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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 5/2018

Open Access 01-05-2018 | Original Article

Changes in multimodality functional imaging parameters early during chemoradiation predict treatment response in patients with locally advanced head and neck cancer

Authors: Kee H. Wong, Rafal Panek, Alex Dunlop, Dualta Mcquaid, Angela Riddell, Liam C. Welsh, Iain Murray, Dow-Mu Koh, Martin O. Leach, Shreerang A. Bhide, Christopher M. Nutting, Wim J. Oyen, Kevin J. Harrington, Kate L. Newbold

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2018

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Abstract

Objective

To assess the optimal timing and predictive value of early intra-treatment changes in multimodality functional and molecular imaging (FMI) parameters as biomarkers for clinical remission in patients receiving chemoradiation for head and neck squamous cell carcinoma (HNSCC).

Methods

Thirty-five patients with stage III-IVb (AJCC 7th edition) HNSCC prospectively underwent 18F–FDG-PET/CT, and diffusion-weighted (DW), dynamic contrast-enhanced (DCE) and susceptibility-weighted MRI at baseline, week 1 and week 2 of chemoradiation. Patients with evidence of persistent or recurrent disease during follow-up were classed as non-responders. Changes in FMI parameters at week 1 and week 2 were compared between responders and non-responders with the Mann–Whitney U test. The significance threshold was set at a p value of <0.05.

Results

There were 27 responders and 8 non-responders. Responders showed a greater reduction in PET-derived tumor total lesion glycolysis (TLG40%; p = 0.007) and maximum standardized uptake value (SUVmax; p = 0.034) after week 1 than non-responders but these differences were absent by week 2. In contrast, it was not until week 2 that MRI-derived parameters were able to discriminate between the two groups: larger fractional increases in primary tumor apparent diffusion coefficient (ADC; p < 0.001), volume transfer constant (Ktrans; p = 0.012) and interstitial space volume fraction (Ve; p = 0.047) were observed in responders versus non-responders. ADC was the most powerful predictor (∆ >17%, AUC 0.937).

