Roland M Martens1, Thomas Koopman2, Cristina Lavini3, Meedie Ali2, Carel F W Peeters4, Daniel P Noij2, Gerben Zwezerijnen2, J Tim Marcus2, Marije R Vergeer5, C René Leemans6, Remco de Bree7, Pim de Graaf2, Ronald Boellaard2, Jonas A Castelijns2. 1. Department of Radiology and Nuclear Medicine, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands. ro.martens@amsterdamumc.nl. 2. Department of Radiology and Nuclear Medicine, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands. 3. Department of Radiology and Nuclear Medicine, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands. 4. Department of Epidemiology and Biostatistics, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands. 5. Department of Radiation Oncology, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands. 6. Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands. 7. Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
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 (Ktrans), 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.
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 (Ktrans), 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.
Entities:
Keywords:
Diffusion magnetic resonance imaging; Magnetic resonance imaging; Positron emission tomography computed tomography; Squamous cell carcinoma of head and neck; Survival analysis
Authors: C S Schouten; P de Graaf; E Bloemena; B I Witte; B J M Braakhuis; R H Brakenhoff; C R Leemans; J A Castelijns; R de Bree Journal: AJNR Am J Neuroradiol Date: 2015-02-26 Impact factor: 3.825
Authors: T de Perrot; V Lenoir; M Domingo Ayllón; N Dulguerov; M Pusztaszeri; M Becker Journal: AJNR Am J Neuroradiol Date: 2017-09-14 Impact factor: 3.825
Authors: Goetz F Lehnerdt; Peter Franz; Anwar Zaqoul; Klaus J Schmitz; Sara Grehl; Stephan Lang; Kurt W Schmid; Winfried Siffert; Klaus Jahnke; Ulrich H Frey Journal: Clin Cancer Res Date: 2008-03-15 Impact factor: 12.531
Authors: Pierluigi Bonomo; A Merlotti; E Olmetto; A Bianchi; I Desideri; A Bacigalupo; P Franco; C Franzese; E Orlandi; L Livi; S Caini Journal: Eur J Nucl Med Mol Imaging Date: 2018-06-09 Impact factor: 9.236
Authors: Travis C Salzillo; Nicolette Taku; Kareem A Wahid; Brigid A McDonald; Jarey Wang; Lisanne V van Dijk; Jillian M Rigert; Abdallah S R Mohamed; Jihong Wang; Stephen Y Lai; Clifton D Fuller Journal: Semin Radiat Oncol Date: 2021-10 Impact factor: 5.421
Authors: Jens P E Schouten; Samantha Noteboom; Roland M Martens; Steven W Mes; C René Leemans; Pim de Graaf; Martijn D Steenwijk Journal: Cancer Imaging Date: 2022-01-15 Impact factor: 3.909
Authors: Roland M Martens; Thomas Koopman; Cristina Lavini; Tim van de Brug; Gerben J C Zwezerijnen; J Tim Marcus; Marije R Vergeer; C René Leemans; Remco de Bree; Pim de Graaf; Ronald Boellaard; Jonas A Castelijns Journal: Cancers (Basel) Date: 2022-01-03 Impact factor: 6.639