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Mohamed ASR, Abusaif A, He R, Wahid KA, Salama V, Youssef S, McDonald BA, Naser M, Ding Y, Salzillo TC, AboBakr MA, Wang J, Lai SY, Fuller CD. Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study. Radiother Oncol 2023; 183:109641. [PMID: 36990394 PMCID: PMC10848569 DOI: 10.1016/j.radonc.2023.109641] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT). METHODS HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify ADC threshold associated with relapse. Cox proportional hazards models were done for clinical vs. clinical and imaging parameters and internal validation was done using bootstrapping technique. RESULTS Eighty-one patients were included. Median follow-up was 31 months. For patients with post-RT CR, there was a significant increase in mean ADC at mid-RT compared to baseline ((1.8 ± 0.29) × 10-3 mm2/s vs. (1.37 ± 0.22) × 10-3 mm2/s, p < 0.0001), while patients with non-CR had no significant increase (p > 0.05). RPA identified GTV-P delta (Δ)ADCmean < 7% at mid-RT as the most significant parameter associated with worse LC and RFS (p = 0.01). Uni- and multi-variable analysis showed that GTV-P ΔADCmean at mid-RT ≥ 7% was significantly associated with better LC and RFS. The addition of ΔADCmean significantly improved the c-indices of LC and RFS models compared with standard clinical variables (0.85 vs. 0.77 and 0.74 vs. 0.68 for LC and RFS, respectively, p < 0.0001 for both). CONCLUSION ΔADCmean at mid-RT is a strong predictor of oncologic outcomes in HNC. Patients with no significant increase of primary tumor ADC at mid-RT are at high risk of disease relapse.
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Affiliation(s)
- Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Abdelrahman Abusaif
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Vivian Salama
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Sara Youssef
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Travis C Salzillo
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Moamen A AboBakr
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
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Cai L, Li X, Wu L, Wang B, Si M, Tao X. A Prognostic Model Generated from an Apparent Diffusion Coefficient Ratio Reliably Predicts the Outcomes of Oral Tongue Squamous Cell Carcinoma. Curr Oncol 2022; 29:9031-9045. [PMID: 36547122 PMCID: PMC9777250 DOI: 10.3390/curroncol29120708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
This study aimed to develop an apparent diffusion coefficient (ADC) ratio-based prognostic model to predict the recurrence and disease-free survival (DFS) of oral tongue squamous cell carcinoma (OTSCC). A total of 188 patients with cT1-2 oral tongue squamous cell carcinoma were enrolled retrospectively. Clinical and laboratory data were extracted from medical records. The ADC values were measured at the regions of interest of the tumor and non-tumor tissues of the MRI images, and the ADC ratio was used for comparison between the patient with recurrence (n = 83 case, 44%) and patients without recurrence (n = 105 cases, 56%). Cox proportional hazards models were generated to analyze the risk factors of cancer recurrence. A nomogram was developed based on significant risk factors to predict 1-, 5- and 10-year DFS. The receiver operator characteristic (ROC) curves of predictors in the multivariable Cox proportional hazards prognostic model were generated to predict the recurrence and DFS. The integrated areas under the ROC curve were calculated to evaluate discrimination of the models. The ADC ratio, tumor thickness and lymph node ratio were reliable predictors in the final prognostic model. The final model had a 71.1% sensitivity and an 81.0% specificity. ADC ratio was the strongest predictor of cancer recurrence in prognostic performance. Discrimination and calibration statistics were satisfactory with C-index above 0.7 for both model development and internal validation. The calibration curve showed that the 5- and 10-year DFS predicted by the nomogram agreed with actual observations.
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Affiliation(s)
- Lingling Cai
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Xiaoguang Li
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Disease, Shanghai 201999, China
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lizhong Wu
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Bocheng Wang
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
| | - Mingjue Si
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
- Correspondence: (M.S.); (X.T.)
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
- Correspondence: (M.S.); (X.T.)
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Prognostic Value of 18F-Fluorodeoxyglucose–Positron Emission Tomography/Magnetic Resonance Imaging in Patients With Hypopharyngeal Squamous Cell Carcinoma. J Comput Assist Tomogr 2022; 46:968-977. [DOI: 10.1097/rct.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Connor S, Anjari M, Burd C, Guha A, Lei M, Guerrero-Urbano T, Pai I, Bassett P, Goh V. The impact of human papilloma virus status on the prediction of head and neck cancer chemoradiotherapy outcomes using the pre-treatment apparent diffusion coefficient. Br J Radiol 2021; 95:20210333. [PMID: 34111977 PMCID: PMC8822554 DOI: 10.1259/bjr.20210333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To determine the impact of Human Papilloma Virus (HPV) oropharyngeal cancer (OPC) status on the prediction of head and neck squamous cell cancer (HNSCC) chemoradiotherapy (CRT) outcomes with pre-treatment quantitative diffusion-weighted magnetic resonance imaging (DW-MRI). Methods: Following ethical approval, 65 participants (53 male, age 59.9 ± 7.86) underwent pre-treatment DW-MRI in this prospective cohort observational study. There were 46 HPV OPC and 19 other HNSCC cases with Stage III/IV HNSCC. Regions of interest (ROIs) (volume, largest area, core) at the primary tumour (n = 57) and largest pathological node (n = 59) were placed to analyse ADCmean and ADCmin. Unpaired t-test or Mann–Whitney test evaluated the impact of HPV OPC status and clinical parameters on their prediction of post-CRT 2 year locoregional and disease-free survival (LRFS and DFS). Multivariate logistic regression compared significant variables with 2 year outcomes. Results: On univariate analysis of all participants, the primary tumour area ADCmean was predictive of 2 year LRFS (p = 0.04). However, only the HPV OPC diagnosis (LFRS p = 0.03; DFS p = 0.02) predicted outcomes on multivariate analysis. None of the pre-treatment ADC values were predictive of 2 year DFS in the HPV OPC subgroup (p = 0.21–0.68). Amongst participants without 2 year disease-free survival, HPV-OPC was found to have much lower primary tumour ADCmean values than other HNSCC. Conclusion: Knowledge of HPV OPC status is required in order to determine the impact of the pre-treatment ADC values on post-CRT outcomes in HNSCC. Advances in knowledge: Pre-treatment ADCmean and ADCmin values acquired using different ROI methods are not predictive of 2 year survival outcomes in HPV OPC.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, United Kingdom.,Department of Neuroradiology, King's College Hospital, London, SE5 9RS, United Kingdom.,Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Mustafa Anjari
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Christian Burd
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Amrita Guha
- Department of Radio-diagnosis, Tata Memorial Hospital, Parel, Homi Bhabha National Institute, Mumbai, India
| | - Mary Lei
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT UK5, United Kingdom
| | - Teresa Guerrero-Urbano
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT UK5, United Kingdom
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, United Kingdom.,Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Paul Bassett
- Freelance medical statistician, London, United Kingdom
| | - Vicky Goh
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, United Kingdom.,Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, United Kingdom
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Prognostic Value of Apparent Diffusion Coefficient in Oropharyngeal Carcinoma. Clin Neuroradiol 2021; 31:1037-1048. [PMID: 33877396 PMCID: PMC8648632 DOI: 10.1007/s00062-021-01014-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
Purpose To investigate clinical and radiological factors predicting worse outcome after (chemo)radiotherapy ([C]RT) in oropharyngeal squamous cell carcinoma (OPSCC) with a focus on apparent diffusion coefficient (ADC). Methods This retrospective study included 67 OPSCC patients, treated with (C)RT with curative intent and diagnosed during 2013–2017. Human papilloma virus (HPV) association was detected with p16 immunohistochemistry. Of all 67 tumors, 55 were p16 positive, 9 were p16 negative, and in 3 the p16 status was unknown. Median follow-up time was 38 months. We analyzed pretreatment magnetic resonance imaging (MRI) for factors predicting disease-free survival (DFS) and locoregional recurrence (LRR), including primary tumor volume and the largest metastasis. Crude and p16-adjusted hazard ratios were analyzed using Cox proportional hazards model. Interobserver agreement was evaluated. Results Disease recurred in 13 (19.4%) patients. High ADC predicted poor DFS, but not when the analysis was adjusted for p16. A break in RT (hazard ratio, HR = 3.972, 95% confidence interval, CI 1.445–10.917, p = 0.007) and larger metastasis volume (HR = 1.041, 95% CI 1.007–1.077, p = 0.019) were associated with worse DFS. A primary tumor larger than 7 cm3 was associated with increased LRR rate (HR = 4.861, 1.042–22.667, p = 0.044). Among p16-positive tumors, mean ADC was lower in grade 3 tumors compared to lower grade tumors (0.736 vs. 0.883; p = 0.003). Conclusion Low tumor ADC seems to be related to p16 positivity and therefore should not be used independently to evaluate disease prognosis or to choose patients for treatment deintensification.