Conclusion

Early intra-treatment changes in FDG-PET, DW and DCE MRI-derived parameters are predictive of ultimate response to chemoradiation in HNSCC. However, the optimal timing for assessment with FDG-PET parameters (week 1) differed from MRI parameters (week 2). This highlighted the importance of scanning time points for the design of FMI risk-stratified interventional studies.
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Literature
1.
Han M, Kim SY, Lee SJ, Choi JW. The correlations between MRI perfusion, diffusion parameters, and 18F-FDG PET metabolic parameters in primary head-and-neck cancer: a cross-sectional analysis in single institute. Medicine (Baltimore). 2015;94:e2141.CrossRef
2.
Subesinghe M, Scarsbrook AF, Sourbron S, Wilson DJ, McDermott G, Speight R, et al. Alterations in anatomic and functional imaging parameters with repeated FDG PET-CT and MRI during radiotherapy for head and neck cancer: a pilot study. BMC Cancer. BioMed Central Ltd. 2015;15:137.CrossRefPubMedPubMedCentral
3.
Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumor imaging: version 2.0. 2nd ed. Eur J Nucl Med Mol Imaging. 2015:328–54.
4.
Larson SM, Erdi Y, Akhurst T, Mazumdar M, Macapinlac HA, Finn RD, et al. Tumor treatment response based on visual and quantitative changes in global tumor Glycolysis using PET-FDG imaging. The visual response score and the change in Total lesion Glycolysis. Clin Positron Imaging. 1999;2:159–71.CrossRefPubMed
5.
d'Arcy JA, Collins DJ, Padhani AR, Walker-Samuel S, Suckling J, Leach MO. Informatics in radiology (infoRAD): magnetic resonance imaging workbench: analysis and visualization of dynamic contrast-enhanced MR imaging data. Radiographics. 2005;26:621–32.CrossRef
6.
Tofts PS, Brix G, Buckley DL, Evelhoch JL, Henderson E, Knopp MV, et al. Estimating kinetic parameters from dynamic contrast-enhanced T 1-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging. 1999;10:223–32.CrossRefPubMed
7.
Orton MR, d'Arcy JA, Walker-Samuel S, Hawkes DJ, Atkinson D, Collins DJ, et al. Computationally efficient vascular input function models for quantitative kinetic modelling using DCE-MRI. Phys Med Biol. 2008;53:1225–39.CrossRefPubMed
8.
Chen AM, Felix C, Wang PC, Hsu S, Basehart V, Garst J, et al. Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study. Lancet Oncol. 2017;18(6):803–11.CrossRefPubMed
9.
Kataria T, Gupta D, Goyal S, Bisht SS, Basu T, Abhishek A, et al. Clinical outcomes of adaptive radiotherapy in head and neck cancers. BJR. 2016;89:20160085–6.CrossRefPubMedPubMedCentral
10.
Pigorsch SU, Wilkens JJ, Kampfer S, Kehl V, Hapfelmeier A, Schläger C, et al. Do selective radiation dose escalation and tumor hypoxia status impact the loco- regional tumor control after radio- chemotherapy of head & neck tumors? The ESCALOX protocol. Radiat Oncol. 2017;12(1):45.CrossRefPubMedPubMedCentral
11.
Bentzen J, Toustrup K, Eriksen JG, Primdahl H, Andersen LJ, Overgaard J. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. Results from the DAHANCA 18 phase II study. Acta Oncol. 2015;54:1001–7.CrossRefPubMed
12.
Nickson CM, Moori P, Carter RJ, Rubbi CP. Misregulation of DNA damage repair pathways in HPV-positive head and neck squamous cell carcinoma contributes to cellular radiosensitivity. Oncotarget. 2017.
13.
Nagasaka M, Zaki M, Kim H, Raza SN, Yoo G, Lin H-S, et al. PD1/PD-L1 inhibition as a potential radiosensitizer in head and neck squamous cell carcinoma: a case report. J Immunother Cancer. 2016;4:83.CrossRefPubMedPubMedCentral
14.
Wong KH, Panek R, Welsh L, McQuaid D, Dunlop A, Riddell A, et al. 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. 2016;57:1843–50.CrossRefPubMed
15.
Powell C, Schmidt M, Borri M, Koh D-M, Partridge M, Riddell A, et al. Changes in functional imaging parameters following induction chemotherapy have important implications for individualised patient-based treatment regimens for advanced head and neck cancer. Radiother Oncol. 2013;106:112–7.CrossRefPubMed
16.
Troost EGC, Bussink J, Hoffmann AL, Boerman OC, Oyen WJG, Kaanders JHAM. 18F-FLT PET/CT for early response monitoring and dose escalation in oropharyngeal tumors. J Nucl Med. 2010;51:866–74.CrossRefPubMed
17.
King AD, Mo FKF, Yu K-H, Yeung DKW, Zhou H, Bhatia KS, et al. Squamous cell carcinoma of the head and neck: diffusion-weighted MR imaging for prediction and monitoring of treatment response. Eur Radiol. 2010;20:2213–20.CrossRefPubMed
18.
Matoba M, Tuji H, Shimode Y, Toyoda I, Kuginuki Y, Miwa K, et al. Fractional change in apparent diffusion coefficient as an imaging biomarker for predicting treatment response in head and neck cancer treated with chemoradiotherapy. AJNR Am J Neuroradiol. 2014;35:379–85.CrossRefPubMed
19.
Kim S, Loevner L, Quon H, Sherman E, Weinstein G, Kilger A, et al. 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. 2009;15:986–94.CrossRefPubMedPubMedCentral
20.
Vandecaveye V, Dirix P, De Keyzer F, Op de Beeck K, Vander Poorten V, Hauben E, et al. Diffusion-weighted magnetic resonance imaging early after chemoradiotherapy to monitor treatment response in head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2012;82:1098–107.CrossRefPubMed
21.
Cao Y, Popovtzer A, Li D, Chepeha DB, Moyer JS, Prince ME, et al. Early prediction of outcome in advanced head-and-neck cancer based on tumor blood volume alterations during therapy: a prospective study. Int J Radiat Oncol Biol Phys. 2008;72:1287–90.CrossRefPubMedPubMedCentral
22.
Baer AH, Hoff BA, Srinivasan A, Galban CJ, Mukherji SK. Feasibility analysis of the parametric response map as an early predictor of treatment efficacy in head and neck cancer. AJNR Am J Neuroradiol. 2015;36:757–62.CrossRefPubMedPubMedCentral
23.
Baudelet C, Gallez B. How does blood oxygen level-dependent (BOLD) contrast correlate with oxygen partial pressure (pO2) inside tumors? Magn Reson Med. 2002;48:980–6.CrossRefPubMed
24.
Li XS, Fan HX, Fang H, Song YL, Zhou CW. Value of R2* obtained from T2*-weighted imaging in predicting the prognosis of advanced cervical squamous carcinoma treated with concurrent chemoradiotherapy. J Magn Reson Imaging. 2015;42:681–8.CrossRefPubMed
25.
Min M, Lee MT, Lin P, Holloway L, Wijesekera D, Gooneratne D, et al. Assessment of serial multi-parametric functional MRI (diffusion-weighted imaging and R2*) with 18F-FDG-PET in patients with head and neck cancer treated with radiation therapy. BJR. 2016;89:20150530–9.CrossRefPubMedPubMedCentral
26.
Panek R, Welsh L, Dunlop A, Wong KH, Riddell AM, Koh D-M, et al. Repeatability and sensitivity of T2* measurements in patients with head and neck squamous cell carcinoma at 3T. J Magn Reson Imaging. 2016;44:72–80.CrossRefPubMedPubMedCentral
27.
Rodrigues LM, Howe FA, Griffiths JR, Robinson SP. Tumor R2* is a prognostic indicator of acute radiotherapeutic response in rodent tumors. J Magn Reson Imaging. 2004;19:482–8.CrossRefPubMed
28.
Dennie J, Mandeville JB, Boxerman JL, Packard SD, Rosen BR, Weisskoff RM. NMR imaging of changes in vascular morphology due to tumor angiogenesis. Magn Reson Med. 1998;40:793–9.CrossRefPubMed
29.
Gambarota G, van Laarhoven HWM, Philippens M, Lok J, van der Kogel A, Punt CJA, et al. Assessment of absolute blood volume in carcinoma by USPIO contrast-enhanced MRI. Magn Reson Imaging. 2006;24:279–86.CrossRefPubMed
Metadata
Title
Changes in multimodality functional imaging parameters early during chemoradiation predict treatment response in patients with locally advanced head and neck cancer
Authors
Kee H. Wong
Rafal Panek
Alex Dunlop
Dualta Mcquaid
Angela Riddell
Liam C. Welsh
Iain Murray
Dow-Mu Koh
Martin O. Leach
Shreerang A. Bhide
Christopher M. Nutting
Wim J. Oyen
Kevin J. Harrington
Kate L. Newbold
Publication date
01-05-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-017-3890-2

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