Abstract
ObjectivesTo evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADCmean) and 18F-FDG PET maximum standardized uptake value (SUVmax) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status.MethodsThis prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADCmean (pre-treatment, 6- and 12-weeks post-CRT) and SUVmax (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann–Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS.ResultsAbsolute post-CRT ADCmean values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADCmean at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUVmax did not predict DFS.ConclusionAbsolute post-CRT ADCmean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADCmean were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes.
Highlights
Head and neck squamous cell cancer (HNSCC) is the seventh commonest cancer (Ferlay et al 2010)
Concomitant chemo-radiotherapy (CRT) is the standard of care for the advanced disease at most head and neck tumour sites, with treatment failing at loco-regional sites in over 30% of stage III or IV tumours (Goodwin 2000)
A number of studies have evaluated post-treatment tumour A DCmean as a biomarker (Kim et al 2009; King et al 2010; Vandecaveye et al 2012; Schouten et al 2014; Marzi et al 2017; Brenet et al 2020) with increased absolute ADCmean, or a greater percentage interval increase in A DCmean from pre-treatment values, being associated with the disease control (King et al 2010; Vandecaveye et al 2012; Brenet et al 2020)
Summary
Head and neck squamous cell cancer (HNSCC) is the seventh commonest cancer (Ferlay et al 2010). Quantitative post-treatment 18F-FDG PET-CT SUVmax (Moeller et al 2009; Chan et al 2012; Sherriff et al 2012; Castelli et al 2016; Kim et al 2016; Matoba et al 2017) has been shown to predict treatment failure and survival outcomes. Quantitative diffusion-weighted MRI (DW-MRI) may provide alternative post-CRT imaging variables for the prediction of treatment success. A number of studies have evaluated post-treatment tumour A DCmean as a biomarker (Kim et al 2009; King et al 2010; Vandecaveye et al 2012; Schouten et al 2014; Marzi et al 2017; Brenet et al 2020) with increased absolute ADCmean, or a greater percentage interval increase in A DCmean from pre-treatment values, being associated with the disease control (King et al 2010; Vandecaveye et al 2012; Brenet et al 2020). Since DWMRI probes a different biological process to 18F-FDG PET-CT, the two modalities may be complementary in stratifying the risk of residual or recurrent disease (Preda et al 2016)
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