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van Houdt PJ, Ragunathan S, Berks M, Ahmed Z, Kershaw LE, Gurney-Champion OJ, Tadimalla S, Arvidsson J, Sun Y, Kallehauge J, Dickie B, Lévy S, Bell L, Sourbron S, Thrippleton MJ. Contrast-agent-based perfusion MRI code repository and testing framework: ISMRM Open Science Initiative for Perfusion Imaging (OSIPI). Magn Reson Med 2024; 91:1774-1786. [PMID: 37667526 DOI: 10.1002/mrm.29826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Software has a substantial impact on quantitative perfusion MRI values. The lack of generally accepted implementations, code sharing and transparent testing reduces reproducibility, hindering the use of perfusion MRI in clinical trials. To address these issues, the ISMRM Open Science Initiative for Perfusion Imaging (OSIPI) aimed to establish a community-led, centralized repository for sharing open-source code for processing contrast-based perfusion imaging, incorporating an open-source testing framework. METHODS A repository was established on the OSIPI GitHub website. Python was chosen as the target software language. Calls for code contributions were made to OSIPI members, the ISMRM Perfusion Study Group, and publicly via OSIPI websites. An automated unit-testing framework was implemented to evaluate the output of code contributions, including visual representation of the results. RESULTS The repository hosts 86 implementations of perfusion processing steps contributed by 12 individuals or teams. These cover all core aspects of DCE- and DSC-MRI processing, including multiple implementations of the same functionality. Tests were developed for 52 implementations, covering five analysis steps. For T1 mapping, signal-to-concentration conversion and population AIF functions, different implementations resulted in near-identical output values. For the five pharmacokinetic models tested (Tofts, extended Tofts-Kety, Patlak, two-compartment exchange, and two-compartment uptake), differences in output parameters were observed between contributions. CONCLUSIONS The OSIPI DCE-DSC code repository represents a novel community-led model for code sharing and testing. The repository facilitates the re-use of existing code and the benchmarking of new code, promoting enhanced reproducibility in quantitative perfusion imaging.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Michael Berks
- Quantitative Biomedical Imaging Laboratory, Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Zaki Ahmed
- Corewell Health William Beaumont University Hospital, Diagnostic Radiology, Royal Oak, USA
| | - Lucy E Kershaw
- Edinburgh Imaging and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Oliver J Gurney-Champion
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Sirisha Tadimalla
- Institute of Medical Physics, The University of Sydney, Sydney, Australia
| | - Jonathan Arvidsson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yu Sun
- Institute of Medical Physics, The University of Sydney, Sydney, Australia
| | - Jesper Kallehauge
- Aarhus University Hospital, Danish Centre for Particle Therapy, Aarhus, Denmark
- Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Ben Dickie
- Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, The University of Manchester, Manchester, UK
| | - Simon Lévy
- MR Research Collaborations, Siemens Healthcare Pty Ltd, Melbourne, Australia
| | - Laura Bell
- Genentech, Inc, Clinical Imaging Group, South San Francisco, USA
| | - Steven Sourbron
- University of Sheffield, Department of Infection, Immunity and Cardiovascular Disease, Sheffield, UK
| | - Michael J Thrippleton
- University of Edinburgh, Edinburgh Imaging and Centre for Clinical Brain Sciences, Edinburgh, UK
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Zhan Y, Wang Y, Wang P, Wang Y, Ni X, Wang J, Tang Z. Pretreatment dual-energy CT for predicting early response to induction chemotherapy and survival in nasopharyngeal carcinoma. Eur Radiol 2023; 33:9052-9062. [PMID: 37405505 DOI: 10.1007/s00330-023-09837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To evaluate the predictive performance of pretreatment dual-energy CT (DECT) for early response to induction chemotherapy and survival in nasopharyngeal carcinoma (NPC). METHODS In this retrospective study, 56 NPC patients who underwent pretreatment DECT scans with posttreatment follow-up were enrolled. The DECT-derived normalised iodine concentration (nIC), effective atomic number (Zeff), 40-180 keV (20 keV interval), and Mix-0.3 value of the tumour lesions were measured to predict the early response to induction chemotherapy and survival in nasopharyngeal carcinoma. The Mann‒Whitney U test, ROC analysis, Kaplan‒Meier method with log-rank test, and Cox proportional hazards model were performed to evaluate the predictive performance of DECT parameters, respectively. RESULTS Among all DECT-derived parameters, ROC analysis showed the predictive performances of nIC and Zeff values for early objective response to induction chemotherapy (AUCs of 0.803 and 0.826), locoregional failure-free survival (AUCs of 0.786 and 0.767), progression-free survival (AUCs of 0.856 and 0.731) and overall survival (AUCs of 0.765 and 0.799) in NPC patients, respectively (all p < 0.05). Moreover, multivariate analysis showed that a high nIC value was an independent predictor of poor survival in NPC. In addition, survival analysis indicated that NPC patients with higher nIC values in primary tumours tend to have lower 5-year locoregional failure-free survival, progression-free survival and overall survival rates than those with lower nIC values. CONCLUSIONS DECT-derived nIC and Zeff values can predict early response to induction chemotherapy and survival in NPC; in particular, a high nIC value is an independent predictive factor of poor survival in NPC. CLINICAL RELEVANCE STATEMENT Preoperative dual-energy computed tomography may provide predictive value for early response and survival outcomes in patients with nasopharyngeal carcinoma, and facilitate their clinical management. KEY POINTS • Pretreatment dual-energy computed tomography helps to predict early response to therapy and survival in NPC. • NIC and Zeff values derived from dual-energy computed tomography can predict early objective response to induction chemotherapy and survival in NPC. • A high nIC value is an independent predictive factor of poor survival in NPC.
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Affiliation(s)
- Yang Zhan
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, China
- Department of Radiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Yuzhe Wang
- Department of Radiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Peng Wang
- Department of Radiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, 214122, China
| | - Yin Wang
- Department of Radiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Xiaochen Ni
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Jie Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Zuohua Tang
- Department of Radiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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van der Hulst HJ, Jansen RW, Vens C, Bos P, Schats W, de Jong MC, Martens RM, Bodalal Z, Beets-Tan RGH, van den Brekel MWM, de Graaf P, Castelijns JA. The Prediction of Biological Features Using Magnetic Resonance Imaging in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:5077. [PMID: 37894447 PMCID: PMC10605807 DOI: 10.3390/cancers15205077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Magnetic resonance imaging (MRI) is an indispensable, routine technique that provides morphological and functional imaging sequences. MRI can potentially capture tumor biology and allow for longitudinal evaluation of head and neck squamous cell carcinoma (HNSCC). This systematic review and meta-analysis evaluates the ability of MRI to predict tumor biology in primary HNSCC. Studies were screened, selected, and assessed for quality using appropriate tools according to the PRISMA criteria. Fifty-eight articles were analyzed, examining the relationship between (functional) MRI parameters and biological features and genetics. Most studies focused on HPV status associations, revealing that HPV-positive tumors consistently exhibited lower ADCmean (SMD: 0.82; p < 0.001) and ADCminimum (SMD: 0.56; p < 0.001) values. On average, lower ADCmean values are associated with high Ki-67 levels, linking this diffusion restriction to high cellularity. Several perfusion parameters of the vascular compartment were significantly associated with HIF-1α. Analysis of other biological factors (VEGF, EGFR, tumor cell count, p53, and MVD) yielded inconclusive results. Larger datasets with homogenous acquisition are required to develop and test radiomic-based prediction models capable of capturing different aspects of the underlying tumor biology. Overall, our study shows that rapid and non-invasive characterization of tumor biology via MRI is feasible and could enhance clinical outcome predictions and personalized patient management for HNSCC.