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Ravanelli M, Grammatica A, Maddalo M, Ramanzin M, Agazzi GM, Tononcelli E, Battocchio S, Bossi P, Vezzoli M, Maroldi R, Farina D. Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation. AJNR Am J Neuroradiol 2020; 41:1473-1479. [PMID: 32732272 DOI: 10.3174/ajnr.a6695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased in the period from the 1970s to 2004, due to increase of infection with human papilloma virus (HPV). This study aimed to examine the role of histogram analysis of the ADC in treatment response and survival prediction of patients with oropharyngeal squamous cell carcinoma and known human papillomavirus status. MATERIALS AND METHODS This was a retrospective single-center study. Following inclusion and exclusion criteria, data for 59 patients affected by T2-T4 (according to the 8th edition of the AJCC Cancer Staging Manual) oropharyngeal squamous cell carcinoma were retrieved. Twenty-eight had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 had human papillomavirus-negative oropharyngeal squamous cell carcinoma. All patients underwent a pretreatment MR imaging. Histogram analysis of ADC maps obtained by DWI (b = 0-1000 mm/s2) was performed on the central section of all of tumors. The minimum follow-up period was 2 years. Histogram ADC parameters were associated with progression-free survival and overall survival. Univariable and multivariable Cox models were applied to the data; P values were corrected using the Benjamini-Hochberg method. RESULTS At univariable analysis, both human papillomavirus status and mean ADC were associated with progression-free survival (hazard ratio = 0.267, P < .05, and hazard ratio = 1.0028, P ≤ .05, respectively), while only human papillomavirus status was associated with overall survival (hazard ratio = 0.213, P ≤ .05) before correction. At multivariable analysis, no parameter was included (in fact, human papillomavirus status lost significance after correction). If we separated the patients into 2 subgroups according to human papillomavirus status, ADC entropy was associated with overall survival in the human papillomavirus-negative group (hazard ratio = 4.846, P = .01). CONCLUSIONS ADC and human papillomavirus status are related to progression-free survival in patients treated with chemoradiation for advanced oropharyngeal squamous cell carcinoma; however, this association seems to result from the strong association between ADC and human papillomavirus status.
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Affiliation(s)
- M Ravanelli
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | | | | | - M Ramanzin
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - G M Agazzi
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - E Tononcelli
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | | | | | - M Vezzoli
- Molecular and Translational Medicine (M.V.), University of Brescia, Brescia, Italy
| | - R Maroldi
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - D Farina
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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Qamar S, King AD, Ai QYH, So TY, Mo FKF, Chen W, Poon DMC, Tong M, Ma BB, Hui EP, Yeung DKW, Wang YX, Yuan J. Pre-treatment intravoxel incoherent motion diffusion-weighted imaging predicts treatment outcome in nasopharyngeal carcinoma. Eur J Radiol 2020; 129:109127. [PMID: 32563165 DOI: 10.1016/j.ejrad.2020.109127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate whether pre-treatment intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can predict treatment outcome after 2 years in patients with nasopharyngeal carcinoma (NPC). METHOD One hundred and sixty-one patients with newly diagnosed NPC underwent pre-treatment IVIM-DWI. Univariate Cox regression analysis was performed to evaluate the correlation of the mean values of the pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction and apparent diffusion coefficient with local relapse-free survival (LRFS), regional relapse-free survival (RRFS), distant metastases-free survival (DMFS) and disease-free survival (DFS). Significant diffusion parameters, together with staging, age, gender and treatment as confounding factors, were added into a multivariate model. The area under the curves (AUCs) of significant parameters for disease relapse were compared using the Delong test. RESULTS Disease relapse occurred in 30 % of the patients at a median follow-up time of 52.1 months. The multivariate analysis showed that high D and T-staging were correlated with poor LRFS (p = 0.042 and 0.020, respectively) and poor DFS (p = 0.023 and 0.001, respectively); low D* and high T-staging with poor RRFS (p = 0.020 and 0.033, respectively); and high N-staging with poor DMFS (p = 0.006). D with the optimal threshold of ≥0.68 × 10-3 mm2/s and T-staging showed similar AUCs (AUC = 0.614 and 0.651, respectively; p = 0.493) for predicting disease relapse. CONCLUSION High D and low D* were predictors of poor locoregional outcome but none of the diffusion parameters predicted DMFS in NPC.
