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

Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors

Background

This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.

Methods

320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60median and AUC60p95) were determined in the tumor volume.

Results

Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60p95 (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.In multivariable analysis, a Cox proportional hazard model showed that a AUC60p95 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, P<.001). Tumor volume was prognostic for DC (HR=3.42, P<.001) and OS (HR=3.27, P<.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.

Conclusion

Low pretreatment AUC60p95 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.

A review of diffusion-weighted magnetic resonance imaging in head and neck cancer patients for treatment evaluation and prediction of radiation-induced xerostomia

The incidence of head and neck cancers (HNC) is rising worldwide especially with HPV-related oropharynx squamous cell carcinoma. The standard of care for the majority of patients with locally advanced pharyngeal disease is curative-intent radiotherapy (RT) with or without concurrent chemotherapy. RT-related toxicities remain a concern due to the close proximity of critical structures to the tumour, with xerostomia inflicting the most quality-of-life burden. Thus, there is a paradigm shift towards research exploring the use of imaging biomarkers in predicting treatment outcomes. Diffusion-weighted imaging (DWI) is a functional MRI feature of interest, as it quantifies cellular changes through computation of apparent diffusion coefficient (ADC) values. DWI has been used in differentiating HNC lesions from benign tissues, and ADC analyses can be done to evaluate tumour responses to RT. It is also useful in healthy tissues to identify the heterogeneity and physiological changes of salivary glands to better understand the inter-individual differences in xerostomia severity. Additionally, DWI is utilised in irradiated salivary glands to produce ADC changes that correlate to clinical xerostomia. The implementation of DWI into multi-modal imaging can help form prognostic models that identify patients at risk of severe xerostomia, and thus guide timely interventions to mitigate these toxicities.

Prognostic functional MR imaging parameters in head and neck squamous cell carcinoma: A systematic review

OBJECTIVE

Functional MR imaging has demonstrated potential for predicting treatment response. This systematic review gives an extensive overview of the current level of evidence for pre-treatment MR-based perfusion and diffusion imaging parameters that are prognostic for treatment outcome in head and neck squamous cell carcinoma (HNSCC) (PROSPERO registrationCRD42020210689).

MATERIALS AND METHODS

According to the PRISMA statements, Medline, Embase and Scopus were queried for articles with a maximum date of October 19th, 2020. Studies investigating the predictive performance of pre-treatment MR-based perfusion and/or diffusion imaging parameters in HNSCC treatment response were included. All prognosticators were extracted from the primary tumor. Risk of bias was assessed using the QUIPS tool. Results were summarized in tables and forest plots.

RESULTS

31 unique studies met the inclusion criteria; among them, 11 articles described perfusion (n = 529 patients) and 28 described diffusion (n = 1626 patients) MR-imaging, eight studies were included in both categories. Higher K^trans and K_ep were associated with better treatment response for OS and DFS, respectively. Study findings for V_p and V_e were inconsistent or not significant. High-level controversy was observed between studies examining the MR diffusion parameters mean and median ADC.

CONCLUSION

For HNSCC patients, the accurate and consistent results of pre-treatment MR-based perfusion parameters K^trans and K_ep are potential for clinical applicability predictive of OS and DFS and treatment decision guidance. Significant heterogeneity in study designs might affect high discrepancy in study results for parameters extracted from diffusion imaging. Furthermore, recommendations for future research were summarized.

MRI Dynamic Contrast Imaging of Oral Cavity and Oropharyngeal Tumors

ABSTRACT

In the past decade, dynamic contrast-enhanced magnetic resonance imaging has had an increasing role in assessing the microvascular characteristics of various tumors, including head and neck cancer. Dynamic contrast-enhanced magnetic resonance imaging allows noninvasive assessment of permeability and blood flow, both important parametric features of tumor hypoxia, which is in turn a marker for treatment resistance for head and neck cancer.In this article we will provide a comprehensive review technique in evaluating tumor proliferation and application of its parameters in differentiating between various tumor types of the oral cavity and how its parameters can correlate between epidermal growth factor receptor and human papillomavirus which can have an implication in patient's overall survival rates.We will also review how the parameters of this method can predict local tumor control after treatment and compare its efficacy with other imaging modalities. Lastly, we will review how its parameters can be used prospectively to identify early complications from treatment.

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

BACKGROUND

Induction chemotherapy (IC) significantly improves the rate of larynx preservation; however, some patients could not benefit from it. Hence, it is of clinical importance to predict the response to IC to determine the necessity of IC. We aimed to develop a clinical nomogram for predicting the treatment response to IC in locally advanced hypopharyngeal carcinoma.

METHODS

We retrospectively include a total of 127 patients with locally advanced hypopharyngeal carcinoma who underwent MRI scans prior to IC between January 2014 and December 2017. The clinical characteristics were collected, which included age, sex, tumor location, invading sites, histological grades, T-stage, N-stage, overall stage, size of the largest lymph node, neutrophil-to-lymphocyte ratio, hemoglobin concentration, and platelet count. Univariate and multivariate logistic regression was used to select the significant predictors of IC response. A nomogram was built based on the results of stepwise logistic regression analysis. The predictive performance and clinical usefulness of the nomogram were determined based on the area under the curve (AUC), calibration curve, and decision curve.