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Affiliation(s)
- Hedda J. van der Hulst
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, 6211 LK Maastricht, The Netherlands
| | - Robin W. Jansen
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Conchita Vens
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- School of Cancer Science, University of Glasgow, Glasgow G61 1QH, UK
| | - Paula Bos
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Winnie Schats
- Scientific Information Service, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Marcus C. de Jong
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Roland M. Martens
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Zuhir Bodalal
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, 6211 LK Maastricht, The Netherlands
| | - Regina G. H. Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, 6211 LK Maastricht, The Netherlands
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Michiel W. M. van den Brekel
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location University of Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Jonas A. Castelijns
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Meng Y, Sun J, Zhang G, Yu T, Piao H. Imaging glucose metabolism to reveal tumor progression. Front Physiol 2023; 14:1103354. [PMID: 36818450 PMCID: PMC9932271 DOI: 10.3389/fphys.2023.1103354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose: To analyze and review the progress of glucose metabolism-based molecular imaging in detecting tumors to guide clinicians for new management strategies. Summary: When metabolic abnormalities occur, termed the Warburg effect, it simultaneously enables excessive cell proliferation and inhibits cell apoptosis. Molecular imaging technology combines molecular biology and cell probe technology to visualize, characterize, and quantify processes at cellular and subcellular levels in vivo. Modern instruments, including molecular biochemistry, data processing, nanotechnology, and image processing, use molecular probes to perform real-time, non-invasive imaging of molecular and cellular events in living organisms. Conclusion: Molecular imaging is a non-invasive method for live detection, dynamic observation, and quantitative assessment of tumor glucose metabolism. It enables in-depth examination of the connection between the tumor microenvironment and tumor growth, providing a reliable assessment technique for scientific and clinical research. This new technique will facilitate the translation of fundamental research into clinical practice.
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Affiliation(s)
- Yiming Meng
- Central Laboratory, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Jing Sun
- Central Laboratory, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Guirong Zhang
- Central Laboratory, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Tao Yu
- Department of Medical Image, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China,*Correspondence: Tao Yu, ; Haozhe Piao,
| | - Haozhe Piao
- Department of Neurosurgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang, China,*Correspondence: Tao Yu, ; Haozhe Piao,
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Touska P, Connor S. Imaging of human papilloma virus associated oropharyngeal squamous cell carcinoma and its impact on diagnosis, prognostication, and response assessment. Br J Radiol 2022; 95:20220149. [PMID: 35687667 PMCID: PMC9815738 DOI: 10.1259/bjr.20220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 06/07/2022] [Indexed: 01/13/2023] Open
Abstract
The clinical behaviour and outcomes of patients with oropharyngeal cancer (OPC) may be dichotomised according to their association with human papilloma virus (HPV) infection. Patients with HPV-associated disease (HPV+OPC) have a distinct demographic profile, clinical phenotype and demonstrate considerably better responses to chemoradiotherapy. This has led to a reappraisal of staging and treatment strategies for HPV+OPC, which are underpinned by radiological data. Structural modalities, such as CT and MRI can provide accurate staging information. These can be combined with ultrasound-guided tissue sampling and functional techniques (such as diffusion-weighted MRI and 18F-fludeoxyglucose positron emission tomography-CT) to monitor response to treatment, derive prognostic information, and to identify individuals who might benefit from intensification or deintensification strategies. Furthermore, advanced MRI techniques, such as intravoxel incoherent motion and perfusion MRI as well as application of artificial intelligence and radiomic techniques, have shown promise in treatment response monitoring and prognostication. The following review will consider the contemporary role and knowledge on imaging in HPV+OPC.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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6
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Lenoir V, Delattre BMA, M'RaD Y, De Vito C, de Perrot T, Becker M. Diffusion-Weighted Imaging to Assess HPV-Positive versus HPV-Negative Oropharyngeal Squamous Cell Carcinoma: The Importance of b-Values. AJNR Am J Neuroradiol 2022; 43:905-912. [PMID: 35618419 DOI: 10.3174/ajnr.a7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Controversy exists as to whether ADC histograms are capable to distinguish human papillomavirus-positive (HPV+) from human papillomavirus-negative (HPV-) oropharyngeal squamous cell carcinoma. We investigated how the choice of b-values influences the capability of ADC histograms to distinguish between the two tumor types. MATERIALS AND METHODS Thirty-four consecutive patients with histologically proved primary oropharyngeal squamous cell carcinoma (11 HPV+ and 23 HPV-) underwent 3T MR imaging with a single-shot EPI DWI sequence with 6 b-values (0, 50, 100, 500, 750, 1000 s/mm2). Monoexponentially calculated perfusion-sensitive (including b=0 s/mm2) and perfusion-insensitive/true diffusion ADC maps (with b ≥ 100 s/mm2 as the lowest b-value) were generated using Matlab. The choice of b-values included 2 b-values (ADCb0-1000, ADCb100-1000, ADCb500-1000, ADCb750-1000) and 3-6 b-values (ADCb0-750-1000, ADCb0-500-750-1000, ADCb0-50-100-1000, ADCb0-50-100-750-1000, ADCb0-50-100-500-750-1000). Readers blinded to the HPV- status contoured all tumors. ROIs were then copied onto ADC maps, and their histograms were compared. RESULTS ADC histogram metrics in HPV+ and HPV- oropharyngeal squamous cell carcinoma changed significantly depending on the b-values. The mean ADC was lower, and skewness was higher in HPV+ than in HPV- oropharyngeal squamous cell carcinoma only for ADCb0-1000, ADCb0-750-1000, and ADCb0-500-750-1000 (P < .05), allowing distinction between the 2 tumor types. Kurtosis was significantly higher in HPV+ versus HPV- oropharyngeal squamous cell carcinoma for all b-value combinations except 2 perfusion-insensitive maps (ADCb500-1000 and ADCb750-1000). Among all b-value combinations, kurtosis on ADCb0-1000 had the highest diagnostic performance to distinguish HPV+ from HPV- oropharyngeal squamous cell carcinoma (area under the curve = 0.893; sensitivity = 100%, specificity = 82.6%). Acquiring multiple b-values for ADC calculation did not improve the distinction between HPV+ and HPV- oropharyngeal squamous cell carcinoma. CONCLUSIONS The choice of b-values significantly affects ADC histogram metrics in oropharyngeal squamous cell carcinoma. Distinguishing HPV+ from HPV- oropharyngeal squamous cell carcinoma is best possible on the ADCb0-1000 map.
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Affiliation(s)
- V Lenoir
- From the Division of Radiology (V.L., B.M.D., Y.M., T.d.P., M.B.), Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - B M A Delattre
- From the Division of Radiology (V.L., B.M.D., Y.M., T.d.P., M.B.), Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Y M'RaD
- From the Division of Radiology (V.L., B.M.D., Y.M., T.d.P., M.B.), Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - C De Vito
- Division of Clinical Pathology (C.D.V.), Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - T de Perrot
- From the Division of Radiology (V.L., B.M.D., Y.M., T.d.P., M.B.), Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - M Becker
- From the Division of Radiology (V.L., B.M.D., Y.M., T.d.P., M.B.), Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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7
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Curcean S, Cheng L, Picchia S, Tunariu N, Collins D, Blackledge M, Popat S, O'Brien M, Minchom A, Leach MO, Koh DM. Early Response to Chemotherapy in Malignant Pleural Mesothelioma Evaluated Using Diffusion-Weighted Magnetic Resonance Imaging: Initial Observations. JTO Clin Res Rep 2021; 2:100253. [PMID: 34870249 PMCID: PMC8626584 DOI: 10.1016/j.jtocrr.2021.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction We compared the magnetic resonance imaging total tumor volume (TTV) and median apparent diffusion coefficient (ADC) of malignant pleural mesothelioma (MPM) before and at 4 weeks after chemotherapy, to evaluate whether these are potential early markers of treatment response. Methods Diffusion-weighted magnetic resonance imaging was performed in 23 patients with MPM before and after 4 weeks of chemotherapy. The TTV was measured by semiautomatic segmentation (GrowCut) and transferred onto ADC maps to record the median ADC. Test-retest repeatability of TTV and ADC was evaluated in eight patients. TTV and median ADC changes were compared between responders and nonresponders, defined using modified Response Evaluation Criteria In Solid Tumors on computed tomography (CT) at 12 weeks after treatment. TTV and median ADC were also correlated with CT size measurement and disease survival. Results The test-retest 95% limits of agreement for TTV were -13.9% to 16.2% and for median ADC -1.2% to 3.3%. A significant increase in median ADC in responders was observed at 4 weeks after treatment (p = 0.02). Correlation was found between CT tumor size change at 12 weeks and median ADC changes at 4 weeks post-treatment (r = -0.560, p = 0.006). An increase in median ADC greater than 5.1% at 4 weeks has 100% sensitivity and 90% specificity for responders (area under the curve = 0.933, p < 0.001). There was also moderate correlation between median tumor ADC at baseline and overall survival (r = 0.45, p = 0.03). Conclusions Diffusion-weighted magnetic resonance imaging measurements of TTV and median ADC in MPM have good measurement repeatability. Increase in ADC at 4 weeks post-treatment has the potential to be an early response biomarker.
