Abstract
Background and PurposeIt is important to identify patients with head and neck squamous cell carcinoma (SCC) who fail to respond to chemoradiotherapy so that they can undergo post-treatment salvage surgery while the disease is still operable. This study aimed to determine the diagnostic performance of dynamic contrast enhanced (DCE)-MRI using a pharmacokinetic model for pre-treatment predictive imaging, as well as post-treatment diagnosis, of residual SCC at primary and nodal sites in the head and neck.Material and MethodsForty-nine patients with 83 SCC sites (primary and/or nodal) underwent pre-treatment DCE-MRI, and 43 patients underwent post-treatment DCE-MRI, of which 33 SCC sites had a residual mass amenable to analysis. Pre-treatment, post-treatment and % change in the mean Ktrans, kep, ve and AUGC were obtained from SCC sites. Logistic regression was used to correlate DCE parameters at each SCC site with treatment response at the same site, based on clinical outcome at that site at a minimum of two years.ResultsNone of the pre-treatment DCE-MRI parameters showed significant correlations with SCC site failure (SF) (29/83 sites) or site control (SC) (54/83 sites). Post-treatment residual masses with SF (14/33) had significantly higher kep (p = 0.05), higher AUGC (p = 0.02), and lower % reduction in AUGC (p = 0.02), than residual masses with SC (19/33), with the % change in AUGC remaining significant on multivariate analysis.ConclusionPre-treatment DCE-MRI did not predict which SCC sites would fail treatment, but post-treatment DCE-MRI showed potential for identifying residual masses that had failed treatment.
Highlights
While neovascularization is necessary for the growth and spread of head and neck squamous cell carcinomas (SCC), it influences the response to chemoradiotherapy (CRT) and radiotherapy (RT)
We report a prospective study in which Dynamic contrast enhanced MRI (DCE-MRI) of the head and neck was performed pre-treatment for prediction and post-treatment for diagnosis
Pre-treatment dynamic contrast enhanced (DCE)-MRI was performed on 85 patients with head and neck SCC. Of these 85 patients, 36 were excluded from the study; in 26 patients the planned treatment was changed to surgery, 5 patients subsequently did not undergo or complete a course of CRT/RT, 3 patients died before Site Failure (SF) or Site Control (SC) could be confirmed, in one patient the AIF could not be obtained and in another the images were degraded
Summary
While neovascularization is necessary for the growth and spread of head and neck squamous cell carcinomas (SCC), it influences the response to chemoradiotherapy (CRT) and radiotherapy (RT). Pre-treatment DCE-MRI, may be able to predict which primary and nodal SCC sites in the head and neck will fail treatment. This information would be valuable for the radiation oncologist, to target specific SCC sites for a radiotherapy boost, and for the radiologist to identify SCC sites with a higher likelihood of residual cancer, so that these sites can undergo post-treatment biopsy or close follow-up by imaging. This study aimed to determine the diagnostic performance of dynamic contrast enhanced (DCE)-MRI using a pharmacokinetic model for pre-treatment predictive imaging, as well as post-treatment diagnosis, of residual SCC at primary and nodal sites in the head and neck
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