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Abstract
ObjectivesPreviously, we showed that pre-treatment tumour plasma perfusion (Fp) predicts RECIST response to induction chemotherapy (ICT) in locoregionally advanced head and neck squamous cell carcinoma (HNSCC). The aim here was to determine whether the pre-treatment tumour Fp estimate, changes in tumour Fp or RECIST response post 2 cycles of ICT were prognostic for long-term survival outcomes.MethodsA prospective study enrolled patients with high stage HNSCC treated with docetaxel (T), cisplatin (P) and 5-fluorouracil (F) (ICT) followed by synchronous cisplatin and intensity modulated radiotherapy. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before and after two cycles of ICT was used to measure Fp and RECIST response.ResultsForty-two patients were recruited and 37 underwent two scans. The median follow-up was 36 (range 23–49) months. Pre-treatment tumour Fp (stratified by median) was not prognostic for overall survival (p = 0.42), disease specific survival (p = 0.20) and locoregional control (p = 0.64). Neither change in tumour Fp nor RECIST response post two cycles of ICT was prognostic for any outcome (p>0.21).ConclusionDCE-MRI parameters do not predict long-term survival outcomes following ICT and RECIST response to ICT may not be an appropriate endpoint to determine early efficacy of a treatment in HNSCC patients.
Highlights
Head and neck cancer is one of the world’s leading malignancies with an estimated global incidence of over 686,000 cases in 2012
Neither change in tumour Fp nor RECIST response post two cycles of induction chemotherapy (ICT) was prognostic for any outcome (p>0.21)
Several head and neck squamous cell carcinoma (HNSCC) studies show pre-treatment tumour hypoxia and haemodynamic imaging parameters such as blood volume (BV) and BF are prognostic for survival outcomes [30,31,32,33,34,35,36,37] there are conflicting reports.[38]
Summary
Head and neck cancer is one of the world’s leading malignancies with an estimated global incidence of over 686,000 cases in 2012. In Europe in 2013, head and neck cancer contributed 135,400 new oncology diagnoses and 61,300 deaths.[1] Concurrent chemoradiotherapy is the non-surgical standard of care for patients who present with high stage disease.[2,3,4] Despite advances in chemoradiotherapy, unlike some other cancer sites where survival rates rose substantially in recent decades, the improvement in head and neck cancer survival rates has been modest. Tumour heterogeneity affects response to treatment. [16] The key to extracting the benefits of ICT may be meticulous patient and tumour selection
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