Abstract
ObjectivesTo 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.MethodsBetween 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.ResultsIn 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).ConclusionsFunctional 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.
Highlights
In patients with advanced stage head and neck squamous cell carcinoma (HNSCC),radiation is the standard organsparing treatment; there is still a 50% (35–65%) recurrence rate [1]
The final study population consisted of 70 patients (Table 1) with a primary tumors (PT) located in the oropharynx (n = 56) or hypopharynx (n = 14)
Correlations between pretreatment diffusion-weighted MRI (DWI)/intravoxel incoherent motion (IVIM), dynamic contrast-enhanced (DCE)-MRI, and 18F-FDG-positron emission tomography (PET)/CT parameters were assessed in order to capture predictive tumor characteristics for locoregional recurrence-free survival (LRFS) and overall survival (OS) in pharyngeal SCC patients treated withradiotherapy
Summary
In patients with advanced stage head and neck squamous cell carcinoma (HNSCC), (chemo)radiation is the standard organsparing treatment; there is still a 50% (35–65%) recurrence rate [1]. Being able to correctly identify patients with a favorable prognosis might allow treatment adaptation to reduce long-term toxicity without compromising outcome [4]. Functional imaging techniques capture a variety of biological characteristics, such as cellularity, perfusion, permeability, and glucose metabolism. Tissue microstructures (i.e., cellularity, necrosis, stroma, hemorrhage) can be assessed by diffusion-weighted MRI (DWI) and quantified by the apparent diffusion coefficient (ADC). An extension of DWI is the intravoxel incoherent motion (IVIM), which can assess both diffusion and perfusion fraction, without contrast injection [5,6,7]
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