Top

Journal of Cancer Research and Clinical Oncology

Published in:

Open Access 01-08-2021 | Oropharyngeal Cancer | Original Article – Cancer Research

The ability of post-chemoradiotherapy DWI ADC_mean and ¹⁸F-FDG SUV_max to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status

Authors: S. Connor, C. Sit, M. Anjari, M. Lei, T. Guerrero-Urbano, T. Szyszko, G. Cook, P. Bassett, V. Goh

Published in: Journal of Cancer Research and Clinical Oncology | Issue 8/2021

Abstract

Objectives

To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADC_mean) and ¹⁸F-FDG PET maximum standardized uptake value (SUV_max) 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.

Methods

This 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 ADC_mean (pre-treatment, 6- and 12-weeks post-CRT) and SUV_max (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.

Results

Absolute post-CRT ADC_mean 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 ADC_mean 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 SUV_max did not predict DFS.

Conclusion

Absolute post-CRT ADC_mean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADC_mean 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.

Available only for authorised users

Agra IM, Carvalho AL, Ulbrich FS et al (2006) Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 28:107–113PubMedCrossRef

Ailianou A, Mundada XP, De Perrot XT, Pusztaszieri XM, Poletti XP-A, Becker XM (2018) MRI with DWI for the detection of posttreatment head and neck squamous cell carcinoma: why morphologic MRI criteria matter. AJNR Am J Neuroradiol 39:748–755PubMedPubMedCentralCrossRef

Becker M, Varoquaux AD, Combescure C et al (2018) Local recurrence of squamous cell carcinoma of the head and neck after radio(chemo)therapy: diagnostic performance of FDG-PET/MRI with diffusion-weighted sequences. Eur Radiol 28:651–663PubMedCrossRef

Berrak S, Chawla S, Kim S et al (2011) Diffusion weighted imaging in predicting progression free survival in patients with squamous cell carcinomas of the head and neck treated with induction chemotherapy. Acad Radiol 18:1225–1232PubMedPubMedCentralCrossRef

Brenet E, Barbe C, Hoeffel C et al (2020) Predictive value of early post-treatment diffusion-weighted MRI for recurrence or tumor progression of head and neck squamous cell carcinoma treated with chemo-radiotherapy. Cancer 12:1234CrossRef

Cao Y, Aryal M, Li P et al (2019) Predictive values of MRI and PET derived quantitative parameters for patterns of failure in both p16+ and p16- high risk head and neck cancer. Front Oncol 14:1118CrossRef

Castelli J, De Bari B, Depeursinge A et al (2016) Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy. Crit Rev Oncol Hematol 108:40–51 PubMedCrossRef

Chan JYK, Sanguineti G, Richmon JD, Marur S (2012) Retrospective review of positron emission tomography with contrast-enhanced computed tomography in the posttreatment setting in human papillomavirus–associated oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 138:1040–1046PubMedPubMedCentralCrossRef

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 J Otorhinolaryngol Relat Spec 78:344–352PubMedCrossRef

Chang JH, Wu CC, Yuan KSP, Wu ATH, Wu SY (2017) Loco-regionally recurrent head and neck squamous cell carcinoma: incidence, survival, prognostic factors and treatment outcomes. Oncotarget 8:55600–55612PubMedPubMedCentralCrossRef

Chaturvedi AK, Engels EA, Pfeiffer RM et al (2011) Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 29:4294–4301PubMedPubMedCentralCrossRef

Chawla S, Kim S, Wang S, Poptani H (2009) Diffusion weighted imaging in head and neck cancers. Future Oncol 5:959–975PubMedCrossRef

Chernock RD, El-Mofty SK, Thorstad WL, Parvin CA, Lewis JS (2009) HPV-related nonkeratinizing squamous cell carcinoma of the oropharynx: utility of microscopic features in predicting patient outcome. Head Neck Pathol 3:186–194PubMedPubMedCentralCrossRef

Choi SH, Paeng JC, Sohn CH et al (2011) Correlation of 18F-FDG uptake with apparent diffusion coefficient ratio measured on standard and high b value diffusion MRI in head and neck cancer. J Nucl Med 52:1056–1062PubMedCrossRef

Ding Y, Hazle JD, Mohamed ASR et al (2015) Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results form a prospective pilot study. NMR Biomed 28:1645–1654PubMedPubMedCentralCrossRef

Driessen JP, van Bemmel AJ, van Kempen PM et al (2016) Correlation of human papillomavirus status with apparent diffusion coefficient of diffusion-weighted MRI in head and neck squamous cell carcinomas. Head Neck 38:E613-618PubMedCrossRef

El-Mofty SK, Lu DW (2003) Prevalence of human papillomavirus type 16 DNA in squamous cell carcinoma of the palatine tonsil, and not the oral cavity, in young patients: a distinct clinicopathologic and molecular disease entity. Am J Surg Pathol 27:1463–1470PubMedCrossRef

