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European Radiology
Published in: European Radiology 2/2021

Open Access 01-02-2021 | Intoxication | Head and Neck

Multiparametric functional MRI and 18F-FDG-PET for survival prediction in patients with head and neck squamous cell carcinoma treated with (chemo)radiation

Authors: Roland M. Martens, Thomas Koopman, Cristina Lavini, Meedie Ali, Carel F. W. Peeters, Daniel P. Noij, Gerben Zwezerijnen, J. Tim Marcus, Marije R. Vergeer, C. René Leemans, Remco de Bree, Pim de Graaf, Ronald Boellaard, Jonas A. Castelijns

Published in: European Radiology | Issue 2/2021

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Abstract

Objectives

To 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.

Methods

Between 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.

Results

In 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).

Conclusions

Functional 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 (K trans ), 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.
Appendix
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Literature
1.
Brockstein B, Haraf DJ, Rademaker AW et al (2004) Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: a 9-year, 337-patient, multi-institutional experience. Ann Oncol 15(8):1179–1186CrossRef
2.
Schuller DE, Grecula JC, Agrawal A et al (2002) Multimodal intensification therapy for previously untreated advanced resectable squamous cell carcinoma of the oral cavity, oropharynx, or hypopharynx. Cancer. 94(12):3169–3178CrossRef
3.
Mirghani H, Blanchard P (2018) Treatment de-escalation for HPV-driven oropharyngeal cancer: where do we stand? Clin Transl Radiat Oncol 8:4–11
4.
Machtay M, Jennifer M, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26(21):3582–3589CrossRef
5.
Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology. 168:497–505
6.
Noij DP, Martens RM, Marcus JT et al (2017) Intravoxel incoherent motion magnetic resonance imaging in head and neck cancer: a systematic review of the diagnostic and prognostic value. Oral Oncol 68:81–91CrossRef
7.
Payabvash S (2018) Quantitative diffusion magnetic resonance imaging in head and neck tumors. Quant Imaging Med Surg 8(10):1052–1065CrossRef
8.
Tofts PS, Brix G, Buckley DL et al (1999) Estimating kinetic parameters from dynamic contrast-enhancedT1-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 10(3):223–232CrossRef
9.
Kwon SH, Yoon JK, An YS et al (2014) Prognostic significance of the intratumoral heterogeneity of (18) F-FDG uptake in oral cavity cancer. J Surg Oncol 110(6):702–706CrossRef
10.
de Perrot T, Lenoir V, Domingo Ayllon M, Dulguerov N, Pusztaszeri M, Becker M (2017) Apparent diffusion coefficient histograms of human papillomavirus-positive and human papillomavirus-negative head and neck squamous cell carcinoma: assessment of tumor heterogeneity and comparison with histopathology. AJNR Am J Neuroradiol 38(11):2153–2610CrossRef
11.
12.
Marzi S, Piludu F, Forina C et al (2017) Correlation study between intravoxel incoherent motion MRI and dynamic contrast-enhanced MRI in head and neck squamous cell carcinoma: evaluation in primary tumors and metastatic nodes. Magn Reson Imaging 37:1–8CrossRef
13.
Xu XQ, Choi YJ, Sung YS et al (2016) Intravoxel incoherent motion MR imaging in the head and neck: correlation with dynamic contrast-enhanced MR imaging and diffusion-weighted imaging. Korean J Radiol 17(5):641–649CrossRef
14.
Bonomo P, Merlotti A, Olmetto E et al (2018) What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 45(12):2122–2138CrossRef
15.
Rumley CN, Lee MT, Holloway L et al (2017) Multiparametric magnetic resonance imaging in mucosal primary head and neck cancer: a prospective imaging biomarker study. BMC Cancer 17(1):475CrossRef
16.
Leifels L, Purz S, Stumpp P et al (2017) Associations between (18)F-FDG-PET, DWI, and DCE parameters in patients with head and neck squamous cell carcinoma depend on tumor grading. Contrast Media Mol Imaging 2017:1–8CrossRef
17.
Chawla S, Kim S, Loevner LA et al (2011) Prediction of disease-free survival in patients with squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging. AJNR AJNR Am J Neuroradiol 32(4):778–784
18.
Chawla S, Kim S, Dougherty L et al (2013) Pretreatment diffusion-weighted and dynamic contrast-enhanced MRI for prediction of local treatment response in squamous cell carcinomas of the head and neck. AJR Am J Roentgenol 200(1):35–43CrossRef
19.
King AD, Mo FK, Yu KH et al (2010) Squamous cell carcinoma of the head and neck: diffusion-weighted MR imaging for prediction and monitoring of treatment response. Eur Radiol 20(9):2213–2220CrossRef
20.
Kim S, Loevner LA, Quon H et al (2010) Prediction of response to chemoradiation therapy in squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging. AJNR. 31(2):262–268CrossRef
21.
22.
23.