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Affiliation(s)
- Sahrish Qamar
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
| | - Qi-Yong H Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Tiffany Y So
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Frankie Kwok Fai Mo
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Weitian Chen
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Darren M C Poon
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Macy Tong
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Brigette B Ma
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Edwin P Hui
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - David Ka-Wai Yeung
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Yi-Xiang Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, China
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Peltenburg B, Driessen JP, Vasmel JE, Pameijer FA, Janssen LM, Terhaard CHJ, de Bree R, Philippens MEP. Pretreatment ADC is not a prognostic factor for local recurrences in head and neck squamous cell carcinoma when clinical T-stage is known. Eur Radiol 2019; 30:1228-1231. [PMID: 31529258 PMCID: PMC6957548 DOI: 10.1007/s00330-019-06426-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022]
Abstract
Objectives Pretreatment identification of radio-insensitive head and neck squamous cell carcinomas (HNSCC) would affect treatment modality selection. The apparent diffusion coefficient (ADC) of a tumor could be a predictor of local recurrence. However, little is known about its prognostic value next to known factors such as clinical T-stage. The aim of the present study is to determine the added value of pretreatment ADC to clinical T-stage as a prognostic factor for local recurrence. Methods This retrospective cohort study included 217 patients with HNSCC treated with (chemo)radiotherapy between April 2009 and December 2015. All patients underwent diffusion-weighted MRI prior to treatment. Median ADC values of all tumors were obtained using a semi-automatic delineation method. Univariate models containing ADC and T-stage were compared with a multivariable model containing both variables. Results Fifty-eight patients experienced a local recurrence within 3 years. On average, the ADC value in the group of patients with a recurrence was 1.01 versus 1.00 (10−3 mm2/s) in the group without a recurrence. Univariate analysis showed no significant association between tumor ADC and local recurrence within 3 years after (chemo)radiotherapy (p = 0.09). Cox regression showed that clinical T-stage was an independent predictor of local recurrence and adding ADC to the model did not increase its performance. Conclusion Pretreatment ADC has no added value as a prognostic factor for local recurrence to clinical T-stage. Key Points • Pretreatment identification of head and neck squamous cell carcinoma patients who do not benefit from (chemo)radiotherapy could improve personalized cancer care. • The apparent diffusion coefficient (ADC) obtained from diffusion-weighted MRI has been reported to be a prognostic factor for local recurrence. • In this study, ADC has no added value as a prognostic factor compared with clinical T-stage. Electronic supplementary material The online version of this article (10.1007/s00330-019-06426-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Boris Peltenburg
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Juliette P Driessen
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanine E Vasmel
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frank A Pameijer
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Payabvash S. Quantitative diffusion magnetic resonance imaging in head and neck tumors. Quant Imaging Med Surg 2018; 8:1052-1065. [PMID: 30598882 DOI: 10.21037/qims.2018.10.14] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with head and neck cancer, conventional anatomical magnetic resonance imaging (MRI) scans are commonly used for identification of primary lesion, assessment of structural distortion, and presence of metastatic lymph nodes. However, quantitative analysis of diffusion MRI can provide added value to structural and anatomical evaluation of head and neck tumors (HNT), by differentiation of primary malignant process, prognostic prediction, and treatment monitoring. In this article, we will review the applications of quantitative diffusion MRI in identification of primary malignant tissue, differentiation of tumor pathology, prediction of molecular phenotype, monitoring of treatment response, and evaluation of posttreatment changes in patient with HNT.
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Affiliation(s)
- Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
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Ravanelli M, Grammatica A, Tononcelli E, Morello R, Leali M, Battocchio S, Agazzi GM, Buglione di Monale E Bastia M, Maroldi R, Nicolai P, Farina D. Correlation between Human Papillomavirus Status and Quantitative MR Imaging Parameters including Diffusion-Weighted Imaging and Texture Features in Oropharyngeal Carcinoma. AJNR Am J Neuroradiol 2018; 39:1878-1883. [PMID: 30213805 DOI: 10.3174/ajnr.a5792] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of Oropharyngeal Squampus Cell Carcinoma (OPSCC) cases is increasing especially in the Western countries due to the spreading of human papilloma virus (HPV) infection. Radiological investigations, MRI in particular, are used in the daily clinical practice to stage OPSCC. The aim of this study was to investigate the association of quantitative MR imaging features including diffusion-weighted imaging and human papillomavirus status in oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS We retrospectively analyzed 59 patients with untreated histologically proved T2-T4 oropharyngeal squamous cell carcinoma. Human papillomavirus status was determined by viral DNA detection on tissue samples. MR imaging protocol included T2-weighted, contrast-enhanced T1-weighted (volumetric interpolated brain examination), and DWI sequences. Parametric maps of apparent diffusion coefficient were obtained from DWI sequences. Texture analysis was performed on T2 and volumetric-interpolated brain examination sequences and on ADC maps. Differences in quantitative MR imaging features between tumors positive and negative for human papillomavirus and among subgroups of patients stratified by smoking status were tested using the nonparametric Mann-Whitney U test; the false discovery rate was controlled using the Benjamini-Hochberg correction; and a predictive model for human papillomavirus status was built using multivariable logistic regression. RESULTS Twenty-eight patients had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 patients had human papillomavirus-negative oropharyngeal squamous cell carcinoma. Tumors positive for human papillomavirus had a significantly lower mean ADC compared with those negative for it (median, 850.87 versus median, 1033.68; P < .001). Texture features had a lower discriminatory power for human papillomavirus status. Skewness on volumetric interpolated brain examination sequences was significantly higher in the subgroup of patients positive for human papillomavirus and smokers (P = .003). A predictive model based on smoking status and mean ADC yielded a sensitivity of 83.3% and specificity 92.6% in classifying human papillomavirus status. CONCLUSIONS ADC is significantly lower in oropharyngeal squamous cell carcinoma positive for human papillomavirus compared with oropharyngeal squamous cell carcinoma negative for it. ADC and smoking status allowed noninvasive prediction of human papillomavirus status with a good accuracy. These results should be validated and further investigated on larger prospective studies.
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Affiliation(s)
- M Ravanelli
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - A Grammatica
- Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - E Tononcelli
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - R Morello
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.).,Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - M Leali
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | | | - G M Agazzi
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | | | - R Maroldi
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - P Nicolai
- Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - D Farina
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
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11
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Wang C, Liu L, Lai S, Su D, Liu Y, Jin G, Zhu X, Luo N. Diagnostic value of diffusion-weighted magnetic resonance imaging for local and skull base recurrence of nasopharyngeal carcinoma after radiotherapy. Medicine (Baltimore) 2018; 97:e11929. [PMID: 30142809 PMCID: PMC6112862 DOI: 10.1097/md.0000000000011929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Tumor recurrence is a major cause of nasopharyngeal carcinoma (NPC) treatment failure. Diffusion-weighted imaging (DWI) is used for a variety of cancers, but few data are available for NPC.The aim of the study was to investigate the DWI features of recurrent NPC after radiotherapy and apparent diffusion coefficient (ADC) thresholds for the diagnosis of recurrent NPC.This was a retrospective study of 160 patients with NPC treated by radiotherapy at the Cancer Hospital affiliated to Guangxi Medical University from May 2012 to March 2015. The patients were divided into the local recurrence (n = 39), fibrosis (n = 51), clivus recurrence (n = 22), and clivus nonrecurrence (n = 48) groups. The patients underwent magnetic resonance imaging (MRI), enhanced MRI, and DWI. Receiver operating characteristics curves were used to determine sensitivity, specificity, and negative predictive values.ADC values were significantly different between the recurrence and fibrosis groups (P < .0001). Using ADC threshold values of 0.887 × 10 mm/s for local recurrence, the area under the curve (AUC) of DWI was 0.967 (87.2% sensitivity and 94.1% specificity), compared with 0.732 for routine MRI (71.8% sensitivity and 74.5% specificity) (P < .001). Using ADC threshold values of 1.018 × 10 mm/s for the diagnosis of clivus recurrent NPC, the AUC of DWI was 0.984 (95.5% sensitivity and 91.7% specificity) compared with 0.558 for routine MRI (63.6% sensitivity and 47.9% specificity) (P < .001).DWI has a higher diagnostic value for recurrent NPC than MRI. DWI can increase the diagnosis sensitivity and specificity of locally recurrent NPC.
