Abstract
Objectives
We prospectively investigated the roles of pretreatment dynamic contrast-enhanced MR imaging (DCE-MRI), diffusion-weighted MR imaging (DWI) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT for predicting survival of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with chemoradiation.
Methods
Patients with histologically proven OHSCC and neck nodal metastases scheduled for chemoradiation were eligible. Clinical variables as well as DCE-MRI-, DWI- and 18F-FDG PET/CT-derived parameters of the primary tumours and metastatic neck nodes were analysed in relation to 3-year progression-free survival (PFS) and overall survival (OS) rates.
Results
Eighty-six patients were available for analysis. Multivariate analysis identified the efflux rate constant (K ep)-tumour < 3.79 min−1 (P = 0.001), relative volume of extracellular extravascular space (V e)-node < 0.23 (P = 0.004) and SUVmax-tumour > 19.44 (P = 0.025) as independent risk factors for both PFS and OS. A scoring system based upon the sum of each of the three imaging parameters allowed stratification of our patients into three groups (patients with 0/1 factor, patients with 2 factors and patients with 3 factors, respectively) with distinct PFS (3-year rates = 72 %, 38 % and 0 %, P < 0.0001) and OS (3-year rates = 81 %, 46 % and 20 %, P < 0.0001).
Conclusions
K ep-tumour, V e-node and SUVmax-tumour were independent prognosticators for OHSCC treated with chemoradiation. Their combination helped survival stratification.
Key Points
• K ep -tumour, V e -node and SUV max -tumour are independent predictors of survival rates.
• The combination of these three prognosticators may help stratification of survival.
• MRI and FDG-PET/CT play complementary roles in prognostication of head and neck cancer.
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Abbreviations
- ADC:
-
apparent diffusion coefficient
- DCE-MRI:
-
dynamic contrast-enhanced magnetic resonance imaging
- DWI:
-
diffusion-weighted imaging
- 18F-FDG PET/CT:
-
18F-fluorodeoxyglucose-positron emission tomography/computed tomography
- HNSCC:
-
head and neck squamous cell carcinoma
- K ep :
-
efflux rate constant
- K trans :
-
volume transfer rate constant
- MTV:
-
metabolic tumour volume
- OHSCC:
-
oropharyngeal or hypopharyngeal squamous cell carcinoma
- OS:
-
overall survival
- PFS:
-
progression-free survival
- SUVmax :
-
maximum standardized uptake value
- TLG:
-
total lesion glycolysis
- V e :
-
relative volume of extracellular extravascular space
- V p :
-
relative vascular plasma volume
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Acknowledgments
The scientific guarantor of this publication is Shu-Hang Ng. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by two grants (99-2314-B-182A-095-MY3 and NSC 102-2314-B-182A-098 -MY2) from the National Science Council-Taiwan. The imaging facility was supported by the Imaging Core Laboratory of Institute for Radiological Research and Center for Advanced Molecular Imaging and Translation. The authors would like to thank the Neuroscience Research Center, Chang Gung Memorial Hospital, Imaging Core Laboratory of Institute for Radiological Research, Chang Gung University / Chang Gung Memorial Hospital, Linkou and the Healthy Aging Center, Chang Gung University for providing support. Two of the authors has significant statistical expertise (Chun-Ta Liao and Lan-Yan Yang). Institutional review board approval was obtained. The Institutional Review Board of the Chang Gung Memorial Hospital approved the study protocol (protocol no. 98-3582B) in December 2009. Written informed consent was obtained from all patients in this study. Some study subjects or cohorts have been previously reported with different research goals in the following two published papers:
Ng SH, Lin CY, Chan SC bet al. (2013) Dynamic contrast-enhanced MR imaging predicts local control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy. PLoS One 8:e72230
Ng SH, Lin CY, Chan SC et al (2014) Clinical utility of multimodality imaging with dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET/CT for the prediction of neck control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. PLoS One 9:e115933
Methodology: prospective, diagnostic or prognostic study, performed at one institution.
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Shu-Hang Ng and Chun-Ta Liao contributed equally to this work.
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Ng, SH., Liao, CT., Lin, CY. et al. Dynamic contrast-enhanced MRI, diffusion-weighted MRI and 18F-FDG PET/CT for the prediction of survival in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. Eur Radiol 26, 4162–4172 (2016). https://doi.org/10.1007/s00330-016-4276-8
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DOI: https://doi.org/10.1007/s00330-016-4276-8