III). There were statistically significant differences in Emax, Tmax, and all of the AUC parameters between 2 groups (P < 0.0083 [0.05/6]). Receiver operating characteristic (ROC) curve analyses indicated that the TSI curve type was the best predictor of local recurrence with a sensitivity of 100% (95% CI, 73.5-100.0) and a specificity of 83.3% (95% CI, 51.6-97.9) (cutoff with type II).Model-free DCE-MRI using TSI curves and TSI curve-derived parameters detects local recurrence in head and neck cancer patients with a high diagnostic accuracy.
Collapse
Affiliation(s)
- Young Jun Choi
- From the Department of Radiology and Research Institute of Radiology (YJC, JHL, YSS, RGY, JEP, JHB); and Department of Otolaryngology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea (SYN)
| | | | | | | | | | | | | |
Collapse
|
15
|
Tumor Regression Patterns Based on Follow-up Duration in Patients With Head and Neck Squamous Cell Carcinoma Treated With Radiotherapy or Chemoradiotherapy. Clin Exp Otorhinolaryngol 2015; 8:416-21. [PMID: 26622964 PMCID: PMC4661261 DOI: 10.3342/ceo.2015.8.4.416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/26/2014] [Accepted: 12/08/2014] [Indexed: 11/08/2022] Open
Abstract
Objectives We describe patterns of tumor regression based on follow-up duration after radiotherapy (RT) or chemo-RT in patients with head and neck squamous cell carcinoma. Methods Thirty-one patients with head and neck squamous cell carcinoma were included in this study and received definitive RT or chemo-RT. The pattern of primary tumor regression after treatment was evaluated every 1 to 2 months. Predictive factors for the length of time to full regression were also analyzed. Results Among all patients, 27 patients showed regression of the primary tumor, 24 patients showed >50% regression, and 15 patients showed total regression. The primary tumor gradually regressed during the course of follow-up. The median time to full regression was 5.2 months (range, 1.3 to 17.9 months). In the 24 patients who showed >50% regression, the rate of >50% regression increased over time as follows: 25.0% at 1 month, 62.5% at 2 months, 75.0% at 3 months, 91.7% at 4 months, and 95.8% at 5 months. Higher total RT dose and shorter RT duration were associated with longer time to full regression. Conclusion A substantial number of patients showed continuous regression of the primary tumor for more than 2 months after treatment. The timing for evaluation of tumor regression must be greater than 2 months from the completion of RT or chemo-RT in patients with head and neck squamous cell carcinoma.
Collapse
|
16
|
Sagardoy T, Fernandez P, Ghafouri A, Digue L, Haaser T, de Clermont-Galleran H, Castetbon V, de Monès E. Accuracy of (18) FDG PET-CT for treatment evaluation 3 months after completion of chemoradiotherapy for head and neck squamous cell carcinoma: 2-year minimum follow-up. Head Neck 2015; 38 Suppl 1:E1271-6. [PMID: 26315809 DOI: 10.1002/hed.24204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/01/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the accuracy of (18) F-fluorodeoxyglucose positron emission tomography ((18) FDG PET)-CT in detecting residual or recurrent disease after nonsurgical treatment for head and neck squamous cell carcinoma (HNSCC). METHODS We conducted a retrospective analysis of patients with oral cavity, oropharynx, larynx, hypopharynx, or cervical lymph node location of SCC treated with chemoradiotherapy. Twelve weeks posttreatment, (18) FDG PET-CT results were compared to histology if residual disease was suspected. Patients with complete response received a minimum of 24-month follow-up. RESULTS Forty-seven patients were included with 40 months of median follow-up: 46 with a squamous cell carcinoma (SCC) at the primary site and 43 in the neck. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86.7%, 90%, 76.5%, and 93.1%, respectively, at the primary site and 100%, 97.2%, 87.5%, 100%, respectively, in the neck. CONCLUSION (18) FDG PET-CT seems effective in detecting residual disease and in predicting recurrent disease within the first 2 years of follow-up after nonsurgical treatment. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1271-E1276, 2016.
Collapse
Affiliation(s)
- Thomas Sagardoy
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Philippe Fernandez
- Department of Nuclear Medicine, Pellegrin University Hospital, Bordeaux University, Bordeaux, France.,Bordeaux University, INCIA, CNRS, Bordeaux, France.,CNRS, INCIA, Bordeaux, France
| | - Abdullah Ghafouri
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Laurence Digue
- Department of Medical Oncology, St André University Hospital, Bordeaux University, Bordeaux, France
| | - Thibaud Haaser
- Department of Radiotherapy, Hôpital du Haut-Lévêque University Hospital, Bordeaux University, Pessac, France
| | | | - Vincent Castetbon
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Erwan de Monès
- Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| |
Collapse
|
17
|
|
18
|
Abstract
Follow-up program in squamous cell carcinoma of head and neck district is crucial to detect locoregional recurrence and second primary tumors and to manage treatment toxicities. The choice of the appropriate frequency of visits and imaging modality can be troublesome. Details of timing surveillance and type of diagnostic procedure are still not well defined. This review highlights the problem from a clinician’s point of view.