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12
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Teng F, Aryal M, Lee J, Lee C, Shen X, Hawkins PG, Mierzwa M, Eisbruch A, Cao Y. Adaptive Boost Target Definition in High-Risk Head and Neck Cancer Based on Multi-imaging Risk Biomarkers. Int J Radiat Oncol Biol Phys 2017; 102:969-977. [PMID: 29428251 DOI: 10.1016/j.ijrobp.2017.12.269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Positron emission tomography with 18F-deoxyglucose (FDG), dynamic contrast-enhanced magnetic resonance imaging (MRI), and diffusion-weighted MRI each identify unique risk factors for treatment outcomes in head and neck cancer (HNC). Clinical trials in HNC largely rely on a single imaging modality to define targets for boosting. This study aimed to investigate the spatial correspondence of FDG uptake, perfusion, and the apparent diffusion coefficient (ADC) in HNC and their response to chemoradiation therapy (CRT) and to determine the implications of this overlap or lack thereof for adaptive boosting. METHODS AND MATERIALS Forty patients with HNC enrolled in a clinical trial underwent FDG positron emission tomography-computed tomography before CRT and underwent dynamic contrast-enhanced and diffusion-weighted MRI scans before and during CRT. The gross tumor volume (GTV) of the primary tumor was contoured on post-gadolinium T1-weighted images. Tumor subvolumes with high FDG uptake, low blood volume (BV), and low ADC were created by using previously established thresholds. Spatial correspondences between subvolumes were analyzed using the Dice coefficient, and those between each pair of image parameters at voxel level were analyzed by Spearman rank correlation coefficients. RESULTS Prior to CRT, the median subvolumes of high FDG, low BV, and low ADC relative to the primary GTV were 20%, 21%, and 45%, respectively. Spearman correlation coefficients between BV and ADC varied from -0.47 to 0.22; between BV and FDG, from -0.08 to 0.59; and between ADC and FDG, from -0.68 to 0.25. Dice coefficients between subvolumes of FDG and BV, FDG and ADC, and BV and ADC were 10%, 46%, and 15%, respectively. The union of the 3 parameters was 64% of the GTV. The union of the subvolumes of BV and ADC was 56% of the GTV before CRT but was reduced significantly by 57% after 10 fractions of radiation therapy. CONCLUSIONS High FDG uptake, low BV, and low ADC as imaging risk biomarkers of HNC identify largely distinct tumor characteristics. A single imaging modality may not define the boosting target adequately.
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Affiliation(s)
- Feifei Teng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Madhava Aryal
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jae Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Xioajin Shen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Peter G Hawkins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Ann Arbor VA Hospital, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.
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13
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Yeh CH, Lin G, Wang JJ, Lin CY, Tsai SY, Lin YC, Wu YM, Ko SF, Wang HM, Chan SC, Yen TC, Liao CT, Ng SH. Predictive value of 1H MR spectroscopy and 18F-FDG PET/CT for local control of advanced oropharyngeal and hypopharyngeal squamous cell carcinoma receiving chemoradiotherapy: a prospective study. Oncotarget 2017; 8:115513-115525. [PMID: 29383178 PMCID: PMC5777790 DOI: 10.18632/oncotarget.23306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 12/05/2017] [Indexed: 01/30/2023] Open
Abstract
Purpose To determine whether pretreatment in vivo 1H magnetic resonance (MR) spectroscopy at 3 Tesla (T) and 18F-FDG PET/CT can offer predictive power regarding the local control of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients. Materials and Methods 1H MR spectroscopy was performed in addition to conventional MR imaging before definitive chemoradiotherapy in 58 patients with advanced OHSCC. The relationship of local control with the 1H MR spectroscopy and 18F-FDG PET/CT parameters was analyzed. Results With a median follow-up of 17.6 months, 13 (22.4%) patients exhibited local failure; whereas the remaining 45 achieved local control. Kaplan-Meier analysis identified age > 60 years, creatine level on MRS ≦ 6.02 mM, glutamine and glutamate (Glx) level on MRS > 3.31 mM, and total lesion glycolysis (TLG) on 18F-FDG PET/CT > 217.18 g/mL × mL as significant adverse predictors for 2-year local control. Multivariate Cox regression analysis showed that age (p=0.017), Glx level on MRS (p=0.021), and TLG on 18F-FDG PET/CT (p=0.028) retained their independent prognostic significance. A scoring system was constructed based on the sum of these three factors. We found that patients with scores of 2-3 had significantly poorer local control rates than patients with scores of 0-1 (33.3% versus 86.8%, p=0.003). Conclusion We conclude that Glx on 1H MR spectroscopy at 3 T was the independent prognostic factor for local control of OHSCC patients treated with chemoradiotherapy, and its combination with age and TLG may help identify a subgroup of patients at high risk for developing local failure.
