Abstract
PurposeTo determine whether pretreatment in vivo 1H magnetic resonance (MR) spectroscopy at 3 Tesla (T) and 18F-FDG PET/CT can offer predictive power regarding the local control of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients.Materials and Methods1H MR spectroscopy was performed in addition to conventional MR imaging before definitive chemoradiotherapy in 58 patients with advanced OHSCC. The relationship of local control with the 1H MR spectroscopy and 18F-FDG PET/CT parameters was analyzed.ResultsWith a median follow-up of 17.6 months, 13 (22.4%) patients exhibited local failure; whereas the remaining 45 achieved local control. Kaplan-Meier analysis identified age > 60 years, creatine level on MRS ≦ 6.02 mM, glutamine and glutamate (Glx) level on MRS > 3.31 mM, and total lesion glycolysis (TLG) on 18F-FDG PET/CT > 217.18 g/mL × mL as significant adverse predictors for 2-year local control. Multivariate Cox regression analysis showed that age (p=0.017), Glx level on MRS (p=0.021), and TLG on 18F-FDG PET/CT (p=0.028) retained their independent prognostic significance. A scoring system was constructed based on the sum of these three factors. We found that patients with scores of 2–3 had significantly poorer local control rates than patients with scores of 0–1 (33.3% versus 86.8%, p=0.003).ConclusionWe conclude that Glx on 1H MR spectroscopy at 3 T was the independent prognostic factor for local control of OHSCC patients treated with chemoradiotherapy, and its combination with age and TLG may help identify a subgroup of patients at high risk for developing local failure.
Highlights
Oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC) are common cancers of the head and neck region
In the post-hoc analysis of 124 cases collected from previous research projects [23], we demonstrated that FDG uptake heterogeneity was superior to traditional PET parameters in prognostic stratification of advanced OHSCC patients treated with chemoradiotherapy
Our results demonstrated the value of pretreatment 1H magnetic resonance (MR) spectroscopy at 3 T and 18F-FDG PET/computed tomography (CT) for patients with advanced OHSCC for predicting local control following chemoradiotherapy
Summary
Oropharyngeal and hypopharyngeal squamous cell carcinoma (OHSCC) are common cancers of the head and neck region. These neoplasms have contiguous anatomical origins and share similar lymphatic drainage and treatment regimens. OHSCC usually manifests as the advanced disease (stage III-IV) at presentation and is primarily treated with an organ-preservation approach based on definitive chemoradiotherapy [1, 2]. Prediction of treatment failure may enable therapeutic modification, including earlier salvage surgery for suitable cases and upfront intensification of chemotherapy or radiotherapy [6]. The identification of reliable imaging biomarkers predicting treatment effects will enable improved prognosis stratification of patients undergoing chemoradiotherapy
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