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Affiliation(s)
- Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiation Oncology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania.,Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lin Cheng
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Simona Picchia
- Department of Radiology, Bordet Institute, Bruxelles, Belgium
| | - Nina Tunariu
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Collins
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Matthew Blackledge
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mary O'Brien
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Minchom
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O Leach
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
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8
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Connor S, Sit C, Anjari M, Lei M, Guerrero-Urbano T, Szyszko T, Cook G, Bassett P, Goh V. The ability of post-chemoradiotherapy DWI ADC mean and 18F-FDG SUV max to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status. J Cancer Res Clin Oncol 2021; 147:2323-2336. [PMID: 34159420 PMCID: PMC8236463 DOI: 10.1007/s00432-021-03662-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADCmean) and 18F-FDG PET maximum standardized uptake value (SUVmax) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status. METHODS This prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADCmean (pre-treatment, 6- and 12-weeks post-CRT) and SUVmax (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann-Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS. RESULTS Absolute post-CRT ADCmean values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADCmean at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUVmax did not predict DFS. CONCLUSION Absolute post-CRT ADCmean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADCmean were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes.
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Affiliation(s)
- S Connor
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, UK.
- Department of Neuroradiology, Ruskin Wing, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK.
| | - C Sit
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - M Anjari
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - M Lei
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - T Guerrero-Urbano
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - T Szyszko
- King's College London & Guy's and St. Thomas' PET Centre, London, SE1 7EH, UK
| | - G Cook
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, UK
- King's College London & Guy's and St. Thomas' PET Centre, London, SE1 7EH, UK
| | - P Bassett
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - V Goh
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, UK
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
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9
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Connor S, Sit C, Anjari M, Szyszko T, Dunn J, Pai I, Cook G, Goh V. Correlations between DW-MRI and 18 F-FDG PET/CT parameters in head and neck squamous cell carcinoma following definitive chemo-radiotherapy. Cancer Rep (Hoboken) 2021; 4:e1360. [PMID: 33960739 PMCID: PMC8388179 DOI: 10.1002/cnr2.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxygluocose (18 F-FDG) positron emission tomography (PET) with computed tomography (PET/CT) have potential prognostic value following chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Correlations between these PET/CT (standardized uptake value or SUV) and DW-MRI (apparent diffusion coefficient or ADC) parameters have only been previously explored in the pretreatment setting. AIM To evaluate stage III and IV HNSCC at 12-weeks post-CRT for the correlation between SUVmax and ADC values and their interval changes from pretreatment imaging. METHODS Fifty-six patients (45 male, 11 female, mean age 59.9 + - 7.38) with stage 3 and 4 HNSCC patients underwent 12-week posttreatment DW-MRI and 18 F-FDG PET/CT studies in this prospective study. There were 41/56 patients in the cohort with human papilloma virus-related oropharyngeal cancer (HPV OPC). DW-MRI (ADCmax and ADCmin) and 18 F-FDG PET/CT (SUVmax and SUVmax ratio to liver) parameters were measured at the site of primary tumors (n = 48) and the largest lymph nodes (n = 52). Kendall's tau evaluated the correlation between DW-MRI and 18 F-FDG PET/CT parameters. Mann-Whitney test compared the post-CRT PET/CT and DW-MRI parameters between those participants with and without 2-year disease-free survival (DFS). RESULTS There was no correlation between DW-MRI and 18 F-FDG PET/CT parameters on 12-week posttreatment imaging (P = .455-.794; tau = -0.075-0.25) or their interval changes from pretreatment to 12-week posttreatment imaging (P = .1-.946; tau = -0.194-0.044). The primary tumor ADCmean (P = .03) and the interval change in nodal ADCmin (P = .05) predicted 2-year DFS but none of the 18 F-FDG PET/CT parameters were associated with 2-year DFS. CONCLUSIONS There is no correlation between the quantitative DWI-MRI and 18 F-FDG PET/CT parameters derived from 12-week post-CRT studies. These parameters may be independent biomarkers however in this HPV OPC dominant cohort, only selected ADC parameters demonstrated prognostic significance. Study was prospectively registered at http://www.controlled-trials.com/ISRCTN58327080.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Cherry Sit
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Mustafa Anjari
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Teresa Szyszko
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Joel Dunn
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of OtolaryngologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Gary Cook
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Vicky Goh
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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10
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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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11
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Diagnostic Accuracy of Combined PET/CT with MRI, 18F-FDG PET/MRI, and 18F-FDG PET/CT in Patients with Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6653117. [PMID: 34007251 PMCID: PMC8099512 DOI: 10.1155/2021/6653117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/03/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
Introduction The aim of this paper is to compare the diagnostic accuracy of PET/CT, PET/MRI, and the combination of PET/CT and MRI for detecting synchronous cancer and distant metastasis in patients with oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC). Method A large and growing body of literature has been conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA). The researchers collected all accessible literature existing through Cochrane Library (John Wiley & Sons) electronic databases, Embase (Elsevier), PubMed (U.S. National Library of Medicine), Scopus, and Google Scholar up to June 2020. Analyses were conducted using Stata version 12.0 (StataCorp LP). Results A total of nine studies consisting of 1166 patients were included. The pooled sensitivity of combined PET/CT with MRI, 18F-FDG PET/MRI, and 18F-FDG PET/CT was 0.92, 0.80, and 0.79, respectively, and the corresponding specificities were 0.93, 0.91, and 0.88. The overall prevalence of distant metastases and synchronous cancer in patients with oropharyngeal and hypopharyngeal squamous cell carcinomas was 9.2% and 11.8%, respectively, with the esophagus (4.6%) being the most common site of synchronous cancer. The most common sites of distant metastases were lung (3%), bone (1.2%), and distant lymph nodes (1.2%), respectively. Conclusion Our study showed an approximately similar diagnostic performance for PET/CT, PET/MRI, and the combination of PET/CT and MRI for metastasis assessment in advanced oropharyngeal and hypopharyngeal squamous cell carcinomas.
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12
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Koopman T, Martens R, Gurney‐Champion OJ, Yaqub M, Lavini C, de Graaf P, Castelijns J, Boellaard R, Marcus JT. Repeatability of IVIM biomarkers from diffusion-weighted MRI in head and neck: Bayesian probability versus neural network. Magn Reson Med 2021; 85:3394-3402. [PMID: 33501657 PMCID: PMC7986193 DOI: 10.1002/mrm.28671] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
Purpose The intravoxel incoherent motion (IVIM) model for DWI might provide useful biomarkers for disease management in head and neck cancer. This study compared the repeatability of three IVIM fitting methods to the conventional nonlinear least‐squares regression: Bayesian probability estimation, a recently introduced neural network approach, IVIM‐NET, and a version of the neural network modified to increase consistency, IVIM‐NETmod. Methods Ten healthy volunteers underwent two imaging sessions of the neck, two weeks apart, with two DWI acquisitions per session. Model parameters (ADC, diffusion coefficient Dt, perfusion fraction fp, and pseudo‐diffusion coefficient Dp) from each fit method were determined in the tonsils and in the pterygoid muscles. Within‐subject coefficients of variation (wCV) were calculated to assess repeatability. Training of the neural network was repeated 100 times with random initialization to investigate consistency, quantified by the coefficient of variance. Results The Bayesian and neural network approaches outperformed nonlinear regression in terms of wCV. Intersession wCV of Dt in the tonsils was 23.4% for nonlinear regression, 9.7% for Bayesian estimation, 9.4% for IVIM‐NET, and 11.2% for IVIM‐NETmod. However, results from repeated training of the neural network on the same data set showed differences in parameter estimates: The coefficient of variances over the 100 repetitions for IVIM‐NET were 15% for both Dt and fp, and 94% for Dp; for IVIM‐NETmod, these values improved to 5%, 9%, and 62%, respectively. Conclusion Repeatabilities from the Bayesian and neural network approaches are superior to that of nonlinear regression for estimating IVIM parameters in the head and neck.