Collapse
|
19
|
Response evaluation after chemoradiotherapy for advanced staged oropharyngeal squamous cell carcinoma: a nationwide survey in the Netherlands. Eur Arch Otorhinolaryngol 2014; 272:3507-13. [DOI: 10.1007/s00405-014-3389-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
|
20
|
Keski-Säntti H, Mustonen T, Schildt J, Saarilahti K, Mäkitie AA. FDG-PET/CT in the Assessment of Treatment Response after Oncologic Treatment of Head and Neck Squamous Cell Carcinoma. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2014; 7:25-9. [PMID: 25210484 PMCID: PMC4149379 DOI: 10.4137/cment.s16399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/07/2014] [Accepted: 06/08/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND In many centers, 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used to monitor treatment response after definitive (chemo)radiotherapy [(C)RT] for head and neck squamous cell carcinoma (HNSCC), but its usefulness remains somewhat controversial. We aimed at assessing the accuracy of FDG-PET/CT in detecting residual disease after (C)RT. METHOD All HNSCC patients with FDG-PET/CT performed to assess treatment response 10–18 weeks after definitive (C)RT at our institution during 2008–2010 were included. The patient charts were reviewed for FDG-PET/CT findings, histopathologic findings, and follow-up data. The median follow-up time for FDG-PET/CT negative patients was 26 months. RESULTS Eighty-eight eligible patients were identified. The stage distribution was as follows: I, n = 1; II, n = 15; III, n = 17; IV, n = 55. The negative predictive value, positive predictive value, specificity, sensitivity, and accuracy of FDG-PET/CT in detecting residual disease were 87%, 81%, 94%, 65%, and 85%, respectively. The corresponding specific figures for the primary tumor site were 91%, 71%, 94%, 59%, and 86% and for the neck 93%, 100%, 100%, 75%, and 94%, respectively. CONCLUSIONS In patients who have received definitive (C)RT for HNSCC, post-treatment FDG-PET/CT has good potential to guide clinical decision-making. Patients with negative scan can safely be followed up clinically only, while positive scan necessitates tissue biopsies or a neck dissection to rule out residual disease.
Collapse
Affiliation(s)
- Harri Keski-Säntti
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Mustonen
- Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Schildt
- Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Kauko Saarilahti
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
21
|
Lambrecht M, Dirix P, Vandecaveye V, De Keyzer F, Hermans R, Nuyts S. Role and value of diffusion-weighted MRI in the radiotherapeutic management of head and neck cancer. Expert Rev Anticancer Ther 2014; 10:1451-9. [DOI: 10.1586/era.10.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
22
|
|
23
|
Wagner MM, Curé JK, Caudell JJ, Spencer SA, Nabell LM, Carroll WR, Bonner JA. Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies. Radiat Oncol 2012; 7:219. [PMID: 23256610 PMCID: PMC3551796 DOI: 10.1186/1748-717x-7-219] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The utility of definitive radiotherapy (RT) for locoregionally advanced squamous cell carcinoma (SCC) of the larynx or hypopharynx in the setting of thyroid or cricoid cartilage invasion (TCCI) is controversial. A retrospective review of our experience was performed. METHODS Our institutional database of patients with SCC of the head and neck treated with radiotherapy (90% received concurrent systemic therapy) between 1995 and 2009 was queried. We identified 87 patients with T3-4 laryngeal or T4 hypopharyngeal cancer for whom initial head and neck imaging was available for review. Imaging of all patients was reviewed by a single radiologist specializing in neuroradiology. The presence and extent of TCCI was determined and used for stratification. RESULTS Median follow-up was 34 months. TCCI was found in 25 (29%) patients, eight limited to the inner cortex and another 17 involving both cortices. Local control (LC) was not significantly affected by TCCI limited to the inner cortex. However, TCCI involving both cortices was correlated with diminished LC at 2 years compared to the group of patients with no or minor invasion (55% vs. 81%, p=0.045). However, TCCI involving both cortices was not associated with significantly reduced rates of survival with a functional larynx, or overall survival (OS). CONCLUSIONS Our results suggest that the rate of LC of T3-4 laryngeal or T4 hypopharyngeal SCC treated with definitive RT is not affected by TCCI of the inner cortex. Although decreased LC was significantly associated with TCCI involving both cortices, this factor did not appear to result in reduced rates of survival with a functional larynx or OS. Therefore, organ preservation may remain an option in these patients.