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Affiliation(s)
- Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Clinical Phenome Center and Imaging Core Lab, Institute for Radiological Research, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yueh Tsai
- Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Chieh Chan
- Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
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14
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Becker M. CT Texture Analysis: Defining and Integrating New Biomarkers for Advanced Oncologic Imaging in Precision Medicine: A Comment on "CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy". AJNR Am J Neuroradiol 2017; 38:2341-2343. [PMID: 29025725 DOI: 10.3174/ajnr.a5451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Becker
- Division of Radiology Department of Imaging and Medical Informatics Geneva University Hospital Geneva, Switzerland
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15
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Kuno H, Qureshi MM, Chapman MN, Li B, Andreu-Arasa VC, Onoue K, Truong MT, Sakai O. CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy. AJNR Am J Neuroradiol 2017; 38:2334-2340. [PMID: 29025727 DOI: 10.3174/ajnr.a5407] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The accurate prediction of prognosis and failure is crucial for optimizing treatment strategies for patients with cancer. The purpose of this study was to assess the performance of pretreatment CT texture analysis for the prediction of treatment failure in primary head and neck squamous cell carcinoma treated with chemoradiotherapy. MATERIALS AND METHODS This retrospective study included 62 patients diagnosed with primary head and neck squamous cell carcinoma who underwent contrast-enhanced CT examinations for staging, followed by chemoradiotherapy. CT texture features of the whole primary tumor were measured using an in-house developed Matlab-based texture analysis program. Histogram, gray-level co-occurrence matrix, gray-level run-length, gray-level gradient matrix, and Laws features were used for texture feature extraction. Receiver operating characteristic analysis was used to identify the optimal threshold of any significant texture parameter. We used multivariate Cox proportional hazards models to examine the association between the CT texture parameter and local failure, adjusting for age, sex, smoking, primary tumor stage, primary tumor volume, and human papillomavirus status. RESULTS Twenty-two patients (35.5%) developed local failure, and the remaining 40 (64.5%) showed local control. Multivariate analysis revealed that 3 histogram features (geometric mean [hazard ratio = 4.68, P = .026], harmonic mean [hazard ratio = 8.61, P = .004], and fourth moment [hazard ratio = 4.56, P = .048]) and 4 gray-level run-length features (short-run emphasis [hazard ratio = 3.75, P = .044], gray-level nonuniformity [hazard ratio = 5.72, P = .004], run-length nonuniformity [hazard ratio = 4.15, P = .043], and short-run low gray-level emphasis [hazard ratio = 5.94, P = .035]) were significant predictors of outcome after adjusting for clinical variables. CONCLUSIONS Independent primary tumor CT texture analysis parameters are associated with local failure in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy.
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Affiliation(s)
- H Kuno
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Department of Diagnostic Radiology (H.K.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - M M Qureshi
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - M N Chapman
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - B Li
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - V C Andreu-Arasa
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - K Onoue
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - M T Truong
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - O Sakai
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.) .,Radiation Oncology (M.M.Q., M.T.T., O.S.).,Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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16
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State of the art MRI in head and neck cancer. Clin Radiol 2017; 73:45-59. [PMID: 28655406 DOI: 10.1016/j.crad.2017.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
Head and neck cancer affects more than 11,000 new patients per year in the UK1 and imaging has an important role in the diagnosis, treatment planning, and assessment, and post-treatment surveillance of these patients. The anatomical detail produced by magnetic resonance imaging (MRI) is ideally suited to staging and follow-up of primary tumours and cervical nodal metastases in the head and neck; however, anatomical images have limitations in cancer imaging and so increasingly functional-based MRI techniques, which provide molecular, metabolic, and physiological information, are being incorporated into MRI protocols. This article reviews the state of the art of these functional MRI techniques with emphasis on those that are most relevant to the current management of patients with head and neck cancer.
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17
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Wong KH, Panek R, Bhide SA, Nutting CM, Harrington KJ, Newbold KL. The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective. Br J Radiol 2017; 90:20160768. [PMID: 28256151 DOI: 10.1259/bjr.20160768] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Head and neck cancer (HNC) is a challenging tumour site for radiotherapy delivery owing to its complex anatomy and proximity to organs at risk (OARs) such as the spinal cord and optic apparatus. Despite significant advances in radiotherapy planning techniques, radiation-induced morbidities remain substantial. Further improvement would require high-quality imaging and tailored radiotherapy based on intratreatment response. For these reasons, the use of MRI in radiotherapy planning for HNC is rapidly gaining popularity. MRI provides superior soft-tissue contrast in comparison with CT, allowing better definition of the tumour and OARs. The lack of additional radiation exposure is another attractive feature for intratreatment monitoring. In addition, advanced MRI techniques such as diffusion-weighted, dynamic contrast-enhanced and intrinsic susceptibility-weighted MRI techniques are capable of characterizing tumour biology further by providing quantitative functional parameters such as tissue cellularity, vascular permeability/perfusion and hypoxia. These functional parameters are known to have radiobiological relevance, which potentially could guide treatment adaptation based on their changes prior to or during radiotherapy. In this article, we first present an overview of the applications of anatomical MRI sequences in head and neck radiotherapy, followed by the potentials and limitations of functional MRI sequences in personalizing therapy.
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Affiliation(s)
- Kee H Wong
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Rafal Panek
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Shreerang A Bhide
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Christopher M Nutting
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Kevin J Harrington
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
| | - Katie L Newbold
- 1 Head and neck unit, The Royal Marsden Hospital, London, UK.,2 Radiotherapy and imaging, The Institute of Cancer Research, London, UK
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18
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Chan SC, Cheng NM, Hsieh CH, Ng SH, Lin CY, Yen TC, Hsu CL, Wan HM, Liao CT, Chang KP, Wang JJ. Multiparametric imaging using 18F-FDG PET/CT heterogeneity parameters and functional MRI techniques: prognostic significance in patients with primary advanced oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy. Oncotarget 2017; 8:62606-62621. [PMID: 28977973 PMCID: PMC5617533 DOI: 10.18632/oncotarget.15904] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/20/2017] [Indexed: 01/22/2023] Open
Abstract
Background In this study, PET heterogeneity was combined with functional MRI techniques to refine the prediction of prognosis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC). Methods A total of 124 patients with primary advanced OHSCC who underwent pretreatment 18F-FDG PET/CT, dynamic contrast-enhanced MR imaging (DCE-MRI), and diffusion-weighted MR imaging (DWI) were enrolled. Conventional and heterogeneity parameters from 18F-FDG PET as well as perfusion parameters from DCE-MRI and diffusion parameter from DWI of primary tumors were analyzed in relation to recurrence-free survival (RFS) and overall survival (OS). Results Multivariate analysis identified hypopharyngeal tumors (P = 0.038), alcohol drinking (P = 0.006), Ktrans ≤ 0.5512 (P = 0.017), and Kep ≤ 0.8872 (P = 0.005) as adverse prognostic factors for RFS. Smoking (p = 0.009), Ktrans ≤ 0.5512 (P = 0.0002), Kep ≤ 0.8872 (P = 0.004), and the PET heterogeneity parameter uniformity ≤ 0.00381 (P = 0.028) were independent predictors of poor OS. The combination of PET uniformity with DCE-MRI parameters and smoking allowed distinguishing four prognostic groups, with 3-year OS rates of 100%, 76.6%, 57.4%, and 7.1%, respectively (P < 0.0001). This prognostic system appeared superior to both the TNM staging system (P = 0.186) and the combination of conventional PET parameters with DCE-MRI (P = 0.004). Conclusions Multiparametric imaging based on PET heterogeneity and DCE-MRI parameters combined with clinical risk factors is superior to the concomitant use of functional MRI coupled with conventional PET parameters. This approach may improve the prognostic stratification of OHSCC patients.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Nai-Ming Cheng
- Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsun Hsieh
- Department of Internal Medicine, Division of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- Department of Internal Medicine, Division of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wan
- Department of Internal Medicine, Division of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
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Perni S, Mohamed ASR, Scott J, Enderling H, Garden AS, Gunn GB, Rosenthal DI, Fuller CD. CT-based volumetric tumor growth velocity: A novel imaging prognostic indicator in oropharyngeal cancer patients receiving radiotherapy. Oral Oncol 2016; 63:16-22. [PMID: 27938995 DOI: 10.1016/j.oraloncology.2016.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Volumetric tumor growth velocity (TGV) reflects in vitro tumor aggressiveness, but its prognostic value has not been investigated in vivo. We examined the prognostic impact of TGV on oncologic outcomes in patients with oropharyngeal squamous cell cancer (OSCC). MATERIALS AND METHODS 101 OSCC patients with two pretreatment CTs with time gap of 2 or more weeks treated at a single institution between 2004 and 2008 were identified. Primary tumor and nodal targets were segmented in scans. Linear growth rates were calculated. Recursive partitioning analysis (RPA) identified cut point associated with outcomes. RESULTS Median follow-up was 59months (range 7-118). Median primary TGV was 0.65% increase per day (range 0-9.37%). RPA identified TGV cut point associated with local control (LC) of 1% per day. Patients with higher TGV had decreased 5-year LC (73% vs. 98%, p=0.0004), distant control (DC, 62% vs. 91%, p=0.0007), and overall survival (OS, 38% versus 93%, p<0.0001). In multivariate analysis including demographics, tumor stage, subsite, and treatment factors, TGV⩾1% per day independently predicted worsened LC (p = 0.02), DC (p = 0.003), and OS (p < 0.0001). However, this TGV cutoff was not significantly predictive of LC, DC, or OS for a subset of presumed HPV-positive patients. CONCLUSION OSCC TGV⩾1% per day is a substantive negative prognostic indicator for disease control and overall survival, particularly in HPV non-associated tumors. This novel CT-based volumetric assessment of TGV suggests a simple methodology for risk stratification of patients.