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Affiliation(s)
- Thomas Koopman
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Roland Martens
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | | | - Maqsood Yaqub
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Cristina Lavini
- Department of RadiologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Jonas Castelijns
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Radiologythe Netherlands Cancer Institute–Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
- Department of Nuclear Medicine and Molecular ImagingUniversity Medical Center GroningenGroningenthe Netherlands
| | - J. Tim Marcus
- Department of Radiology and Nuclear MedicineAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
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13
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Belgioia L, Morbelli SD, Corvò R. Prediction of Response in Head and Neck Tumor: Focus on Main Hot Topics in Research. Front Oncol 2021; 10:604965. [PMID: 33489911 PMCID: PMC7821385 DOI: 10.3389/fonc.2020.604965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
Radiation therapy is a cornerstone in the treatment of head and neck cancer patients; actually, their management is based on clinical and radiological staging with all patients at the same stage treated in the same way. Recently the increasing knowledge in molecular characterization of head and neck cancer opens the way for a more tailored treatment. Patient outcomes could be improved by a personalized radiotherapy beyond technological and anatomical precision. Several tumor markers are under evaluation to understand their possible prognostic or predictive value. In this paper we discuss those markers specific for evaluate response to radiation therapy in head and neck cancer for a shift toward a biological personalization of radiotherapy.
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Affiliation(s)
- Liliana Belgioia
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Health Science Department (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Daniela Morbelli
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy.,Nuclear Medicine Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Renzo Corvò
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Health Science Department (DISSAL), University of Genoa, Genoa, Italy
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14
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Diffusion-weighted magnetic resonance imaging (DWMRI) of head and neck squamous cell carcinoma: could it be an imaging biomarker for prediction of response to chemoradiation therapy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chemoradiation therapy (CRT) has become a primary definitive treatment modality for head and neck squamous cell carcinoma (HNSCC); however, not all patients respond completely to treatment. Ability to identify those patients, who would not achieve complete response, before or early during the course of CRT will allow treatment modifications to improve outcome and overall survival. The aim of this prospective study was to assess the usefulness of diffusion-weighted imaging (DWI) in prediction of early therapeutic response of HNSCC after CRT.
Results
Local control was achieved in 22 patients out of 46 patients with pathologically proven HNSCC treated by chemoradiation therapy and local failure was detected in 24 patients out of 46 patients. Pretreatment mean apparent diffusion coefficient (ADCpre) was significantly higher in local failure group (1.1 ± 0.2 × 10−3 mm2/s) than local control group (0.89 ± 0.1 × 10−3 mm2/s). An optimal cut-off value of more than 0.94 × 10−3 mm2/s was predictive of local failure with sensitivity 83.33%, specificity 59.9%, PPV 69%, NPV 76.5%. Early intra-treatment percentage change of ADC (ΔADC) was significantly lower in local failure group (21.8% ± 21.3) than in local control group (45.2% ± 27.8). An optimal cut-off value of ≤ 33% was predictive of local failure after CRT with sensitivity of 71.34%, specificity of 60%, PPV of 62.5%, and NPV of 69.2%.
Conclusions
Diffusion-weighted MRI could be a potential predictive biomarker for therapeutic response of HNSCC to CRT. Primary tumors with higher pretreatment mean ADC, and a smaller early intratreatment percentage increase of mean ADC would be more likely to fail treatment.
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15
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Multiparametric functional MRI and 18F-FDG-PET for survival prediction in patients with head and neck squamous cell carcinoma treated with (chemo)radiation. Eur Radiol 2020; 31:616-628. [PMID: 32851444 PMCID: PMC7813703 DOI: 10.1007/s00330-020-07163-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 12/02/2022]
Abstract
Objectives To assess (I) correlations between diffusion-weighted (DWI), intravoxel incoherent motion (IVIM), dynamic contrast-enhanced (DCE) MRI, and 18F-FDG-PET/CT imaging parameters capturing tumor characteristics and (II) their predictive value of locoregional recurrence-free survival (LRFS) and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy. Methods Between 2014 and 2018, patients with histopathologically proven HNSCC, planned for curative (chemo) radiotherapy, were prospectively included. Pretreatment clinical, anatomical, and functional imaging parameters (obtained by DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT) were extracted for primary tumors (PT) and lymph node metastases. Correlations and differences between parameters were assessed. The predictive value of LRFS and OS was assessed, performing univariable, multivariable Cox and CoxBoost regression analyses. Results In total, 70 patients were included. Significant correlations between 18F-FDG-PET parameters and DWI-/DCE volume parameters were found (r > 0.442, p < 0.002). The combination of HPV (HR = 0.903), intoxications (HR = 1.065), PT ADCGTV (HR = 1.252), Ktrans (HR = 1.223), and Ve (HR = 1.215) was predictive for LRFS (C-index = 0.546; p = 0.023). N-stage (HR = 1.058), HPV positivity (HR = 0.886), hypopharyngeal tumor location (HR = 1.111), ADCGTV (HR = 1.102), ADCmean (HR = 1.137), D* (HR = 0.862), Ktrans (HR = 1.106), Ve (HR = 1.195), SUVmax (HR = 1.094), and TLG (HR = 1.433) were predictive for OS (C-index = 0.664; p = 0.046). Conclusions Functional imaging parameters, performing DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT, yielded complementary value in capturing tumor characteristics. More specific, intoxications, HPV-negative status, large tumor volume-related parameters, high permeability (Ktrans), and high extravascular extracellular space (Ve) parameters were predictive for adverse locoregional recurrence-free survival and adverse overall survival. Low cellularity (high ADC) and high metabolism (high SUV) were additionally predictive for decreased overall survival. These different predictive factors added to estimated locoregional and overall survival. Key Points • Parameters of DWI/IVIM, DCE-MRI, and 18F-FDG-PET/CT were able to capture complementary tumor characteristics. • Multivariable analysis revealed that intoxications, HPV negativity, large tumor volume and high vascular permeability (Ktrans), and extravascular extracellular space (Ve) were complementary predictive for locoregional recurrence. • In addition to predictive parameters for locoregional recurrence, also high cellularity (low ADC) and high metabolism (high SUV) were complementary predictive for overall survival. Electronic supplementary material The online version of this article (10.1007/s00330-020-07163-3) contains supplementary material, which is available to authorized users.
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16
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Chong WQ, Lim CM, Sinha AK, Tan CS, Chan GHJ, Huang Y, Kumarakulasinghe NB, Sundar R, Jeyasekharan AD, Loh WS, Tay JK, Yadav K, Wang L, Wong AL, Kong LR, Soo RA, Lau JA, Soon YY, Goh RM, Ho FCH, Chong SM, Lee SC, Loh KS, Tai BC, Lim YC, Goh BC. Integration of Antiangiogenic Therapy with Cisplatin and Gemcitabine Chemotherapy in Patients with Nasopharyngeal Carcinoma. Clin Cancer Res 2020; 26:5320-5328. [PMID: 32816944 DOI: 10.1158/1078-0432.ccr-20-1727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/26/2020] [Accepted: 08/04/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE Induction cisplatin and gemcitabine chemotherapy is a standard treatment for locally advanced nasopharyngeal carcinoma (NPC). Inhibition of VEGF axis has been shown to promote maturation of microvasculature and improve perfusion. We conducted a four-arm study to assess the effect of two doses of either sunitinib or bevacizumab with chemotherapy in NPC. PATIENTS AND METHODS Patients with treatment-naïve locally advanced NPC were treated with three cycles of 3-weekly cisplatin and gemcitabine preceded by 1 week of anti-VEGF therapy for each cycle, followed by standard concurrent chemoradiation: arm A patients received 7 days of 12.5 mg/day sunitinib; arm B 7 days of 25 mg/day sunitinib; arm C bevacizumab 7.5 mg/kg infusion; arm D bevacizumab 2.5 mg/kg infusion. Patients with metastatic NPC were treated with up to six cycles of similar treatment without concurrent chemoradiation. RESULTS Complete metabolic response (mCR) by whole body 18FDG PET was highest in arm C (significant difference in four groups Fisher exact test P = 0.001; type 1 error = 0.05), with 42% mCR (95% confidence interval, 18-67) and 3-year relapse-free survival of 88% in patients with locally advanced NPC. Significant increase in pericyte coverage signifying microvascular maturation and increased immune cell infiltration was observed in posttreatment tumor biopsies in Arm C. Myelosuppression was more profound in sunitinib containing arms, and tolerability was established in arm C where hypertension was the most significant toxicity. CONCLUSIONS Bevacizumab 7.5 mg/kg with cisplatin and gemcitabine was well tolerated. Promising tumor response was observed and supported mechanistically by positive effects on tumor perfusion and immune cell trafficking into the tumor.