Collapse
Affiliation(s)
- Marcus M Wagner
- Department of Radiation Oncology, University of Alabama at Birmingham, Hazelrig-Salter Radiation Oncology Center, 1700 6th Avenue South, Birmingham, AL 35249-6832, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Head and neck imaging has benefited from 1.5 T magnetic resonance (MR) imaging, providing faster sequences, better soft tissue evaluation, and 3-axis imaging, with less radiation and iodine-based contrast injection. The US Food and Drug Administration has approved human MR imaging at high-field strength up to 4 T in clinical practice. 3 T MR imaging has become widely available, with the hope of significant advance in the evaluation of the head and neck region. This article reviews the benefits, disadvantages, and challenges of high-field imaging of the head and neck region, focusing on the imaging of head and neck cancer.
Collapse
|
25
|
Ghanooni R, Delpierre I, Magremanne M, Vervaet C, Dumarey N, Remmelink M, Lacroix S, Trotta N, Hassid S, Goldman S. ¹⁸F-FDG PET/CT and MRI in the follow-up of head and neck squamous cell carcinoma. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 6:260-6. [PMID: 21861286 DOI: 10.1002/cmmi.425] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We evaluated the diagnostic performance of (18)F-FDG PET/CT and MRI for the assessment of head and neck squamous cell carcinoma (HNSCC) relapse. Since early treatment might prevent inoperable relapse, we also evaluated THE performance of early unenhanced (18)F-FDG PET/CT in residual tumor detection. The study was prospectively performed on 32 patients who underwent (18)F-FDG PET/CT and MRI before treatment and at 4 and 12 months after treatment. (18)F-FDG PET/CT was also performed 2 weeks after the end of radiotherapy. Histopathology or a minimum of 18 months follow-up were used as gold standard. Before treatment (18)F-FDG PET/CT and MRI detected all primary tumors except for two limited vocal fold lesions (sensitivity 94%). MRI was more sensitive than (18)F-FDG PET/CT for the detection of local extension sites (sensitivity 75 vs 58%), but at the cost of a higher rate of false positive results (positive predictive value 74 vs 86%). For relapse detection at 4 months, sensitivity was significantly higher for (18)F-FDG PET/CT (92%) than for MRI (70%), but the diagnostic performances were not significantly different at 12 months. For the detection of residual malignant tissue 2 weeks post-radiotherapy, sensitivity and specificity of (18)F-FDG PET/CT were respectively 86 and 85% (SUV cut-off value 5.8). (18)F-FDG PET/CT is effective in the differentiation between residual tumor and radiation-induced changes, as early as 2 weeks after treatment of a primary HNSCC. For follow-up, performance of (18)F-FDG PET/CT and MRI are similar except for a higher sensitivity of (18)F-FDG PET/CT at 4 months.
Collapse
Affiliation(s)
- Rose Ghanooni
- Department of Otorhinolaryngology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Gourin CG, Frick KD. National trends in oropharyngeal cancer surgery and the effect of surgeon and hospital volume on short-term outcomes and cost of care. Laryngoscope 2012; 122:543-51. [DOI: 10.1002/lary.22447] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 02/18/2011] [Accepted: 02/23/2011] [Indexed: 02/06/2023]
|
27
|
Wanebo HJ, Rathore R, Chougule P, DiSiena MR, Koness RJ, McRae RG, Nigri PT, Radie-Keane K, Ready N. Selective Organ Preservation in Operable Locally Advanced Head and Neck Squamous Cell Carcinomas Guided by Primary Site Restaging Biopsy: Long-Term Results of Two Sequential Brown University Oncology Group Chemoradiotherapy Studies. Ann Surg Oncol 2011; 18:3479-85. [PMID: 21553142 DOI: 10.1245/s10434-011-1697-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Harold J Wanebo