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Affiliation(s)
- Subha Perni
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA; Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, NY, USA.
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Chamblion Street, El Azareeta, Alexandria, Egypt.
| | - Jacob Scott
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA.
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA; Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA.
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
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20
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Diffusion-weighted imaging of nasopharyngeal carcinoma to predict distant metastases. Eur Arch Otorhinolaryngol 2016; 274:1045-1051. [DOI: 10.1007/s00405-016-4333-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
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21
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King AD, Thoeny HC. Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma: potential and limitations. Cancer Imaging 2016; 16:23. [PMID: 27542718 PMCID: PMC4992206 DOI: 10.1186/s40644-016-0080-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/02/2016] [Indexed: 12/27/2022] Open
Abstract
Pre-treatment or early intra-treatment prediction of patients with head and neck squamous cell carcinomas (HNSCC) who are likely to have tumours that are resistant to chemoradiotherapy (CRT) would enable treatment regimens to be changed at an early time point, or allow patients at risk of residual disease to be targeted for more intensive post-treatment investigation. Research into the potential advantages of using functional-based magnetic resonance imaging (MRI) sequences before or during cancer treatments to predict treatment response has been ongoing for several years. In regard to HNSCC, the reported results from functional MRI research are promising but they have yet to be transferred to the clinical domain. This article will review the functional MRI literature in HNSCC to determine the current status of the research and try to identify areas that are close to application in clinical practice. This review will focus on diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE–MRI) and briefly include proton magnetic resonance spectroscopy (1H-MRS)and blood oxygen level dependent (BOLD) MRI.
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Affiliation(s)
- Ann D King
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong S.A.R. China.
| | - Harriet C Thoeny
- Department of Radiology, Neuroradiology and Nuclear Medicine, Inselspital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
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22
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Law BKH, King AD, Bhatia KS, Ahuja AT, Kam MKM, Ma BB, Ai QY, Mo FKF, Yuan J, Yeung DKW. Diffusion-Weighted Imaging of Nasopharyngeal Carcinoma: Can Pretreatment DWI Predict Local Failure Based on Long-Term Outcome? AJNR Am J Neuroradiol 2016; 37:1706-12. [PMID: 27151750 DOI: 10.3174/ajnr.a4792] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Pretreatment prediction of patients with nasopharyngeal carcinoma who will fail conventional treatment would potentially allow these patients to undergo more intensive treatment or closer posttreatment monitoring. The aim of the study was to determine the ability of pretreatment DWI to predict local failure in patients with nasopharyngeal carcinoma based on long-term clinical outcome. MATERIALS AND METHODS One hundred fifty-eight patients with pretreatment DWI underwent analysis of the primary tumor to obtain the ADC mean, ADC skewness, ADC kurtosis, volume, and T-stage. Univariate and multivariate analyses using logistic regression were performed to compare the ADC parameters, volume, T-stage, and patient age in primary tumors with local failure and those with local control, by using a minimum of 5-year follow-up to confirm local control. RESULTS Local control was achieved in 131/158 (83%) patients (range, 60.3-117.7 months) and local failure occurred in 27/158 (17%) patients (range, 5.2-79.8 months). Compared with tumors with local control, those with local failure showed a significantly lower ADC skewness (ADC values with the greatest frequencies were shifted away from the lower ADC range) (P = .006) and lower ADC kurtosis (curve peak broader) (P = .024). The ADC skewness remained significant on multivariate analysis (P = .044). There was a trend toward higher tumor volumes in local failure, but the volume, together with T-stage and ADC mean, were not significantly different between the 2 groups. CONCLUSIONS Pretreatment DWI of primary tumors found that the skewness of the ADC distribution curve was a predictor of local failure in patients with nasopharyngeal carcinoma, based on long-term clinical outcome.
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Affiliation(s)
- B K H Law
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - A D King
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - K S Bhatia
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - A T Ahuja
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - M K M Kam
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - B B Ma
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - Q Y Ai
- From the Departments of Imaging and Interventional Radiology (B.K.H.L., A.D.K., K.S.B., A.T.A., Q.Y.A.)