Chan SC, Cheng NM, Hsieh CA et al (2017) Multiparametric imaging using 18 parameters and functional MRI F-FDG PET/CT heterogeneity techniques: prognostic significance in patients with primary advanced oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy. Oncotarget. 8(37):62606–62621CrossRef
24.
Schouten CS, Hakim S, Boellaard R et al (2016) Interaction of quantitative (18)F-FDG-PET-CT imaging parameters and human papillomavirus status in oropharyngeal squamous cell carcinoma. Head Neck 38(4):529–535CrossRef
25.
Vokes EE, Agrawal N, Seiwert TY (2015) HPV-associated head and neck cancer. J Natl Cancer Inst 107(12):344CrossRef
26.
Hashibe M, Brennan P, Benhamou S et al (2007) Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst 99(10):777–789CrossRef
27.
Lavini C, Kramer G, Pieters-den Bos I, Hoekstra O, Marcus JT (2017) MRI protocol optimization for quantitative DCE-MRI of the spine. Magn Reson Imaging 44:96–103CrossRef
28.
Boellaard R, Delgado-Bolton R, Oyen WJG et al (2015) FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 42(2):328–354CrossRef
29.
Frings V, Van Velden FHP, Velasquez LM et al (2014) Repeatability of metabolically active tumor volume measurements with FDG PET/CT in advanced gastrointestinal malignancies: a multicenter study. Radiology. 273(2):538–548CrossRef
30.
Moons KG, Altman DG, Reitsma JB et al (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 162(1):W1–W73
31.
Collins GS, Reitsma JB, Altman DG, Moons KG (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med 162(1):55–63CrossRef
32.
Schouten CS, de Graaf P, Bloemena E et al (2015) Quantitative diffusion-weighted MRI parameters and human papillomavirus status in oropharyngeal squamous cell carcinoma. AJNR Am J Neuroradiol 36(4):763–767CrossRef
33.
Chan MW, Higgins K, Enepekides D et al (2016) Radiologic differences between human papillomavirus-related and human papillomavirus-unrelated oropharyngeal carcinoma on diffusion-weighted imaging. ORL. 78(6):344–352CrossRef
34.
Wong KH, Panek R, Welsh L et al (2016) The predictive value of early assessment after 1 cycle of induction chemotherapy with 18F-FDG PET/CT and diffusion-weighted MRI for response to radical chemoradiotherapy in head and neck squamous cell carcinoma. J Nucl Med 57(12):1843–1850CrossRef
35.
Driessen JP, van Bemmel AJ, van Kempen PM et al (2015) Correlation of human papillomavirus status with apparent diffusion coefficient of diffusion-weighted MRI in head and neck squamous cell carcinomas. Head Neck 38:E613–E6E8CrossRef
36.
Nakajo M, Nakajo M, Kajiya Y et al (2012) FDG PET/CT and diffusion-weighted imaging of head and neck squamous cell carcinoma: comparison of prognostic significance between primary tumor standardized uptake value and apparent diffusion coefficient. Clin Nucl Med 37(5):475–480CrossRef
37.
Agrawal S, Awasthi R, Singh A, Haris M, Gupta RK, Rathore RKS (2012) An exploratory study into the role of dynamic contrast-enhanced (DCE) MRI metrics as predictors of response in head and neck cancers. Clin Radiol 67(9):1–5CrossRef
38.
39.
Covello M, Cavaliere C, Aiello M et al (2015) Simultaneous PET/MR head-neck cancer imaging: preliminary clinical experience and multiparametric evaluation. Eur J Radiol 84(7):1269–1276CrossRef
40.
Han MW, Lee HJ, Cho KJ et al (2012) Role of FDG-PET as a biological marker for predicting the hypoxic status of tongue cancer. Head Neck 34(10):1395–1402CrossRef
41.
Ng SH, Liao CT, Lin CY et al (2016) Dynamic contrast-enhanced MRI, diffusion-weighted MRI and (18)F-FDG PET/CT for the prediction of survival in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. Eur Radiol 26(11):4162–4172CrossRef
42.
Hatakenaka M, Nakamura K, Yabuuchi H et al (2011) Pretreatment apparent diffusion coefficient of the primary lesion correlates with local failure in head-and-neck cancer treated with chemoradiotherapy or radiotherapy. Int J Radiat Oncol Biol Phys 81(2):339–345CrossRef
43.
Kim S, Loevner L, Quon H et al (2009) Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck. Clin Cancer Res 15(3):986–994CrossRef
44.
Lehnerdt GF, Franz P, Zaqoul A et al (2008) Overall and relapse-free survival in oropharyngeal and hypopharyngeal squamous cell carcinoma are associated with genotypes of T393C polymorphism of the GNAS1 gene. Clin Cancer Res 14(6):1753–1758CrossRef
45.
Surov A, Stumpp P, Meyer HJ et al (2016) Simultaneous (18)F-FDG-PET/MRI: associations between diffusion, glucose metabolism and histopathological parameters in patients with head and neck squamous cell carcinoma. Oral Oncol 58:14–20CrossRef
46.
Metadata
Title
Multiparametric functional MRI and 18F-FDG-PET for survival prediction in patients with head and neck squamous cell carcinoma treated with (chemo)radiation
Authors
Roland M. Martens
Thomas Koopman
Cristina Lavini
Meedie Ali
Carel F. W. Peeters
Daniel P. Noij
Gerben Zwezerijnen
J. Tim Marcus
Marije R. Vergeer
C. René Leemans
Remco de Bree
Pim de Graaf
Ronald Boellaard
Jonas A. Castelijns
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07163-3

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