Fakhry C, Lacchetti C, Rooper LM et al (2018) Papillomavirus testing in head and neck carcinomas: ASCO Clinical Practice Guideline Endorsement of the College of American Pathologists Guideline. J Clin Oncol 36:3152–3161PubMedCrossRef

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917PubMedCrossRef

Galbán CJ, Lemasson L, Hoff BA et al (2015) Development of a multiparametric voxel-based magnetic resonance imaging biomarker for early cancer therapeutic response assessment. Tomography 1:44–52PubMedPubMedCentralCrossRef

Goodwin WJ Jr (2000) Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 110:1–18PubMedCrossRef

Helsen N, Van den Wyngaert T, Carp L, Stroobants S (2018) FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. EJNMMI 45:1063–1071

Hermans R, Pameijer FA, Mancuso AA, Parsons JT, Mendenhall WM (2000) Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone? Radiology 214:683–687PubMedCrossRef

Kendi AT, Magliocca K, Corey A et al (2015) Do 18F-FDG PET/CT parameters in oropharyngeal and oral cavity squamous cell carcinomas indicate HPV status? Clin Nucl Med 40:e196–e200PubMedPubMedCentralCrossRef

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 15:986–994PubMedPubMedCentralCrossRef

Kim R, Ock CY, Keam B et al (2016) Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study. BMC Cancer 16:116PubMedPubMedCentralCrossRef

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 20:2213–2220PubMedCrossRef

King AD, Chow K-K, Yu K-H et al (2013a) Head and neck squamous cell carcinoma: diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response. Radiology 266:531–538PubMedCrossRef

King AD, Keung CK, Yu KH et al (2013b) T2-weighted MR imaging early after chemoradiotherapy to evaluate treatment response in head and neck squamous cell carcinoma. AJNR Am J Neuroradiol 34:1237–1241PubMedPubMedCentralCrossRef

Koksel Y, Gencturk M, Spano A et al (2019) Utility of Likert scale (Deauville criteria) in assessment of chemoradiotherapy response of primary oropharyngeal squamous cell cancer site. Clin Imaging 55:89–94PubMedCrossRef

Koshkareva Y, Branstetter BB, Gaughan JP, Ferris RL (2014) Predictive accuracy of first post-treatment PET/CT in HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope 124:1843–1847PubMedCrossRef

Krabbe CA, Prium J, Dijkstra PU et al (2009) 18F-FDG PET as a routine posttreatment surveillance tool in oral and oropharyngeal squamous cell carcinoma: a prospective study. J Nucl Med 50:1940–1947PubMedCrossRef

Krupar R, Robold K, Gaag D et al (2014) Immunologic and metabolic characteristics of HPV-negative and HPV-positive head and neck squamous cell carcinomas are strikingly different. Virchows Arch 465:299–312PubMedCrossRef

Kuang F, Yan Z, Wang J, Rao Z (2011) The value of diffusion-weighted MRI to evaluate the response to radiochemotherapy for cervical cancer. Magn Reson Imaging 32:342–349CrossRef

Liu Y-H, Milne R, Lock G, Panizza B (2019) Utility of a repeat PET/CT scan in HPV-associated oropharyngeal cancer following incomplete nodal response from (chemo)radiotherapy. Oral Oncol 88:153–159PubMedCrossRef

Marcus C, Ciarollo A, Tahari AK et al (2014) Head and neck PET/CT: therapy response interpretation criteria (Hopkins Criteria)–interreader reliability, accuracy, and survival outcomes. J Nucl Med 55:1411–1416PubMedCrossRef

Martins BL, Chojniak R, Kowalski LP, Nicolau UR, Lima ENP, Bitencourt AGV (2015) Diffusion-weighted MRI in the assessment of early treatment response in patients with squamous-cell carcinoma of the head and neck: comparison with morphological and PET/CT findings. PLoS ONE 10:e0140009PubMedPubMedCentralCrossRef

Marzi S, Piludu F, Sanguineti G et al (2017) The prediction of the treatment response of cervical nodes using intravoxel incoherent motion diffusion-weighted imaging. Eur J Radiol 92:93–102PubMedCrossRef

Matoba M, Tuji H, Shimode Y et al (2014) 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 35:379–385PubMedPubMedCentralCrossRef

Matoba M, Tuji H, Shimode Y, Kondo T, Oota K, Tonami H (2017) The role of changes in maximum standardized uptake value of FDG PET-CT for posttreatment surveillance in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy: preliminary findings. Br J Radiol 90:20150404PubMedPubMedCentralCrossRef

Mehanna H, Wong WL, McConkey C et al (2016) PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med 374:1444–1454PubMedCrossRef

Moeller BJ, Rana V, Cannon BA et al (2009) Prospective risk-adjusted [18F] fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol 27:2509–2515PubMedPubMedCentralCrossRef