- Division of Surgical Oncology, Landmark Medical Center, Woonsocket, RI, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Vandecaveye V, Dirix P, De Keyzer F, Op de Beeck K, Vander Poorten V, Hauben E, Lambrecht M, Nuyts S, Hermans R. Diffusion-weighted magnetic resonance imaging early after chemoradiotherapy to monitor treatment response in head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2011; 82:1098-107. [PMID: 21514067 DOI: 10.1016/j.ijrobp.2011.02.044] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 02/01/2011] [Accepted: 02/17/2011] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in head and neck squamous cell carcinoma (HNSCC) three weeks after the end of chemoradiotherapy (CRT). METHODS AND MATERIALS Twenty-nine patients with HNSCC underwent magnetic resonance imaging (MRI) prior to and 3 weeks after CRT, including T(2)-weighted and pre- and postcontrast T(1)-weighted sequences and an echo-planar DWI sequence with six b values (0 to 1,000 s/mm(2)), from which the apparent diffusion coefficient (ADC) was calculated. ADC changes 3 weeks posttreatment compared to baseline (∆ADC) between responding and nonresponding primary lesions and adenopathies were correlated with 2 years locoregional control and compared with a Mann-Whitney test. In a blinded manner, the ∆ADC was compared to conventional MRI 3 weeks post-CRT and the routinely implemented CT, on average 3 months post-CRT, which used size-related and morphological criteria. Positive and negative predictive values (PPV and NPV, respectively) were compared between the ∆ADC and anatomical imaging. RESULTS The ∆ADC of lesions with later tumor recurrence was significantly lower than lesions with complete remission for both primary lesions (-2.3% ± 0.3% vs. 80% ± 41%; p < 0.0001) and adenopathies (19.9% ± 32% vs. 63% ± 36%; p = 0.003). The ∆ADC showed a PPV of 89% and an NPV of 100% for primary lesions and a PPV of 70% and an NPV of 96% for adenopathies per neck side. DWI improved PPV and NPV compared to anatomical imaging. CONCLUSION DWI with the ∆ADC 3 weeks after concluding CRT for HNSCC allows for early assessment of treatment response.
Collapse
|
29
|
Gourin CG, Forastiere AA, Sanguineti G, Marur S, Koch WM, Bristow RE. Volume-based trends in surgical care of patients with oropharyngeal cancer. Laryngoscope 2011; 121:738-45. [DOI: 10.1002/lary.21457] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 10/26/2010] [Indexed: 02/06/2023]
|
30
|
King KG, Kositwattanarerk A, Genden E, Kao J, Som PM, Kostakoglu L. Cancers of the Oral Cavity and Oropharynx: FDG PET with Contrast-enhanced CT in the Posttreatment Setting. Radiographics 2011; 31:355-73. [DOI: 10.1148/rg.312095765] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
31
|
Takes RP, Strojan P, Silver CE, Bradley PJ, Haigentz M, Wolf GT, Shaha AR, Hartl DM, Olofsson J, Langendijk JA, Rinaldo A, Ferlito A. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck 2010; 34:270-81. [PMID: 22228621 DOI: 10.1002/hed.21613] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 01/18/2023] Open
Abstract
Squamous cell carcinoma of the hypopharynx represents a distinct clinical entity. Most patients present with significant comorbidities and advanced-stage disease. The overall survival is relatively poor because of high rates of regional and distant metastasis at presentation or early in the course of the disease. A multidisciplinary approach is crucial in the overall management of these patients to achieve the best results and maintain or improve functional results. Traditionally, operable hypopharyngeal cancer has been treated by total (occasionally partial) laryngectomy and partial or circumferential pharyngectomy, followed by reconstruction and postoperative radiotherapy in most cases. Efforts to preserve speech and swallowing function in the surgical treatment of hypopharyngeal (and laryngeal) cancer have resulted in a declining use of total laryngopharyngectomy and improved reconstructive efforts, including microvascular free tissue transfer. There are many surgical, as well as nonsurgical, options available for organ and function preservation, which report equally effective tumor control and survival. The selection of appropriate treatment is of crucial importance in the achievement of optimal results for these patients. In this article, several aspects of surgical and nonsurgical approaches in the treatment of hypopharyngeal cancer are discussed. Future studies must be carefully designed within clearly defined populations and use uniform terminology and standardized functional assessment and declare appropriate patient or disease endpoints. These studies should focus on improvement of results, without increasing patient morbidity. In this respect, technical improvements in radiotherapy such as intensity-modulated radiotherapy, advances in supportive care, and incorporation of newer systemic agents such as targeted therapy, are relevant developments.