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Affiliation(s)
- Wan Qin Chong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Arvind Kumar Sinha
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Chee Seng Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Gloria Hui Jia Chan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | | | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Anand D Jeyasekharan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | - Woei Shyang Loh
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Joshua K Tay
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Kritika Yadav
- Cancer Science Institute of Singapore, NUS, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, NUS, Singapore.,Department of Pharmacology, National University of Singapore, Singapore
| | - Andrea L Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | - Li Ren Kong
- Cancer Science Institute of Singapore, NUS, Singapore
| | - Ross Andrew Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | | | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Robby Miguel Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Francis Cho Hao Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Siew Meng Chong
- Department of Pathology, National University of Singapore, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Bee Choo Tai
- School of Public Health, National University of Singapore, Singapore
| | - Yaw Chyn Lim
- Department of Pathology, National University of Singapore, Singapore.,Department of Physiology, National University of Singapore, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore. .,Cancer Science Institute of Singapore, NUS, Singapore.,Department of Pharmacology, National University of Singapore, Singapore
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17
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Liu Z, Cao Y, Diao W, Cheng Y, Jia Z, Peng X. Radiomics-based prediction of survival in patients with head and neck squamous cell carcinoma based on pre- and post-treatment 18F-PET/CT. Aging (Albany NY) 2020; 12:14593-14619. [PMID: 32674074 PMCID: PMC7425452 DOI: 10.18632/aging.103508] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/04/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-PET/CT) has been widely applied for the imaging of head and neck squamous cell carcinoma (HNSCC). This study examined whether pre- and post-treatment 18F-PET/CT features can help predict the survival of HNSCC patients. RESULTS Three radiomics features were identified as prognostic factors. Radiomics score calculated from these features significantly predicted overall survival (OS) and disease-free disease (DFS). The clinicopathological characteristics combined with pre- or post-treatment nomograms showed better ROC curves and decision curves than the nomogram based only on clinicopathological characteristics. CONCLUSIONS Combining clinicopathological characteristics with radiomics features of pre-treatment PET/CT or post-treatment PET/CT assessment of primary tumor sites as positive or negative may substantially improve prediction of OS and DFS of HNSCC patients. METHODS 171 patients who received pre-treatment 18F-PET/CT scans and 154 patients who received post-treatment 18F-PET/CT scans with HNSCC in the Cancer Imaging Achieve (TCIA) were included. Nomograms that combined clinicopathological features with either pre-treatment PET/CT radiomics features or post-treatment assessment of primary tumor sites were constructed using data from 154 HNSCC patients. Receiver operating characteristic (ROC) curves and decision curves were used to compare the predictions of these models with those of a model incorporating only clinicopathological features.
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Affiliation(s)
- Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Wei Diao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yue Cheng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China
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18
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Wu J, Gensheimer MF, Zhang N, Guo M, Liang R, Zhang C, Fischbein N, Pollom EL, Beadle B, Le QT, Li R. Tumor Subregion Evolution-Based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer. J Nucl Med 2020; 61:327-336. [PMID: 31420498 PMCID: PMC7067523 DOI: 10.2967/jnumed.119.230037] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/29/2019] [Indexed: 12/19/2022] Open
Abstract
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been rapidly increasing. Disease stage and smoking history are often used in current clinical trials to select patients for deintensification therapy, but these features lack sufficient accuracy for predicting disease relapse. Our purpose was to develop an imaging signature to assess early response and predict outcomes of OPSCC. Methods: We retrospectively analyzed 162 OPSCC patients treated with concurrent chemoradiotherapy, equally divided into separate training and validation cohorts with similar clinical characteristics. A robust consensus clustering approach was used to spatially partition the primary tumor and involved lymph nodes into subregions (i.e., habitats) based on 18F-FDG PET and contrast CT imaging. We proposed quantitative image features to characterize the temporal volumetric change of the habitats and peritumoral/nodal tissue between baseline and midtreatment. The reproducibility of these features was evaluated. We developed an imaging signature to predict progression-free survival (PFS) by fitting an L1-regularized Cox regression model. Results: We identified 3 phenotypically distinct intratumoral habitats: metabolically active and heterogeneous, enhancing and heterogeneous, and metabolically inactive and homogeneous. The final Cox model consisted of 4 habitat evolution-based features. In both cohorts, this imaging signature significantly outperformed traditional imaging metrics, including midtreatment metabolic tumor volume for predicting PFS, with a C-index of 0.72 versus 0.67 (training) and 0.66 versus 0.56 (validation). The imaging signature stratified patients into high-risk versus low-risk groups with 2-y PFS rates of 59.1% versus 89.4% (hazard ratio, 4.4; 95% confidence interval, 1.4-13.4 [training]) and 61.4% versus 87.8% (hazard ratio, 4.6; 95% confidence interval, 1.7-12.1 [validation]). The imaging signature remained an independent predictor of PFS in multivariable analysis adjusting for stage, human papillomavirus status, and smoking history. Conclusion: The proposed imaging signature allows more accurate prediction of disease progression and, if prospectively validated, may refine OPSCC patient selection for risk-adaptive therapy.
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Affiliation(s)
- Jia Wu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Nasha Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Meiying Guo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Rachel Liang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Carrie Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Nancy Fischbein
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; and
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19
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Chung SR, Choi YJ, Suh CH, Lee JH, Baek JH. Diffusion-weighted Magnetic Resonance Imaging for Predicting Response to Chemoradiation Therapy for Head and Neck Squamous Cell Carcinoma: A Systematic Review. Korean J Radiol 2020; 20:649-661. [PMID: 30887747 PMCID: PMC6424826 DOI: 10.3348/kjr.2018.0446] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To systematically review the evaluation of the diagnostic accuracy of pre-treatment apparent diffusion coefficient (ADC) and change in ADC during the intra- or post-treatment period, for the prediction of locoregional failure in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Ovid-MEDLINE and Embase databases were searched up to September 8, 2018, for studies on the use of diffusion-weighted magnetic resonance imaging for the prediction of locoregional treatment response in patients with HNSCC treated with chemoradiation or radiation therapy. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. RESULTS Twelve studies were included in the systematic review, and diagnostic accuracy assessment was performed using seven studies. High pre-treatment ADC showed inconsistent results with the tendency for locoregional failure, whereas all studies evaluating changes in ADC showed consistent results of a lower rise in ADC in patients with locoregional failure compared to those with locoregional control. The sensitivities and specificities of pre-treatment ADC and change in ADC for predicting locoregional failure were relatively high (range: 50-100% and 79-96%, 75-100% and 69-95%, respectively). Meta-analytic pooling was not performed due to the apparent heterogeneity in these values. CONCLUSION High pre-treatment ADC and low rise in early intra-treatment or post-treatment ADC with chemoradiation, could be indicators of locoregional failure in patients with HNSCC. However, as the studies are few, heterogeneous, and at high risk for bias, the sensitivity and specificity of these parameters for predicting the treatment response are yet to be determined.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,Department of Radiology, Namwon Medical Center, Namwon, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Semrau S, Schmidt D, Hecht M, Haderlein M, Kitzsteiner C, Müller S, Traxdorf M, Agaimy A, Iro H, Kuwert T, Fietkau R. Classification of three prognostically different groups of head and neck cancer patients based on their metabolic response to induction chemotherapy (IC-1). Oral Oncol 2019; 100:104479. [PMID: 31786390 DOI: 10.1016/j.oraloncology.2019.104479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES There exist no uniform decision criteria for conservative organ preservation treatments in head and neck cancer patients. Even with 18F-FDG-PET/CT after induction chemotherapy patient selection is challenging. This study correlated metabolic tumor response with treatment types and recurrence patterns. MATERIALS AND METHODS Decrease in SUVmax in 18F-FDG-PET/CT was measured 21-28 days after IC-1 in 102 patients and correlated to cancer-specific endpoints. RESULTS Residual SUVmax (resSUVmax) values were uniformly distributed across five cut-off levels (0-0.2 vs. >0.2-0.4 vs. >0.4-0.6 vs. >0.6-0.8 vs. >0.8) containing 20%, 25% 25%, 15% and 15% of patients. Patients were stratified into three response categories according to residual SUVmax (Group A: 0-0.4 = high response Group B: >0.4-0.8 = moderate response, Group C > 0.8 = non-response), 5-year local control rates were 90.5% (Group A) vs. 78.9% (Group B; univariate p = 0.07, multivariate: HR: 3.6, p = 0.03) vs. 49.4% (Group C vs. B; univariate p = 0.04, multivariate: HR 5.5, p < 0.01). After IC-1, Group A received chemoradiotherapy (CRT) only. Group B received surgery plus either (chemo)radiotherapy (B_S + RT/CRT) or chemoradiotherapy (B_CRT), yielding local control rates of 100% and 74.2% (p = 0.11). Group C received surgery plus CRT or CRT alone; both achieved equally poor local control (p = 0.71). Group C had significantly worse distant metastasis-free survival and overall survival than Groups A and B (p < 0.05). CONCLUSION Metabolic response after IC-1 differentiates HNC patients into three subgroups predicting local tumor control. Non-response was associated with a poor outcome.
