Early prediction of outcome in advanced head-and-neck cancer based on tumor blood volume alterations during therapy: a prospective study.
OBJECTIVE
To assess whether alterations in tumor blood volume (BV) and blood flow (BF) during the early course of chemo-radiotherapy (chemo-RT) for head-and-neck cancer (HNC) predict treatment outcome.


METHODS
Fourteen patients receiving concomitant chemo-RT for nonresectable, locally advanced HNC underwent dynamic contrast-enhanced (DCE) MRI scans before therapy and 2 weeks after initiation of chemo-RT. The BV and BF were quantified from DCE MRI. Preradiotherapy BV and BF, as well as their changes during RT, were evaluated separately in the primary gross tumor volume (GTV) and nodal GTV for association with outcomes.


RESULTS
At a median follow-up of 10 months (range, 5-27 months), 9 patients had local-regional controlled disease. One patient had regional failure, 3 had local failures, and 1 had local-regional failure. Reduction in tumor volume after 2 weeks of chemo-RT did not predict for local control. In contrast, the BV in the primary GTV after 2 weeks of chemo-RT was increased significantly in the local control patients compared with the local failure patients (p < 0.03).


CONCLUSIONS
Our data suggest that an increase in available primary tumor blood for oxygen extraction during the early course of RT is associated with local control, thus yielding a predictor with potential to modify treatment. These findings require validation in larger studies.
Cao
Yue
Y
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Popovtzer
Aron
A
Li
Diana
D
Chepeha
Douglas B
DB
Moyer
Jeffrey S
JS
Prince
Mark E
ME
Worden
Francis
F
Teknos
Theodoros
T
Bradford
Carol
C
Mukherji
Suresh K
SK
Eisbruch
Avraham
A
D000328:Adult; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001810:Blood Volume / Q000528:radiation effects; D016190:Carboplatin / Q000008:administration & dosage; D000068818:Cetuximab; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011879:Radiotherapy Dosage; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D016190:Carboplatin; D017239:Paclitaxel; D000068818:Cetuximab