Collapse
Affiliation(s)
- Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Andrews G, Lango M, Cohen R, Feigenberg S, Burtness B, Mehra R, Ahmed S, Nicolaou N, Gaughan J, Ridge JA. Nonsurgical management of oropharyngeal, laryngeal, and hypopharyngeal cancer: The Fox Chase Cancer Center experience. Head Neck 2010; 33:1433-40. [DOI: 10.1002/hed.21615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 08/03/2010] [Accepted: 08/12/2010] [Indexed: 11/11/2022] Open
|
33
|
Udoff RA, Elam JC, Gourin CG. Primary surgery for oropharyngeal cancer. Otolaryngol Head Neck Surg 2010; 143:644-9. [DOI: 10.1016/j.otohns.2010.06.922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/05/2010] [Accepted: 06/30/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The development of new techniques for transoral resection has led to a renewed interest in primary surgical treatment of oropharyngeal squamous cell cancer (SCCA). We reviewed our experience with primary surgery for oropharyngeal SCCA to identify factors associated with survival. STUDY DESIGN Case series with chart review. SETTING Tertiary medical center. SUBJECTS AND METHODS Patients who underwent primary surgical treatment of oropharyngeal SCCA from 1985 to 2002 were analyzed. Patients who failed nonoperative treatment or had distant metastases at presentation were excluded. RESULTS A total of 105 patients met study criteria. The majority of patients (91%) had advanced stage disease (III/IV). All patients received postoperative radiation; chemotherapy was used in eight patients. Five-year disease-free survival was 83 percent for stage I, 67 percent for stage II, 56 percent for stage III, and 43 percent for stage IV disease. Crude local control rates were 94 percent for T1 disease, 90 percent for T2 disease, 81 percent for T3 disease, and 80 percent for T4 disease; crude regional control rates were 100 percent for N0 disease, 90 percent for N1 disease, 84 percent for N2 disease, and 82 percent for N3 disease. Cox proportional hazards models revealed that nodal stage (hazard ratio [HR] 2.3, P = 0.02) and black race (HR 2.6, P = 0.004) were the only significant predictors of disease-free survival. CONCLUSION: Primary surgical treatment of oropharyngeal SCCA is effective in achieving excellent locoregional control and permits deintensification of adjuvant therapy, even in patients with advanced stage disease. Nodal status and race are the primary determinants of disease-free survival. These data provide useful information for counseling and treatment planning.
Collapse
Affiliation(s)
- Ross A. Udoff
- From the Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, GA
| | - Jackson C. Elam
- From the Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, GA
| | - Christine G. Gourin
- and the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| |
Collapse
|
34
|
Vandecaveye V, De Keyzer F, Dirix P, Lambrecht M, Nuyts S, Hermans R. Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology 2010; 52:773-84. [PMID: 20631998 DOI: 10.1007/s00234-010-0743-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 06/28/2010] [Indexed: 11/24/2022]
Abstract
In the head and neck, squamous cell carcinoma is one of the most common tumour types. Currently, the primary imaging modalities for initial locoregional staging are computed tomography and-to a lesser extent-magnetic resonance imaging, whilst [(18)F]fluorodeoxyglucose (FDG) positron emission tomography has additional value in the detection of subcentimetric metastatic lymph nodes and of tumour recurrence after chemoradiotherapy (CRT). However, dependency on the morphological and size-related criteria of anatomical imaging and the limited spatial resolution and FDG avidity of inflammation in metabolic imaging may reduce diagnostic accuracy in the head and neck. Diffusion-weighted magnetic resonance imaging (DWI) is a noninvasive imaging technique that measures the differences in water mobility in different tissue microstructures. Water mobility is likely influenced by cell size, density, and cellular membrane integrity and is quantified by means of the apparent diffusion coefficient. As such, the technique is able to differentiate tumoural tissue from normal tissue, inflammatory tissue and necrosis. In this article, we examine the use of DWI in head and neck cancer, focussing on technique optimization and image interpretation. Afterwards, the value of DWI will be outlined for clinical questions regarding nodal staging, lesion characterization, differentiation of post-CRT tumour recurrence from necrosis and inflammation, and predictive imaging towards treatment outcome. The possible consequences of adding DWI towards therapeutic management are outlined.