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Affiliation(s)
- Sabine Semrau
- Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany.
| | - Daniela Schmidt
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany
| | - Marlen Haderlein
- Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany
| | - Christian Kitzsteiner
- Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany
| | - Sarina Müller
- Department of Otorhinolaryngology, Head & Neck Surgery University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maximilian Traxdorf
- Department of Otorhinolaryngology, Head & Neck Surgery University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head & Neck Surgery University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany
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21
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Surov A, Meyer HJ, Höhn AK, Winter K, Sabri O, Purz S. Associations Between [ 18F]FDG-PET and Complex Histopathological Parameters Including Tumor Cell Count and Expression of KI 67, EGFR, VEGF, HIF-1α, and p53 in Head and Neck Squamous Cell Carcinoma. Mol Imaging Biol 2019; 21:368-374. [PMID: 29931433 DOI: 10.1007/s11307-018-1223-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) is one of common cancers worldwide. Positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is increasingly used for diagnosing and staging, as well as for monitoring of treatment of HNSCC. PET parameters like maximum and mean standard uptake values (SUVmax, SUVmean) can predict the behavior of HNSCC. The purpose of this study was to analyze possible associations between these PET parameters and clinically relevant histopathological features in patients with HNSCC. PROCEDURES Overall, 22 patients, mean age, 55.2 ± 11.0 years, with different HNSCC were acquired. Low grade (G1/2) tumors were diagnosed in 10 cases (45 %) and high grade (G3) tumor in 12 (55 %) patients. In all cases, whole body PET was performed. For this study, the following specimen stainings were performed: MIB-1 staining (KI 67 expression), epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), tumor suppressor protein p53, hypoxia-inducible factor (HIF)-1α, and human papilloma virus (p16 expression). All stained specimens were digitalized and analyzed by using the ImageJ software 1.48v. Spearman's correlation coefficient (ρ) was used to analyze associations between investigated parameters. P values <0.05 were taken to indicate statistical significance. RESULTS P16-negative tumors showed statistically significant higher SUVmax (ρ = 0.006) and SUVmean values (ρ = 0.002) in comparison to p16-positive carcinomas. No significant differences were identified in the analyzed parameters between poorly and moderately/well-differentiated tumors. In overall sample, there were no statistically significant correlations between the [18F]FDG-PET and histopathological parameters. Also, in G1/2 tumors, no significant correlations were identified. In G3 carcinomas, cell count correlated statistical significant with SUVmax (p = 0.580, P = 0.048) and SUVmean (ρ = 0.587, P = 0.045). CONCLUSION Associations between [18F]FDG-PET parameters and different histopathological features in HNSCC depend significantly on tumor grading. In G1/2 carcinomas, there were no significant correlations between [18F]FDG-PET parameters and histopathology. In G3 lesions, SUVmax and SUVmean reflect tumor cellularity.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Karsten Winter
- Institute of Anatomy, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
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22
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Payabvash S, Chan A, Jabehdar Maralani P, Malhotra A. Quantitative diffusion magnetic resonance imaging for prediction of human papillomavirus status in head and neck squamous-cell carcinoma: A systematic review and meta-analysis. Neuroradiol J 2019; 32:232-240. [PMID: 31084347 DOI: 10.1177/1971400919849808] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Head and neck squamous-cell carcinoma (HNSCC) related to human papillomavirus (HPV) infection represents a distinct biological and prognostic subtype compared to the HPV-negative form. Prior studies suggest a correlation between the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) of primary tumor lesion and HPV status in HNSCC. In this meta-analysis, we compared the average ADC of primary lesion between HPV-positive and HPV-negative HNSCC. METHODS A comprehensive literature search of PubMed and Embase was performed. Studies comparing the average ADC on echo-planar DWI of primary tumor lesions between HPV-positive and HPV-negative HNSCC were included. The standardized mean difference was calculated using fixed- and random-effects models. Tau-squared estimates of total heterogeneity and Higgins inconsistency index (I2 test) were determined. RESULTS A total of five studies, pooling data of 264 patients, were included for meta-analysis. Among these five studies, three had included oral cavity, hypopharyngeal, and/or laryngeal HNSCC in addition to oropharyngeal subsite. Primary lesions were comprised of 185 HPV-negative and 79 HPV-positive HNSCC. The meta-analysis showed lower average ADC values in HPV-positive HNSCC compared to the HPV-negative form, with a standardized mean difference of 0.961 (95% confidence interval 0.644-1.279; p < 0.0001). Since there was no significant heterogeneity in analysis (p = 0.3852), both random- and fixed-effects models resulted in the same estimates of overall effect. CONCLUSIONS HPV-positive HNSCC primary lesions have a lower average ADC compared to the HPV-negative form, highlighting the potential application of quantitative diffusion magnetic resonance imaging as a noninvasive imaging biomarker for prediction of HPV status.
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Affiliation(s)
| | - Aimee Chan
- 2 Department of Medical Imaging, University of Toronto, Canada
| | | | - Ajay Malhotra
- 1 Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA
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23
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Surov A, Meyer HJ, Höhn AK, Wienke A, Sabri O, Purz S. 18F-FDG-PET Can Predict Microvessel Density in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11040543. [PMID: 30991696 PMCID: PMC6521262 DOI: 10.3390/cancers11040543] [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: 03/11/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022] Open
Abstract
Aim: Positron emission tomography (PET) with 18F-fluordeoxyglucose (18F-FDG) plays an essential role in the staging and tumor monitoring of head and neck squamous cell carcinoma (HNSCC). Microvessel density (MVD) is one of the clinically important histopathological features in HNSCC. The purpose of this study was to analyze possible associations between 18F-FDG-PET findings and MVD parameters in HNSCC. Materials and Methods: Overall, 22 patients with a mean age of 55.2 ± 11.0 and with different HNSCC were acquired. In all cases, whole-body 18F-FDG-PET was performed. For each tumor, the maximum and mean standardized uptake values (SUVmax; SUVmean) were determined. The MVD, including stained vessel area and total number of vessels, was estimated on CD105 stained specimens. All specimens were digitalized and analyzed by using ImageJ software 1.48v. Spearman's correlation coefficient (r) was used to analyze associations between investigated parameters. p-values of <0.05 were taken to indicate statistical significance. Results: SUVmax correlated with vessel area (r = 0.532, p = 0.011) and vessel count (r = 0.434, p = 0.043). Receiver operating characteristic analysis identified a threshold SUVmax of 15 to predict tumors with high MVD with a sensitivity of 72.7% and specificity of 81.8%, with an area under the curve of 82.6%. Conclusion: ⁸F-FDG-PET parameters correlate statistically significantly with MVD in HNSCC. SUVmax may be used for discrimination of tumors with high tumor-related MVD.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06097 Halle, Germany.
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstrasse 18, 04103 Leipzig, Germany.
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstrasse 18, 04103 Leipzig, Germany.
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24
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Abstract
There are recent advances, namely, a standardized method for reporting therapy response (Hopkins criteria), a multicenter prospective cohort study with excellent negative predictive value of F-FDG PET/CT for N0 clinical neck, a phase III multicenter randomized controlled study establishing the value of a negative posttherapy F-FDG PET/CT for patient management, a phase II randomized controlled study demonstrating radiation dose reduction strategies for human papilloma virus-related disease, and Food and Drug Administration approval of nivolumab for treatment of recurrent head and neck squamous cell carcinoma.
