Abstract
The role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI) and diffusion-weighted MR imaging (DWI) in predicting the treatment response of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) to chemoradiation remains unclear. We prospectively investigated the ability of pharmacokinetic parameters derived from pretreatment DCE-PWI and DWI to predict the local control of OHSCC patients treated with chemoradiation. Between August, 2010 and March, 2012, patients with untreated OHSCC scheduled for chemoradiation were eligible for this prospective study. DCE-PWI and DWI were performed in addition to conventional MRI. The relationship of local control with the following clinical and imaging variables was analyzed: the hemoglobin level, T-stage, tumor location, gross tumor volume, maximum standardized uptake value, metabolic tumor volume and total lesion glycolysis on FDG PET/CT, transfer constant (K trans), volume of blood plasma and volume of extracellular extravascular space on DCE-PWI, and apparent diffusion coefficient on DWI of the primary tumor. The patients were also divided into a local control group and a local failure group, and their clinical and imaging parameters were compared. There were 58 patients (29 with oropharynx squamous cell carcinoma [SCC] and 29 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 18.2 months, 17 (29.3%) participants had local failure, whereas the remaining 41 patients achieved local control. Univariate analysis revealed that only the K trans value was significantly associated with local control (P = 0.03). When the local control and local failure groups were compared, significant differences were observed in K trans and the tumor location (P = 0.01 and P = 0.04, respectively). In the multivariable analysis, only K trans was statistically significant (P = 0.04). Our results suggest that pretreatment K trans may help predict the local control in OHSCC patients treated with chemoradiation.
Highlights
Oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC) are common malignant tumors of the head and neck that has long been considered as having similar risk factors and lymphatic drainage
We evaluated the capability of pharmacokinetic parameters derived from pretreatment DCE-PWI and diffusion-weighted MR imaging (DWI) in combination with other potential factors to predict the local control of cancer after chemoradiation in patients with OHSCC
Since Ktrans is the pharmacokinetic parameter of DCE-PWI that reflects tumor vascularity and permeability, it can influence the delivery of chemotherapy drugs as well as oxygen during radiotherapy
Summary
Oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC) are common malignant tumors of the head and neck that has long been considered as having similar risk factors and lymphatic drainage. Human papillomavirus (HPV) is recently recognized to play a role in the pathogenesis of a subset of clinically and molecularly distinct head and neck squamous cell carcinomas (HNSCC), most commonly located in the oropharynx. An organ-preservation approach with chemoradiation has become an accepted treatment option for OHSCC [3]. Such treatment mode is not always successful, and the reported local control rates were about 80% [4,5].
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