| | - F K F Mo
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - J Yuan
- Medical Physics and Research Department (J.Y.), Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong S.A.R., China
| | - D K W Yeung
- Clinical Oncology (M.K.M.K., B.B.M., F.K.F.M., D.K.W.Y.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
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23
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Ng SH, Liao CT, Lin CY, Chan SC, Lin YC, Yen TC, Chang JTC, Ko SF, Fan KH, Wang HM, Yang LY, Wang JJ. Dynamic contrast-enhanced MRI, diffusion-weighted MRI and 18F-FDG PET/CT for the prediction of survival in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. Eur Radiol 2016; 26:4162-4172. [PMID: 26911889 DOI: 10.1007/s00330-016-4276-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We prospectively investigated the roles of pretreatment dynamic contrast-enhanced MR imaging (DCE-MRI), diffusion-weighted MR imaging (DWI) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT for predicting survival of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with chemoradiation. METHODS Patients with histologically proven OHSCC and neck nodal metastases scheduled for chemoradiation were eligible. Clinical variables as well as DCE-MRI-, DWI- and 18F-FDG PET/CT-derived parameters of the primary tumours and metastatic neck nodes were analysed in relation to 3-year progression-free survival (PFS) and overall survival (OS) rates. RESULTS Eighty-six patients were available for analysis. Multivariate analysis identified the efflux rate constant (K ep)-tumour < 3.79 min-1 (P = 0.001), relative volume of extracellular extravascular space (V e)-node < 0.23 (P = 0.004) and SUVmax-tumour > 19.44 (P = 0.025) as independent risk factors for both PFS and OS. A scoring system based upon the sum of each of the three imaging parameters allowed stratification of our patients into three groups (patients with 0/1 factor, patients with 2 factors and patients with 3 factors, respectively) with distinct PFS (3-year rates = 72 %, 38 % and 0 %, P < 0.0001) and OS (3-year rates = 81 %, 46 % and 20 %, P < 0.0001). CONCLUSIONS K ep-tumour, V e-node and SUVmax-tumour were independent prognosticators for OHSCC treated with chemoradiation. Their combination helped survival stratification. KEY POINTS • K ep -tumour, V e -node and SUV max -tumour are independent predictors of survival rates. • The combination of these three prognosticators may help stratification of survival. • MRI and FDG-PET/CT play complementary roles in prognostication of head and neck cancer.
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Affiliation(s)
- Shu-Hang Ng
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheng-Chieh Chan
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Yu-Chun Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics and Informatics Unit, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University / Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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24
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Zhang Y, Liu X, Zhang Y, Li WF, Chen L, Mao YP, Shen JX, Zhang F, Peng H, Liu Q, Sun Y, Ma J. Prognostic value of the primary lesion apparent diffusion coefficient (ADC) in nasopharyngeal carcinoma: a retrospective study of 541 cases. Sci Rep 2015; 5:12242. [PMID: 26184509 PMCID: PMC4505330 DOI: 10.1038/srep12242] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/18/2015] [Indexed: 12/15/2022] Open
Abstract
The prognostic value of the primary lesion pretreatment apparent diffusion coefficient (ADC), which is obtained by diffusion-weighted magnetic resonance imaging (MR-DWI), remains unknown in nasopharyngeal carcinoma (NPC). Thus, to investigate whether the pretreatment ADC value as measured from the primary site on MR-DWI is an independent prognostic factor in NPC, we retrospectively reviewed a cohort of 541 patients with histologically-proven stage I-IVB NPC. All patients underwent MRI using a 3-Tesla system (Trio Tim; Siemens, Erlangen Germany). To calculate ADC, the primary lesion was designated on the ADC map at the level of the largest tumor diameter to cover most of the lesion, avoiding cystic or necrotic components. Median and mean (±SD) pretreatment ADC were 0.713 and 0.716 ± 0.079 × 10−3 mm2/s, respectively. Univariate and multivariate analysis confirmed high pretreatment ADC was a good prognostic factor for poor local relapse-free survival and disease-free survival. Furthermore, the area under the ROC curve for prediction of local failure significantly increased when pretreatment ADC was combined with T classification (P = 0.004). Thus, pretreatment ADC might provide useful information for predicting outcome and selecting high-risk patients appropriate for more aggressive therapy. Further studies are warranted to investigate the biological basis of this observation.
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Affiliation(s)
- Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Xu Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Yun Zhang
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Wen-Fei Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Jing-Xian Shen
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Fan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Hao Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Qing Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Canton, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
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25
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Ng SH, Lin CY, Chan SC, Lin YC, Yen TC, Liao CT, Chang JTC, Ko SF, Wang HM, Chang CJ, Wang JJ. Clinical utility of multimodality imaging with dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET/CT for the prediction of neck control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. PLoS One 2014; 9:e115933. [PMID: 25531391 PMCID: PMC4274121 DOI: 10.1371/journal.pone.0115933] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/27/2014] [Indexed: 11/21/2022] Open
Abstract
The clinical usefulness of pretreatment imaging techniques for predicting neck control in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and [18F]fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT derived imaging markers for the prediction of neck control in OHSCC patients treated with chemoradiation. Patients with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and volume of extracellular extravascular space (Ve) on DCE-PWI; apparent diffusion coefficient (ADC) on DWI; maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis on 18F-FDG PET/CT. There were 69 patients (37 with oropharynx SCC and 32 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 31 months, 25 (36.2%) participants had neck failure. Multivariate analysis identified hemoglobin level <14.3 g/dL (P = 0.019), Ve <0.23 (P = 0.040), and ADC >1.14×10−3 mm2/s (P = 0.003) as independent prognostic factors for 3-year neck control. A prognostic scoring system was formulated by summing up the three significant predictors of neck control. Patients with scores of 2–3 had significantly poorer neck control and overall survival rates than patients with scores of 0–1. We conclude that hemoglobin levels, Ve, and ADC are independent pretreatment prognostic factors for neck control in OHSCC treated with chemoradiation. Their combination may identify a subgroup of patients at high risk of developing neck failure.
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Affiliation(s)
- Shu-Hang Ng
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheng-Chieh Chan
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Yu-Chun Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Hung- Ming Wang
- Department of medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- * E-mail:
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26
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Iizuka Y, Matsuo Y, Umeoka S, Nakamoto Y, Ueki N, Mizowaki T, Togashi K, Hiraoka M. Prediction of clinical outcome after stereotactic body radiotherapy for non-small cell lung cancer using diffusion-weighted MRI and (18)F-FDG PET. Eur J Radiol 2014; 83:2087-92. [PMID: 25174774 DOI: 10.1016/j.ejrad.2014.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the use of diffusion-weighted magnetic resonance imaging (DW-MRI) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for predicting disease progression (DP) among patients with non-small cell lung carcinoma (NSCLC) treated with stereotactic body radiotherapy (SBRT). MATERIALS/METHODS Fifteen patients with histologically confirmed stage I NSCLC who underwent pre-treatment DW-MRI and PET and were treated with SBRT were enrolled. The mean apparent diffusion coefficient (ADC) value and maximum standardised uptake value (SUVmax) were measured at the target lesion and evaluated for correlations with DP. RESULTS The median pre-treatment ADC value was 1.04×10(-3) (range 0.83-1.29×10(-3))mm(2)/s, and the median pre-treatment SUVmax was 9.9 (range 1.6-30). There was no correlation between the ADC value and SUVmax. The group with the lower ADC value (≤1.05×10(-3)mm(2)/s) and that with a higher SUVmax (≥7.9) tended to have poor DP, but neither trend was statistically significant (p=0.09 and 0.32, respectively). The combination of the ADC value and SUVmax was a statistically significant predictor of DP (p=0.036). CONCLUSION A low ADC value on pre-treatment DW-MRI and a high SUVmax may be associated with poor DP in NSCLC patients treated with SBRT. Using both values in combination was a better predictor.