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25
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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: 39] [Impact Index Per Article: 6.5] [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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26
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Value of early evaluation of treatment response using 18F-FDG PET/CT parameters and the Epstein-Barr virus DNA load for prediction of outcome in patients with primary nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging 2018; 46:650-660. [DOI: 10.1007/s00259-018-4172-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022]
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27
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Nicolau UR, de Jesus VHF, Lima ENP, Alves MS, de Oliveira TB, Andrade LDB, Silva VS, Bes PC, de Paiva TF, Calsavara VF, Guimarães APG, Cezana L, Barbosa PNVP, Porto GCLM, Pellizzon ACA, de Carvalho GB, Kowalski LP. Early metabolic 18F-FDG PET/CT response of locally advanced squamous-cell carcinoma of head and neck to induction chemotherapy: A prospective pilot study. PLoS One 2018; 13:e0200823. [PMID: 30114190 PMCID: PMC6095513 DOI: 10.1371/journal.pone.0200823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/30/2018] [Indexed: 12/12/2022] Open
Abstract
Objective The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN). Methods and findings A prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA–B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056–0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040–0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062–0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013–0.96; p = 0.046) survival. Conclusions These results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Loureno Cezana
- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, A.C. Camargo Cancer Center, São Paulo, Brazil
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28
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Baker LCJ, Sikka A, Price JM, Boult JKR, Lepicard EY, Box G, Jamin Y, Spinks TJ, Kramer-Marek G, Leach MO, Eccles SA, Box C, Robinson SP. Evaluating Imaging Biomarkers of Acquired Resistance to Targeted EGFR Therapy in Xenograft Models of Human Head and Neck Squamous Cell Carcinoma. Front Oncol 2018; 8:271. [PMID: 30083516 PMCID: PMC6064942 DOI: 10.3389/fonc.2018.00271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/02/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Overexpression of EGFR is a negative prognostic factor in head and neck squamous cell carcinoma (HNSCC). Patients with HNSCC who respond to EGFR-targeted tyrosine kinase inhibitors (TKIs) eventually develop acquired resistance. Strategies to identify HNSCC patients likely to benefit from EGFR-targeted therapies, together with biomarkers of treatment response, would have clinical value. Methods: Functional MRI and 18F-FDG PET were used to visualize and quantify imaging biomarkers associated with drug response within size-matched EGFR TKI-resistant CAL 27 (CALR) and sensitive (CALS) HNSCC xenografts in vivo, and pathological correlates sought. Results: Intrinsic susceptibility, oxygen-enhanced and dynamic contrast-enhanced MRI revealed significantly slower baseline R 2 ∗ , lower hyperoxia-induced Δ R 2 ∗ and volume transfer constant Ktrans in the CALR tumors which were associated with significantly lower Hoechst 33342 uptake and greater pimonidazole-adduct formation. There was no difference in oxygen-induced ΔR1 or water diffusivity between the CALR and CALS xenografts. PET revealed significantly higher relative uptake of 18F-FDG in the CALR cohort, which was associated with significantly greater Glut-1 expression. Conclusions: CALR xenografts established from HNSCC cells resistant to EGFR TKIs are more hypoxic, poorly perfused and glycolytic than sensitive CALS tumors. MRI combined with PET can be used to non-invasively assess HNSCC response/resistance to EGFR inhibition.
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Affiliation(s)
- Lauren C. J. Baker
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Arti Sikka
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jonathan M. Price
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jessica K. R. Boult
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Elise Y. Lepicard
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Gary Box
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Yann Jamin
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Terry J. Spinks
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Gabriela Kramer-Marek
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Martin O. Leach
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Suzanne A. Eccles
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Carol Box
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Simon P. Robinson
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
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29
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Dregely I, Prezzi D, Kelly‐Morland C, Roccia E, Neji R, Goh V. Imaging biomarkers in oncology: Basics and application to MRI. J Magn Reson Imaging 2018; 48:13-26. [PMID: 29969192 PMCID: PMC6587121 DOI: 10.1002/jmri.26058] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
Cancer remains a global killer alongside cardiovascular disease. A better understanding of cancer biology has transformed its management with an increasing emphasis on a personalized approach, so-called "precision cancer medicine." Imaging has a key role to play in the management of cancer patients. Imaging biomarkers that objectively inform on tumor biology, the tumor environment, and tumor changes in response to an intervention complement genomic and molecular diagnostics. In this review we describe the key principles for imaging biomarker development and discuss the current status with respect to magnetic resonance imaging (MRI). LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 5 J. Magn. Reson. Imaging 2018;48:13-26.
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Affiliation(s)
- Isabel Dregely
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
| | - Davide Prezzi
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
| | - Christian Kelly‐Morland
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
| | - Elisa Roccia
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
| | - Radhouene Neji
- Biomedical Engineering, School of Biomedical Engineering & Imaging SciencesKing's Health Partners, St Thomas' HospitalLondon, UK
- MR Research CollaborationsSiemens HealthcareFrimleyUK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences King's College London, King's Health Partners, St Thomas' Hospital, LondonUK
- RadiologyGuy's & St Thomas' NHS Foundation TrustLondonUK
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30
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Wong KH, Panek R, Dunlop A, Mcquaid D, Riddell A, Welsh LC, Murray I, Koh DM, Leach MO, Bhide SA, Nutting CM, Oyen WJ, Harrington KJ, Newbold KL. Changes in multimodality functional imaging parameters early during chemoradiation predict treatment response in patients with locally advanced head and neck cancer. Eur J Nucl Med Mol Imaging 2018; 45:759-767. [PMID: 29164301 PMCID: PMC5978912 DOI: 10.1007/s00259-017-3890-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the optimal timing and predictive value of early intra-treatment changes in multimodality functional and molecular imaging (FMI) parameters as biomarkers for clinical remission in patients receiving chemoradiation for head and neck squamous cell carcinoma (HNSCC). METHODS Thirty-five patients with stage III-IVb (AJCC 7th edition) HNSCC prospectively underwent 18F-FDG-PET/CT, and diffusion-weighted (DW), dynamic contrast-enhanced (DCE) and susceptibility-weighted MRI at baseline, week 1 and week 2 of chemoradiation. Patients with evidence of persistent or recurrent disease during follow-up were classed as non-responders. Changes in FMI parameters at week 1 and week 2 were compared between responders and non-responders with the Mann-Whitney U test. The significance threshold was set at a p value of <0.05. RESULTS There were 27 responders and 8 non-responders. Responders showed a greater reduction in PET-derived tumor total lesion glycolysis (TLG40%; p = 0.007) and maximum standardized uptake value (SUVmax; p = 0.034) after week 1 than non-responders but these differences were absent by week 2. In contrast, it was not until week 2 that MRI-derived parameters were able to discriminate between the two groups: larger fractional increases in primary tumor apparent diffusion coefficient (ADC; p < 0.001), volume transfer constant (Ktrans; p = 0.012) and interstitial space volume fraction (Ve; p = 0.047) were observed in responders versus non-responders. ADC was the most powerful predictor (∆ >17%, AUC 0.937). CONCLUSION Early intra-treatment changes in FDG-PET, DW and DCE MRI-derived parameters are predictive of ultimate response to chemoradiation in HNSCC. However, the optimal timing for assessment with FDG-PET parameters (week 1) differed from MRI parameters (week 2). This highlighted the importance of scanning time points for the design of FMI risk-stratified interventional studies.
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Affiliation(s)
- Kee H Wong
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK.
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK.
| | - Rafal Panek
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
| | - Alex Dunlop
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
| | - Dualta Mcquaid
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Angela Riddell
- Clinical Radiology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Liam C Welsh
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
| | - Iain Murray
- Nuclear Medicine, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Dow-Mu Koh
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
- Clinical Radiology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Martin O Leach
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Shreerang A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
| | - Christopher M Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
| | - Wim J Oyen
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
- Nuclear Medicine, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Kevin J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
| | - Kate L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK
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31
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Mazzola R, Fiorentino A, Ricchetti F, Gregucci F, Corradini S, Alongi F. An update on radiation therapy in head and neck cancers. Expert Rev Anticancer Ther 2018; 18:359-364. [PMID: 29485913 DOI: 10.1080/14737140.2018.1446832] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Technological and technical improvements allowed for significant advances in the field of radiation therapy (RT) of head and neck cancer (HNC). Several organ-sparing strategies have been investigated with the objective to decrease acute and long-term adverse effects and, subsequently, to assure a better quality of life in patients affected by HNC. In this context, intensity modulated irradiation and the use of multimodality-imaging could help clinicians to obtain a rapid dose fall off towards surrounding healthy tissues and a better delineation of targets volumes and organs at risk. Areas covered: A literature review was performed with the aim to offer an update on radiation therapy in HNC. Expert commentary: During these last years, radiation oncologists have observed a continuous changing regarding radiation treatment for HNC. The adoption of intensity-modulated RT (IMRT) and the use of multimodality-imaging for tumor volume definition and organs at risk or delineation have improved the clinical outcomes of HNC patients. In the future, a better integration of functional imaging for target volume delineation as well as adaptive delivery strategies will allow to further personalize radiation oncology in HNC. Furthermore, the latest breakthrough technologies, such as magnetic resonance imaging (MRI)-linacs and heavy particles technologies have a great potential to improve treatment-related quality of life in HNC. Future studies are needed to demonstrate the clinical advantages of these new RT technologies in HNC.
