Abstract
Few studies have investigated the relationship between ADC and clinical outcome in HNSCC. Our hypothesis has that relatively high pretreatment ADC would correlate with local failure of HNSCC treated with radiation therapy. This includes prospective and validation studies. Seventeen patients treated with radiation therapy for primary HNSCC completed the prospective study. Variables considered to affect local failure including MR imaging-related parameters such as ADC and its change ratio were compared between patients with local failure and controls, and those showing difference or association with local failure were further tested by survival analysis. Furthermore, variables were analyzed in 40 patients enrolled in the validation study. Relatively high ADC calculated with b-values (300, 500, 750, and 1000 s/mm(2)) before treatment, high ADC increase ratio, and treatment method (chemoradiotherapy versus radiation therapy alone) revealed significant difference between patients with local failure and controls or association with local failure. In Cox proportional hazard testing, high ADC before treatment alone showed significant association with local failure (P = .0186). In the validation study, tumor volume before treatment, high ADC before treatment, T stage (T12 versus T34), and treatment method showed significance. Tumor volume before treatment (P = .0217) and high ADC before treatment (P = .0001) revealed significant association with local failure in Cox proportional hazard testing. High ADC before treatment was superior to tumor volume before treatment regarding association with local failure. These results suggest pretreatment ADC obtained at high b-values as well as tumor volume correlate with local failure of HNSCC treated with radiation therapy.
Highlights
AND PURPOSE: Few studies have investigated the relationship between ADC and clinical outcome in HNSCC
Relatively high ADC calculated with b-values (300, 500, 750, and 1000 s/mm2) before treatment, high ADC increase ratio, and treatment method revealed significant difference between patients with local failure and controls or association with local failure
These results suggest pretreatment ADC obtained at high b-values as well as tumor volume correlate with local failure of HNSCC treated with radiation therapy
Summary
Seventeen patients treated with radiation therapy for primary HNSCC completed the prospective study. Variables were analyzed in 40 patients enrolled in the validation study. We enrolled 32 patients who were histologically proved to have primary HNSCC in our institute between April 2006 and July 2008 and who were scheduled to receive radical radiation therapy (Ͼ60 Gy to GTV). Nasopharyngeal cancer is known to be more radiosensitive than other types of HNSCC.[24] Among the 32 patients enrolled, 3 were excluded because detection of the primary lesion on DWI was difficult due to small lesions or artifacts, 7 were excluded because early-phase MR imaging could not be obtained or the lesion could not be detected clearly on the early-phase imaging, and 5 were excluded because the radiation dose to the GTV was Ͻ60 Gy due to poor patient condition or severe side effects. No patient had a history of receiving chemotherapy or radiation therapy
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