title: Dynamic contrast-enhanced magnetic resonance imaging as a predictor of outcome in head-and-neck squamous cell carcinoma patients with nodal metastases.
abstract: OBJECTIVE
  Dynamic contrast-enhanced MRI (DCE-MRI) can provide information regarding tumor perfusion and permeability and has shown prognostic value in certain tumors types. The goal of this study was to assess the prognostic value of pretreatment DCE-MRI in head and neck squamous cell carcinoma (HNSCC) patients with nodal disease undergoing chemoradiation therapy or surgery.
  
  
  METHODS
  Seventy-four patients with histologically proven squamous cell carcinoma and neck nodal metastases were eligible for the study. Pretreatment DCE-MRI was performed on a 1.5T MRI. Clinical follow-up was a minimum of 12 months. DCE-MRI data were analyzed using the Tofts model. DCE-MRI parameters were related to treatment outcome (progression-free survival [PFS] and overall survival [OS]). Patients were grouped as no evidence of disease (NED), alive with disease (AWD), dead with disease (DOD), or dead of other causes (DOC). Prognostic significance was assessed using the log-rank test for single variables and Cox proportional hazards regression for combinations of variables.
  
  
  RESULTS
  At last clinical follow-up, for Stage III, all 12 patients were NED. For Stage IV, 43 patients were NED, 4 were AWD, 11 were DOD, and 4 were DOC. K(trans) is volume transfer constant. In a stepwise Cox regression, skewness of K(trans) (volume transfer constant) was the strongest predictor for Stage IV patients (PFS and OS: p <0.001).
  
  
  CONCLUSIONS
  Our study shows that skewness of K(trans) was the strongest predictor of PFS and OS in Stage IV HNSCC patients with nodal disease. This study suggests an important role for pretreatment DCE-MRI parameter K(trans) as a predictor of outcome in these patients.
authors: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. davea@mskcc.org
authors: Amita
authors: A
authors: Shukla-Dave
authors: Nancy Y
authors: NY
authors: Lee
authors: Jacobus F A
authors: JF
authors: Jansen
authors: Howard T
authors: HT
authors: Thaler
authors: Hilda E
authors: HE
authors: Stambuk
authors: Matthew G
authors: MG
authors: Fury
authors: Snehal G
authors: SG
authors: Patel
authors: Andre L
authors: AL
authors: Moreira
authors: Eric
authors: E
authors: Sherman
authors: Sasan
authors: S
authors: Karimi
authors: Ya
authors: Y
authors: Wang
authors: Dennis
authors: D
authors: Kraus
authors: Jatin P
authors: JP
authors: Shah
authors: David G
authors: DG
authors: Pfister
authors: Jason A
authors: JA
authors: Koutcher
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