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Affiliation(s)
- Rosario Mazzola
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Alba Fiorentino
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Francesco Ricchetti
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Fabiana Gregucci
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy
| | - Stefanie Corradini
- b Radiation Oncology , University Hospital, LMU Munich , Munich , Germany
| | - Filippo Alongi
- a Radiation Oncology , Sacro Cuore Don Calabria Hospital , Negrar-Verona , Italy.,c Radiation Oncology , University of Brescia , Brescia , Italy
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32
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33
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Alves WEFM, Pitella FA, da Rocha ET, Wichert-Ana L. The Role of PET/CT with 18F-FDG in the Assessment of Therapeutic Response of Head and Neck Cancer. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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de Bree R, Wolf GT, de Keizer B, Nixon IJ, Hartl DM, Forastiere AA, Haigentz M, Rinaldo A, Rodrigo JP, Saba NF, Suárez C, Vermorken JB, Ferlito A. Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond. Head Neck 2017; 39:2329-2349. [PMID: 28815841 PMCID: PMC5656833 DOI: 10.1002/hed.24883] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/27/2017] [Accepted: 05/31/2017] [Indexed: 01/27/2023] Open
Abstract
Significant correlations between the response to induction chemotherapy and success of subsequent radiotherapy have been reported and suggest that the response to induction chemotherapy is able to predict a response to radiotherapy. Therefore, induction chemotherapy may be used to tailor the treatment plan to the individual patient with head and neck cancer: following the planned subsequent (chemo)radiation schedule, planning a radiation dose boost, or reassessing the modality of treatment (eg, upfront surgery). Findings from reported trials suggest room for improvement in clinical response assessment after induction chemotherapy, but an optimal method has yet to be identified. Historically, indices of treatment efficacy in solid tumors have been based solely on systematic assessment of tumor size. However, functional imaging (eg, fluorodeoxyglucose‐positron emission tomography (FDG‐PET) potentially provides an earlier indication of response to treatment than conventional imaging techniques. More advanced imaging techniques are still in an exploratory phase and are not ready for use in clinical practice.
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Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Edinburgh, UK
| | - Dana M Hartl
- Department of Otolaryngology - Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Arlene A Forastiere
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Missak Haigentz
- Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Juan P Rodrigo
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.,Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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35
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Petkar I, Bhide S, Newbold K, Harrington K, Nutting C. Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it? Clin Oncol (R Coll Radiol) 2017; 29:e110-e118. [PMID: 28242166 DOI: 10.1016/j.clon.2017.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
Dysphagia after primary chemoradiotherapy or radiation alone in pharyngeal cancers can have a devastating impact on a patient's physical, social and emotional state. Establishing and validating efficient dysphagia-optimised radiotherapy techniques is, therefore, of paramount importance in an era where health-related quality of life measures are increasingly influential determinants of curative management strategies, particularly as the incidence of good prognosis, human papillomavirus-driven pharyngeal cancer in younger patients continues to rise. The preferential sparing achievable with intensity-modulated radiotherapy (IMRT) of key swallowing structures implicated in post-radiation dysfunction, such as the pharyngeal constrictor muscles (PCM), has generated significant research into toxicity-mitigating strategies. The lack of randomised evidence, however, means that there remains uncertainty about the true clinical benefits of the dosimetric gains offered by technological advances in radiotherapy. As a result, we feel that IMRT techniques that spare PCM cannot be incorporated into routine practice. In this review, we discuss the swallowing structures responsible for functional impairment, analyse the studies that have explored the dose-response relationship between these critical structures and late dysphagia, and consider the merits of reported dysphagia-optimised IMRT (Do-IMRT) approaches, thus far. Finally, we discuss the dysphagia/aspiration-related structures (DARS) study (ISRCTN 25458988), which is the first phase III randomised controlled trial designed to investigate the impact of swallow-sparing strategies on improving long-term function. To maximise patient benefits, improvements in radiation delivery will need to integrate with novel treatment paradigms and comprehensive rehabilitation strategies to eventually provide a patient-centric, personalised treatment plan.
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Affiliation(s)
- I Petkar
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - S Bhide
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Newbold
- The Royal Marsden NHS Foundation Trust, London, UK
| | - K Harrington
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
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36
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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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37
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Cacicedo J, Fernandez I, Del Hoyo O, Navarro A, Gomez-Iturriaga A, Pijoan JI, Martinez-Indart L, Escudero J, Gomez-Suarez J, de Zarate RO, Perez JF, Bilbao P, Rades D. Prognostic value of maximum standardized uptake value measured by pretreatment 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinoma. Clin Transl Oncol 2017; 19:1337-1349. [PMID: 28540535 DOI: 10.1007/s12094-017-1674-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/12/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the prognostic impact of maximum standardized uptake value (SUVmax) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography/computed tomography (FDG PET/CT) imaging. MATERIALS/METHODS Fifty-eight patients undergoing FDG PET/CT before radical treatment with definitive radiotherapy (±concomitant chemotherapy) or surgery + postoperative (chemo)radiation were analyzed. The effects of clinicopathological factors (age, gender, tumor location, stage, Karnofsky Performance Status (KPS), and treatment strategy) including primary tumor SUVmax and nodal SUVmax on overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) were evaluated. Kaplan-Meier survival curves were generated and compared with the log-rank test. RESULTS Median follow-up for the whole population was 31 months (range 2.3-53.5). Two-year OS, LRC, DFS and DMFS, for the entire cohort were 62.1, 78.3, 55.2 and 67.2%, respectively. Median pretreatment SUVmax for the primary tumor and lymph nodes was 11.85 and 5.4, respectively. According to univariate analysis, patients with KPS < 80% (p < 0.001), AJCC stage IVa or IVb vs III (p = 0.037) and patients undergoing radiotherapy vs surgery (p = 0.042) were significantly associated with worse OS. Patients with KPS < 80% (p = 0.003) or age ≥65 years (p = 0.007) had worse LRC. The KPS < 80% was the only factor associated with decreased DFS (p = 0.001). SUVmax of the primary tumor or the lymph nodes were not associated with OS, DFS or LRC. The KPS < 80% (p = 0.002), tumor location (p = 0.047) and AJCC stage (p = 0.025) were associated with worse cancer-specific survival (CSS). According to Cox regression analysis, on multivariate analysis KPS < 80% was the only independent parameter determining worse OS, DFS, CSS. Regarding LRC only patients with IK < 80% (p = 0.01) and ≥65 years (p = 0.01) remained statistically significant. Nodal SUVmax was the only factor associated with decreased DMFS. Patients with a nodal SUVmax > 5.4 presented an increased risk for distant metastases (HR, 3.3; 95% CI 1.17-9.25; p = 0.023). CONCLUSIONS The pretreatment nodal SUVmax in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUVmax and nodal SUVmax were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.
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Affiliation(s)
- J Cacicedo
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain.
| | - I Fernandez
- Nuclear Medicine Department, Cruces University Hospital, Barakaldo, Spain
| | - O Del Hoyo
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain
| | - A Navarro
- Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, 199-203, Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - A Gomez-Iturriaga
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain
| | - J Ignacio Pijoan
- Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - L Martinez-Indart
- Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - J Escudero
- Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - J Gomez-Suarez
- Otolaryngology Department, Cruces University Hospital, c/Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya (Basque Country), Spain
| | - R Ortiz de Zarate
- Medical Physics and Radioprotection Department, Cruces University Hospital/Biocruces Health Research Institute, Vizcaya, Spain
| | - J Fernando Perez
- Medical Physics and Radioprotection Department, Cruces University Hospital/Biocruces Health Research Institute, Vizcaya, Spain
| | - P Bilbao
- Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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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: 42] [Impact Index Per Article: 6.0] [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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