Collapse
Affiliation(s)
- Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
35
|
Piazza C, Cocco D, De Benedetto L, Bon FD, Nicolai P, Peretti G. Role of narrow-band imaging and high-definition television in the surveillance of head and neck squamous cell cancer after chemo- and/or radiotherapy. Eur Arch Otorhinolaryngol 2010; 267:1423-8. [PMID: 20352239 DOI: 10.1007/s00405-010-1236-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 03/10/2010] [Indexed: 01/07/2023]
Abstract
Narrow-band imaging (NBI) is an endoscopic technique enhancing mucosal vasculature and better identifying superficial carcinomas due to their neo-angiogenic pattern. NBI accuracy is increased by combination with a high-definition television (HDTV) camera. The aim of this report was to evaluate the diagnostic improvement of NBI +/- HDTV in the evaluation of head and neck squamous cell cancer (HNSCC) previously treated by chemo-radiotherapy (CHT-RT) or RT. A total of 390 patients affected by HNSCC were prospectively evaluated by NBI and white light (WL) endoscopy +/- HDTV between April 2007 and April 2009 at a single academic institution. Among them, we focused on 59 (15%) patients who received CHT-RT or RT as part of their treatment. Of 59 patients, 13 (22%) showed adjunctive preoperative NBI findings when compared to the standard WL examination. These findings were always confirmed by intraoperative HDTV NBI, while only eight (62%) were visible with HDTV WL. Of 13 lesions, 12 received histopathologic confirmation (from carcinoma in situ to invasive carcinoma). The sensitivity of flexible NBI, HDTV WL, and HDTV NBI was 100, 66 and 100%, respectively. The specificity was 98, 100, and 98%. The positive predictive value was 92, 100, and 92%. The negative predictive value was 100, 94, and 100%. The accuracy was 98, 91, and 98%. NBI +/- HDTV after CHT-RT or RT was of value in detecting tumor persistence (n = 2), early recurrences (n = 6), and metachronous tumors (n = 4). By contrast, only 1 of 59 (2%) patients was found to be false positive.
Collapse
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy.
| | | | | | | | | | | |
Collapse
|
36
|
Rich JT, Milov S, Lewis JS, Thorstad WL, Adkins DR, Haughey BH. Transoral laser microsurgery (TLM) +/- adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors. Laryngoscope 2010; 119:1709-19. [PMID: 19572271 DOI: 10.1002/lary.20552] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Document survival, prognostic variables, and functional outcomes of patients with AJCC stage III or IV oropharyngeal cancer, treated with transoral laser microsurgery (TLM) +/- adjuvant therapy. STUDY DESIGN Analysis of prospectively assembled data pertaining to the above-described patient cohort. METHODS Patients treated with TLM for AJCC stage III or IV oropharyngeal cancer at Washington University School of Medicine from 1996 to 2006 were followed for a minimum of 2 years. Recurrence, survival, functional, and human papilloma virus data were analyzed. RESULTS Eighty-four patients met inclusion criteria. Mean follow-up was 52.6 months. Overall AJCC stages were: III 15% and IV 85%. T stages were T1-2, 74%; T3-4, 26%. Eighty-three patients underwent neck dissection, 50 received adjuvant radiotherapy, and 28 received adjuvant chemoradiotherapy. Overall survival at 2 and 5 years was 94% and 88%, respectively. Disease-specific survival at 2 and 5 years was 96% and 92%, respectively. Six patients recurred (7%): locally (one), regionally (four), and distant (five). T stage, positive margins, and p16 status significantly impacted survival. The addition of adjuvant chemotherapy in high-risk patients did not significantly impact survival. Five patients (6%) had major surgical complications, but without mortality. Eighty-one percent of patients had acceptable swallowing function at last follow-up. Immediately postoperatively, 17% required G-tubes, which dropped to 3.4% of living patients at 3 years. CONCLUSIONS In this population, our findings validate TLM +/- adjuvant therapy as a highly effective strategy for survival, locoregional control, and swallowing recovery in AJCC stage III and IV oropharyngeal cancer. Our finding also show that p16 positivity improves survival.
Collapse
Affiliation(s)
- Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | | | | | |
Collapse
|
37
|
Kostrzewa JP, Lancaster WP, Iseli TA, Desmond RA, Carroll WR, Rosenthal EL. Outcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope 2010; 120:267-72. [PMID: 20013840 DOI: 10.1002/lary.20743] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate outcomes of salvage surgery with free flap reconstruction for recurrent squamous cell carcinoma of the oropharynx and oral cavity with increased use of chemoradiotherapy. STUDY DESIGN Retrospective patient review. METHODS All patients undergoing salvage surgery with free flap reconstruction for oropharynx (n = 36) and oral cavity (n = 36) squamous cell carcinomas between January 2001 and January 2008 were obtained. Mean follow-up was 14 months. Previous chemoradiotherapy was used in 40% and radiotherapy alone in 60%. RESULTS Complications were more frequent in oropharynx than oral cavity tumors (36% and 14%, respectively; P = .05) requiring more secondary procedures (15 for oropharynx vs. six for oral cavity). Few patients returned to a normal diet (8%), and a majority retained an enterogastric feeding tube (56%). Median survival overall following salvage surgery was 44.8 months for oral cavity and 53.8 months for oropharynx head and neck squamous cell carcinoma. Overall estimated 1-, 2-, and 5-year observed survivals were 98%, 77.2%, and 43.7%, respectively. Twelve patients had a disease-free interval of <6 months, 92% of whom died of disease. Of 17 patients with disease at the primary site and involved regional lymph nodes, 94% died of disease. CONCLUSIONS Salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal tumors after chemoradiotherapy has acceptable morbidity and similar cure rates as salvage following radiotherapy without chemotherapy. Concurrent nodal recurrence and short disease-free interval are associated with reduced cure rates. A significant proportion will require enterogastric feeding and few will tolerate a normal diet.