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shigeaki Umeoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nami Ueki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Jeong J, Setton JS, Lee NY, Oh JH, Deasy JO. Estimate of the impact of FDG-avidity on the dose required for head and neck radiotherapy local control. Radiother Oncol 2014; 111:340-7. [PMID: 24833560 PMCID: PMC4822492 DOI: 10.1016/j.radonc.2014.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/14/2014] [Accepted: 03/22/2014] [Indexed: 11/29/2022]
Abstract
Background and purpose Although FDG-avid tumors are recognized as a potential target for dose escalation, there is no clear basis for selecting a boost dose to counter this apparent radioresistance. Using a novel analysis method, based on the new concept of an outcome-equivalent dose, we estimate the extra dose required to equalize local control between FDG-avid and non-avid head and neck tumors. Materials and methods Based on a literature review, five reports of head and neck cancer (423 patients in total), along with an internal validation dataset from our institution (135 oropharynx patients), were used in this analysis. To compensate for the heterogeneity among multi-institutional patient cohorts and corresponding treatment techniques, local control data of the cohorts were fit to a single dose–response curve with a clinically representative steepness (γ50 = 2), thereby defining an ‘outcome-equivalent dose’ (OED) for each institutional cohort. Separate dose–response curves were then determined for the FDG-avid and FDG-non-avid patient cohorts, and the ratio of TD50 (tumor dose required for 50% of control) values between the high- and low-FDG-uptake groups (TD50,high/TD50,low) was estimated, resulting in an estimated metabolic dose-modifying factor (mDMF) due to FDG-avidity. Results For individual datasets, the estimated mDMFs were found to be in the range of 1.07–1.62, decreasing if the assumed slope (γ50) increased. Weighted logistic regression for the six datasets resulted in a mDMF of 1.19 [95% CI: 1.04–1.34] for a γ50 value of 2, which translates to a needed dose increase of about 1.5 Gy per unit increase in the maximum standardized uptake value (SUVm) of FDG-PET [95% CI: 0.3–2.7]. Assumptions of lower or higher γ50 values (1.5 or 2.5) resulted in slightly different mDMFs: 1.26 or 1.15, respectively. A validation analysis with seven additional datasets, based on relaxed criteria, was consistent with the estimated mDMF. Conclusions We introduced a novel outcome-equivalent dose analysis method to estimate the dose– response modifying effect of FDG uptake variation. To reach equal response rates, FDG-avid tumors are likely to require 10% to 30% more dose than FDG-non-avid tumors. These estimates provide a rational starting point for selecting IMRT boosts for FDG-avid tumors. However, independent tests and refinements of the estimated dose-modifying effect, using high-quality prospective clinical trial data, are needed.
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Affiliation(s)
- Jeho Jeong
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jeremy S Setton
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA.
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Hatakenaka M, Nakamura K, Yabuuchi H, Shioyama Y, Matsuo Y, Kamitani T, Yonezawa M, Yoshiura T, Nakashima T, Mori M, Honda H. Apparent diffusion coefficient is a prognostic factor of head and neck squamous cell carcinoma treated with radiotherapy. Jpn J Radiol 2014; 32:80-9. [PMID: 24408077 DOI: 10.1007/s11604-013-0272-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/09/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the correlation between apparent diffusion coefficient (ADC) and prognosis in head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy. MATERIALS AND METHODS We retrospectively studied 41 patients (38 male and 3 female, ages 37-85 years) diagnosed with HNSCC (14 oropharynx, 22 hypopharynx, 4 larynx, 1 oral cavity) and treated with radiotherapy, with radiation dose to gross tumor volume over 60 Gy. The association between age, gender, performance status, tumor location, T stage, N stage, stage, dose, overall treatment time, treatment method, adjuvant therapy, or ADC and prognosis was analyzed using a Cox proportional hazard test. RESULTS ADC calculated with b-values of 300, 500, 750, and 1,000 s/mm(2) (ADC 300-1,000) alone showed a significant correlation with all of the analyses (p = 0.022 for local control, p = 0.0109 for regional control, p = 0.0041 for disease-free survival, and p = 0.0014 for overall survival). ADC calculated with b-values of 0, 100, and 200 s/mm(2) (ADC 0-200) showed a significant correlation with overall survival (p = 0.0012). N stage showed a significant correlation with regional control (p = 0.0241). Performance status showed significant association with local control (p = 0.0459), disease-free survival (p = 0.023), and overall survival (p = 0.0151), respectively. CONCLUSION ADC is an independent predictor of prognosis in HNSCC treated with radiotherapy.
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Affiliation(s)
- Masamitsu Hatakenaka
- Department of Diagnostic Radiology, School of Medicine, Sapporo Medical University, Minami 1, Nishi 17, Chuo-ku, Sapporo, 060-8556, Japan,
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29
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Dynamic contrast-enhanced MR imaging predicts local control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy. PLoS One 2013; 8:e72230. [PMID: 23951300 PMCID: PMC3737151 DOI: 10.1371/journal.pone.0072230] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/05/2013] [Indexed: 01/22/2023] Open
Abstract
The role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI) and diffusion-weighted MR imaging (DWI) in predicting the treatment response of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) to chemoradiation remains unclear. We prospectively investigated the ability of pharmacokinetic parameters derived from pretreatment DCE-PWI and DWI to predict the local control of OHSCC patients treated with chemoradiation. Between August, 2010 and March, 2012, patients with untreated OHSCC scheduled for chemoradiation were eligible for this prospective study. DCE-PWI and DWI were performed in addition to conventional MRI. The relationship of local control with the following clinical and imaging variables was analyzed: the hemoglobin level, T-stage, tumor location, gross tumor volume, maximum standardized uptake value, metabolic tumor volume and total lesion glycolysis on FDG PET/CT, transfer constant (Ktrans), volume of blood plasma and volume of extracellular extravascular space on DCE-PWI, and apparent diffusion coefficient on DWI of the primary tumor. The patients were also divided into a local control group and a local failure group, and their clinical and imaging parameters were compared. There were 58 patients (29 with oropharynx squamous cell carcinoma [SCC] and 29 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 18.2 months, 17 (29.3%) participants had local failure, whereas the remaining 41 patients achieved local control. Univariate analysis revealed that only the Ktrans value was significantly associated with local control (P = 0.03). When the local control and local failure groups were compared, significant differences were observed in Ktrans and the tumor location (P = 0.01 and P = 0.04, respectively). In the multivariable analysis, only Ktrans was statistically significant (P = 0.04). Our results suggest that pretreatment Ktrans may help predict the local control in OHSCC patients treated with chemoradiation.
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