Diffusion-Weighted Magnetic Resonance Imaging Early After Chemoradiotherapy to Monitor Treatment Response in Head-and-Neck Squamous Cell Carcinoma

• Published in: International journal of radiation oncology, biology, physics Vol. 82; no. 3; pp. 1098 - 1107
• Main Authors: Vandecaveye, Vincent, Dirix, Piet, De Keyzer, Frederik, Op de Beeck, Katya, Vander Poorten, Vincent, Hauben, Esther, Lambrecht, Maarten, Nuyts, Sandra, Hermans, Robert
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier
• Subjects: Adult; Aged; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; CARCINOMAS; Chemoradiotherapy; Cisplatin - therapeutic use; COMBINED THERAPY; DIFFUSION; Diffusion Magnetic Resonance Imaging - methods; Diffusion-weighted MRI; HEAD; Head and neck cancer; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Hematology, Oncology and Palliative Medicine; Humans; Lymphatic Metastasis; Medical sciences; Middle Aged; NECK; Neoplasm Staging; NMR IMAGING; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; PATIENTS; Prospective Studies; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiotherapy Dosage; Tomography, X-Ray Computed; Treatment assessment; Treatment Outcome; Tumors; Head and neck cancer; Treatment assessment; Chemoradiotherapy; Diffusion-weighted MRI; Treatment efficiency; Malignant tumor; Radiotherapy; Nuclear magnetic resonance imaging; Weight; Chemotherapy; Treatment; Cancerology; Medical imagery; ENT disease; Head and neck squamous cell carcinoma; Early; Diffusion; Cancer
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.02.044

To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in head and neck squamous cell carcinoma (HNSCC) three weeks after the end of chemoradiotherapy (CRT). Twenty-nine patients with HNSCC underwent magnetic resonance imaging (MRI) prior to and 3 weeks after CRT, including T2-weighted and pre- and postcontrast T1-weighted sequences and an echo-planar DWI sequence with six b values (0 to 1,000 s/mm2), from which the apparent diffusion coefficient (ADC) was calculated. ADC changes 3 weeks posttreatment compared to baseline (ΔADC) between responding and nonresponding primary lesions and adenopathies were correlated with 2 years locoregional control and compared with a Mann-Whitney test. In a blinded manner, the ΔADC was compared to conventional MRI 3 weeks post-CRT and the routinely implemented CT, on average 3 months post-CRT, which used size-related and morphological criteria. Positive and negative predictive values (PPV and NPV, respectively) were compared between the ΔADC and anatomical imaging. The ΔADC of lesions with later tumor recurrence was significantly lower than lesions with complete remission for both primary lesions (−2.3% ± 0.3% vs. 80% ± 41%; p < 0.0001) and adenopathies (19.9% ± 32% vs. 63% ± 36%; p = 0.003). The ΔADC showed a PPV of 89% and an NPV of 100% for primary lesions and a PPV of 70% and an NPV of 96% for adenopathies per neck side. DWI improved PPV and NPV compared to anatomical imaging. DWI with the ΔADC 3 weeks after concluding CRT for HNSCC allows for early assessment of treatment response.