Collapse
Affiliation(s)
- John P Kostrzewa
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA
| | | | | | | | | | | |
Collapse
|
38
|
Gourin CG, Johnson JT. A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck. Laryngoscope 2009; 119:2124-34. [DOI: 10.1002/lary.20619] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
39
|
Gupta T, Chopra S, Agarwal JP, Laskar SG, D’cruz AK, Shrivastava SK, Dinshaw KA. Squamous cell carcinoma of the hypopharynx: single-institution outcome analysis of a large cohort of patients treated with primary non-surgical approaches. Acta Oncol 2009; 48:541-48. [PMID: 18979267 DOI: 10.1080/02841860802488839] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hypopharyngeal cancers have extensive submucosal spread, high risk of nodal involvement and relatively high propensity of distant metastases. Contemporary paradigms for hypopharyngeal cancers aim to maximize loco-regional control while attempting to preserve laryngo-pharyngeal form and function. AIMS To retrospectively review outcome of large cohort of patients with hypopharyngeal cancers treated with curative intent radiotherapy with or without systemic chemotherapy in an academic tertiary referral centre. MATERIAL AND METHODS Medical records of patients with hypopharyngeal cancers treated with primary non-surgical approaches over a 15-year period were reviewed retrospectively. Loco-regional control (LRC) and disease-free survival (DFS) were considered as outcome measures. RESULTS Electronic search of database identified 501 patients with hypopharyngeal cancers treated with definitive radiotherapy. The median age was 55 years (range 20-87 years) and median radiotherapy dose 70 Gy (range 5.4-72 Gy). With a mean follow-up period of 22 months (median 12 months), the 3-year LRC and DFS was 47.1% and 40.9% respectively. Stage (T-stage, N-stage, overall stage grouping), and age influenced outcome significantly. The 3-year LRC for T1-T2 disease was 49.7% versus 43.1% for T3- T4 stage (p0.056). The 3-year DFS was 49.4% and 36.9% respectively (p0.014). The 3-year LRC and DFS for N0; N1; and N2-3 disease was 57.3% & 54.3%; 40.5% & 35.3%; and 33% & 27% respectively with highly significant p-values. CONCLUSION This is an outcome analysis of the largest cohort of patients with hypopharyngeal cancers managed with primary non-surgical approaches. Stage and age remain the most important determinants of outcome.
Collapse
|
40
|
Inohara H, Enomoto K, Tomiyama Y, Higuchi I, Inoue T, Hatazawa J. Impact of FDG-PET on Prediction of Clinical Outcome after Concurrent Chemoradiotherapy in Hypopharyngeal Carcinoma. Mol Imaging Biol 2009; 12:89-97. [DOI: 10.1007/s11307-009-0229-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 01/16/2009] [Indexed: 10/20/2022]
|
41
|
|
42
|
Abstract
PURPOSE OF REVIEW Primary treatment of many head and neck cancers is shifting to nonsurgical modalities with concomitant chemoradiation becoming increasing prevalent. With this change, surgery is moving to a role as a salvage treatment modality. As a result of this shift, it is important to understand the issues surrounding surgical salvage after chemoradiation. RECENT FINDINGS Studies have consistently found that salvage surgery after chemoradiation carries a high complication rate, higher than either primary surgery or salvage surgery after radiation alone. There are very few reports on the success rate of salvage surgery after failed primary concurrent chemoradiation, but what little data we have seems to suggest success rates approximate success rates for salvage after radiation therapy. There are also reasons to believe that efficacy of salvage surgery varies by stage and site of disease. Also, fundamental differences in the nature of cancer after failed primary therapy have been elucidated by recent studies. SUMMARY While salvage surgery is fraught with higher morbidity and lower efficacy than primary surgery, it remains the only potentially curative option available to patients who have failed 'organ preservation' primary therapy. We review issues to consider when managing these challenging patients.