RESULTS

Age, T-stage, hemoglobin, and platelet were four independent predictors of IC treatment response, which were incorporated into the nomogram. The AUC of the nomogram was 0.860 (95% confidence interval [CI]: 0.780-0.940), which was validated using 3-fold cross-validation (AUC, 0.864; 95% CI: 0.755-0.973). The calibration curve demonstrated good consistency between the prediction by the nomogram and actual observation. Decision curve analysis shows that the nomogram was clinically useful.

CONCLUSION

The proposed nomogram resulted in an accurate prediction of the efficacy of IC for patients with locally advanced hypopharyngeal carcinoma.

Associations between histogram analysis parameters derived from dynamic-contrast enhanced MRI and PD L1-expression in head and neck squamous cell carcinomas. A preliminary study

PURPOSE

Programmed death 1 ligand (PD-L 1) plays an essential role in oncology. It might be crucial to predict its expression non-invasively by imaging. Dynamic-contrast enhanced MRI (DCE MRI) is one of the important imaging modalities in head and neck squamous cell cancer (HNSCC). The aim of the present study was to analyze possible associations between histogram analysis parameters of DCE MRI and PD-L 1 expression in HNSCC METHODS: Overall, 26 patients with primary HNSCC of different localizations were involved in the study. DCE MRI was obtained on a 3 T MRI and analyzed with a whole lesion measurement using a histogram approach. PD-L 1 expression was estimated on bioptic samples before any form of treatment using 3 scores (Tumor positive score (TPS), Immune cell score (ICS) and Combined positive score (CPS)).

RESULTS

CPS correlated with mode derived from Ktrans (r = 0.40, p = .04). Also CPS correlated with P90 derived from Kep (r = 0.40, p = .04). ICS correlated with the maximum derived from Kep (r = 0.41, p = .03) and entropy derived from Kep (r = 0.43, p = .02). There were no associations between DCE MRI parameters and TPS.

CONCLUSION

Ktrans and Kep related histogram analysis parameters derived from DCE MRI correlated moderately with PD-L 1 expression of immune cells in HNSCC.

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

Aims: To investigate the predictive capacity of early post-treatment diffusion-weighted magnetic resonance imaging (MRI) for recurrence or tumor progression in patients with no tumor residue after chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma, and, to assess the predictive capacity of pre-treatment diffusion-weighted MRI for persistent tumor residue post-CRT. Materials and Method: A single center cohort study was performed in one French hospital. All patients with squamous cell carcinoma receiving CRT (no surgical indication) were included. Two diffusion-weighted MRI were performed: one within 8 days before CRT and one 3 months after completing CRT with determination of median tumor apparent diffusion coefficient (ADC). Main outcome: The primary endpoint was progression-free survival. Results: 59 patients were included prior to CRT and 46 (78.0%) completed CRT. A post-CRT tumor residue was found in 19/46 (41.3%) patients. In univariate analysis, initial ADC was significantly lower in patients with residue post CRT (0.56 ± 0.11 versus 0.79 ± 0.13; p < 0.001). When initial ADC was dichotomized at the median, initial ADC lower than 0.7 was significantly more frequent in patients with residue post CRT (73.7% versus 11.1%, p < 0.0001). In multivariate analysis, only initial ADC lower than 0.7 was significantly associated with tumor residue (OR = 22.6; IC [4.9–103.6], p < 0.0001). Among 26 patients without tumor residue after CRT and followed up until 12 months, 6 (23.1%) presented recurrence or progression. Only univariate analysis was performed due to a small number of events. The only factor significantly associated with disease progression or early recurrence was the delta ADC (p = 0.0009). When ADC variation was dichotomized at the median, patients with ADC variation greater than 0.7 had time of disease-free survival significantly longer than patients with ADC variation lower than 0.7 (377.5 [286–402] days versus 253 [198–370], p < 0.0001). Conclusion and relevance: Diffusion-weighted MRI could be a technique that enables differentiation of patients with high potential for early recurrence for whom intensive post-CRT monitoring is mandatory. Prospective studies with more inclusions would be necessary to validate our results.

Super-enhancers: A new frontier for glioma treatment

Glioma is the most common primary malignant tumor in the human brain. Although there are a variety of treatments, such as surgery, radiation and chemotherapy, glioma is still an incurable disease. Super-enhancers (SEs) are implicated in the control of tumor cell identity, and they promote oncogenic transcription, which supports tumor cells. Inhibition of the SE complex, which is required for the assembly and maintenance of SEs, may repress oncogenic transcription and impede tumor growth. In this review, we discuss the unique characteristics of SEs compared to typical enhancers, and we summarize the recent advances in the understanding of their properties and biological role in gene regulation. Additionally, we highlight that SE-driven lncRNAs, miRNAs and genes are involved in the malignant phenotype of glioma. Most importantly, the application of SE inhibitors in different cancer subtypes has introduced new directions in glioma treatment.