title: 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.
abstract: The clinical usefulness of pretreatment imaging techniques for predicting neck control in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and [18F]fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT derived imaging markers for the prediction of neck control in OHSCC patients treated with chemoradiation. Patients with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and volume of extracellular extravascular space (Ve) on DCE-PWI; apparent diffusion coefficient (ADC) on DWI; maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis on 18F-FDG PET/CT. There were 69 patients (37 with oropharynx SCC and 32 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 31 months, 25 (36.2%) participants had neck failure. Multivariate analysis identified hemoglobin level <14.3 g/dL (P = 0.019), Ve <0.23 (P = 0.040), and ADC >1.14×10-3 mm2/s (P = 0.003) as independent prognostic factors for 3-year neck control. A prognostic scoring system was formulated by summing up the three significant predictors of neck control. Patients with scores of 2-3 had significantly poorer neck control and overall survival rates than patients with scores of 0-1. We conclude that hemoglobin levels, Ve, and ADC are independent pretreatment prognostic factors for neck control in OHSCC treated with chemoradiation. Their combination may identify a subgroup of patients at high risk of developing neck failure.
authors.affiliation: Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan; Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Sheng-Chieh
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
authors.affiliation: Department of medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.affiliation: Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan.
authors.forename: Jiun-Jie
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009333:Neck / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18