Collapse
|
43
|
Bisdas S, Baghi M, Smolarz A, Pihno NC, Lehnert T, Knecht R, Mack MG, Vogl TJ, Tuerkay S, Koh TS. Quantitative measurements of perfusion and permeability of oropharyngeal and oral cavity cancer, recurrent disease, and associated lymph nodes using first-pass contrast-enhanced computed tomography studies. Invest Radiol 2007; 42:172-9. [PMID: 17287647 DOI: 10.1097/01.rli.0000252496.74242.0b] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We sought to evaluate the routine clinical use of perfusion computed tomography in the detection and differentiation of primary and recurrent oropharynx and oral cavity tumors as well as of nodal disease. MATERIALS AND METHODS A total of 77 patients with primary cancer as well as suspected recurrent disease and lymph nodes were evaluated. A dynamic acquisition (4 x 6-mm slices) of the largest axial tumor surface was performed and the tumor blood flow (BF), blood volume (BV), and mean transit time (MTT) were calculated by using a modified deconvolution-based analysis taking into account the extravasation of the contrast agent for permeability surface area product imaging (PS). Tumor volume was calculated and region of interest analysis was performed on the pathologic and normal tissue. RESULTS The mean BF, BV, and PS values in the primary tumors (77.48 mL/min/100 g tissue; 5.29 mL/min; 13.33 mL/min/100 g tissue, respectively) were highly significantly different (P < 0.01) than those obtained in the normal structures. Mean MTT values (9.01 seconds) also were significantly lowered in the tumors compared with normal tissue (P < 0.05). There was no statistical difference in the perfusion values between the primary and the recurrent tumors. Recurrent disease could be differentiated on the basis of BF (P < 0.05) from tissue changes after chemo-radiation-treatment (mean BF: 69.71 versus 45.31 mL/min/100 g tissue, respectively). Differentiation of the lymph nodes was not possible by means of perfusion values. Tumor volume did not significantly correlate with any perfusion parameter. CONCLUSIONS Perfusion CT of oropharyngeal and oral cavity cancer in clinical routine is feasible and helps outlining the malignant tissue as well as differentiating recurrent disease from nonspecific post-therapeutic changes.
Collapse
Affiliation(s)
- Sotirios Bisdas
- Department of Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Outcome of multimodal treatment for oropharyngeal carcinoma: A single institution experience. Oral Oncol 2007; 43:402-7. [DOI: 10.1016/j.oraloncology.2006.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 04/19/2006] [Accepted: 04/21/2006] [Indexed: 11/17/2022]
|
45
|
Vandecaveye V, De Keyzer F, Nuyts S, Deraedt K, Dirix P, Hamaekers P, Vander Poorten V, Delaere P, Hermans R. Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo)radiotherapy: Correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 2007; 67:960-71. [PMID: 17141979 DOI: 10.1016/j.ijrobp.2006.09.020] [Citation(s) in RCA: 196] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 08/29/2006] [Accepted: 09/01/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the value of diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating persistent or recurrent head and neck squamous cell carcinoma (HNSCC) from nontumoral postradiotherapeutic alterations. METHODS AND MATERIALS In 26 patients with suspicion of persistent or recurrent HNSCC, MRI of the head and neck was performed, including routine turbo spin-echo (TSE) sequences and an additional echo-planar DW-MRI sequence, using a large range of b-values (0-1000 s/mm(2)). Apparent diffusion coefficient (ADC) maps were calculated. In the suspect areas at the primary site and in the suspect lymph nodes, signal intensity was measured on the native b0 and b1000 images and ADC values were calculated for these tissues. The same was done for surrounding irradiated normal tissue. Imaging results were correlated to histopathology. RESULTS Signal intensity on native b0 images was significantly lower for HNSCC than for nontumoral postradiotherapeutic tissue (p < 0.0001), resulting in a sensitivity of 66.2%, specificity of 60.8%, and accuracy of 62.4%. Signal intensity on native b1000 images was significantly higher for HNSCC than for nontumoral tissue (p < 0.0001), resulting in a sensitivity of 71.6%, specificity of 71.3%, and accuracy of 71.4%. ADC values were significantly lower for HNSCC than for nontumoral tissue (p < 0.0001), resulting in a sensitivity of 94.6%, specificity of 95.9%, and accuracy of 95.5%. When compared with computed tomography, TSE-MRI and fluorodeoxyglucose-positron emission tomography, DW-MRI yielded fewer false-positive results in persistent primary site abnormalities and in persistent adenopathies, and aided in the detection of subcentimetric nodal metastases. CONCLUSIONS Diffusion weighted-MRI accurately differentiates persistent or recurrent HNSCC from nontumoral tissue changes after (chemo)radiotherapy.
Collapse
|