Mowery YM, Vergalasova I, Rushing CN et al (2020) Early ¹⁸F-FDG-PET response during radiation therapy for HPV-related oropharyngeal cancer may predict disease recurrence. Int J Rad Oncol Biol Phys 108:969–976CrossRef

Paudyal R, Hun J, Riaz N et al (2017) Intravoxel incoherent motion diffusion-weighted MRI during chemoradiation therapy to characterize and monitor treatment response in human papillomavirus head and neck squamous cell carcinoma. JMRI 45:1013–1023PubMedCrossRef

Porceddu SV, Pryor DI, Burmeister E et al (2011) Results of a prospective study of positron emission tomography-directed management of residual nodal abnormalities in node-positive head and neck cancer after definitive radiotherapy with or without systemic therapy. Head Neck 33:1675–1682PubMedCrossRef

Preda L, Conte G, Bonello L et al (2016) Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma. Eur Radiol 26:4432–4441PubMedCrossRef

Schouten CS, de Bree R, van der Putten L et al (2014) Diffusion-weighted EPI- and HASTE-MRI and 18F-FDG-PET-CT early during chemoradiotherapy in advanced head and neck cancer. Quant Imaging Med Surg 4:239–250PubMedPubMedCentral

Sheikhbahaei S, Taghipour M, Ahmad R et al (2015) Diagnostic accuracy of follow-up FDG PET or PET/CT in patients with head and neck cancer after definitive treatment: A systematic review and meta-analysis. Am J Roentgenol 205:629–639CrossRef

Sherriff JM, Ogunremi B, Colley S, Sanghera P, Hartley A (2012) The role of positron emission tomography/CT imaging in head and neck cancer patients after radical chemoradiotherapy. Br J Radiol 85:e1120–e1126PubMedPubMedCentralCrossRef

Sjövall J, Bitzen U, Kjellen E et al (2016) Qualitative interpretation of PET scans using a Likert scale to assess neck node response to radiotherapy in head and neck cancer. Eur j Nucl Med Mol Imaging 43:609–616PubMedCrossRef

Tahari AK, Alluri KC, Quon H, Koch W, Wahl RL, Subramaniam RM (2014) FDG PET/CT imaging of oropharyngeal squamous cell carcinoma: characteristics of human papillomavirus-positive and -negative tumors. Clin Nucl Med 39:225–231PubMedPubMedCentralCrossRef

Theony HC, De Keyzer F, King AD (2012) Diffusion-weighted MR imaging in the head and neck. Radiology 263:19–32CrossRef

Vainshtein JM, Spector ME, Stenmark MH et al (2014) Reliability of post-chemoradiotherapy F-18-FDG PET/CT for prediction of locoregional failure in human papillomavirus-associated oropharyngeal cancer. Oral Oncol 50:234–239PubMedCrossRef

Vandecaveye V, Dirix P, De Keyzer F et al (2012) 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 82:1098–1107PubMedCrossRef

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 57:1843–1850PubMedCrossRef

Zhang I, Branstetter BF, Beswick DM et al (2010) The Benefit of early PET/CT surveillance in HPV-associated head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 137:1106–1111CrossRef

Zhang Q, Zhou Z, Qin G et al (2018) Prediction of local persistence/recurrence on PET/CT scans after radiation therapy treatmnet of head and neck cancer using a multi-objective radiomics model. Int J Rad Oncol Bio Phys 102:S94CrossRef

Zhong J, Sundersingh M, Dyker K et al (2020) Post-treatment FDG PET-CT in head and neck carcinoma: comparative analysis of 4 qualitative interpretative criteria in a large patient cohort. Sci Rep 10:4086PubMedPubMedCentralCrossRef

Title: The ability of post-chemoradiotherapy DWI ADCmean and 18F-FDG SUVmax to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status
Authors: S. Connor
C. Sit
M. Anjari
M. Lei
T. Guerrero-Urbano
T. Szyszko
G. Cook
P. Bassett
V. Goh
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keyword: Oropharyngeal Cancer
Published in: Journal of Cancer Research and Clinical Oncology / Issue 8/2021
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-021-03662-y

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The ability of post-chemoradiotherapy DWI ADC_mean and ¹⁸F-FDG SUV_max to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status

Abstract

Objectives

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2021

Apatinib combined with PD-L1 blockade synergistically enhances antitumor immune responses and promotes HEV formation in gastric cancer

Correction to: Multigene panel testing for hereditary breast and ovarian cancer in the province of Ontario

Associated factors and outcomes of delaying adjuvant chemotherapy in breast cancer by biologic subtypes: a National Cancer Database study

Testicular cancer follow-up costs in Germany from 2000 to 2015

Treatment stage migration and treatment sequences in patients with hepatocellular carcinoma: drawbacks and opportunities

Is the prediction of one or two ipsilateral positive lymph nodes by computerized tomography and ultrasound reliable enough to restrict therapeutic neck dissection in oral squamous cell carcinoma (OSCC) patients?

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page