title: Tumor plasma flow determined by dynamic contrast-enhanced MRI predicts response to induction chemotherapy in head and neck cancer.
abstract: OBJECTIVE
  Non-response to induction chemotherapy (IC) occurs in 30% of head and neck squamous cell carcinoma (HNSCC) and has been predicted by tumor plasma flow (Fp) derived by perfusion computed tomography. The present study was designed to test whether baseline tumor Fp determined by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) would predict IC response.
  
  
  METHODS
  A prospective open study powered to test the relationship between tumor Fp and response to IC (docetaxel, cisplatin, 5-fluorouracil) enrolled 50 patients with stage IV HNSCC. Response after two IC cycles was measured by MRI using Response Evaluation Criteria in Solid Tumors in 37 patients. Tumor Fp (primary end point) and multiple parameters in tumors and lymph nodes (secondary end points) were generated at baseline. Differences in baseline DCE-MRI parameters according to IC response were assessed by the Mann-Whitney U test, and predictive value by receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  Median baseline tumor Fp was 53.2ml/100ml/min in 25 responders and 23.9 in 12 non-responders (U 82; P=0.027; area under ROC curve (AUC) 0.73). Median baseline Fp in lymph nodes was 25.8ml/100ml/min for 37 nodes in 25 responders and 17.1 for 15 nodes in 12 non-responders (U 186, P=0.066; AUC 0.67). Frequency of IC response in 37 patients was 68% overall, 83% for tumor Fp above the median (40.6ml/100ml/min) and 45% below the median. Other DCE-MRI parameters were not associated with IC response.
  
  
  CONCLUSIONS
  Pre-treatment tumor Fp determined by DCE-MRI predicts IC response in HNSCC.
authors.affiliation: University Department of Otolaryngology - Head & Neck Surgery, Manchester Academic Health Science Centre, University of Manchester, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK; Translational Radiobiology Group, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK. Electronic address: jonathan.bernstein@doctors.org.uk.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Bernstein
authors.affiliation: Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Kershaw
authors.affiliation: Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Withey
authors.affiliation: Translational Radiobiology Group, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Lowe
authors.affiliation: University Department of Otolaryngology - Head & Neck Surgery, Manchester Academic Health Science Centre, University of Manchester, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK; Translational Radiobiology Group, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Jarrod J
authors.initials: JJ
authors.lastname: Homer
authors.affiliation: Translational Radiobiology Group, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Slevin
authors.affiliation: Department of Radiology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Bonington
authors.affiliation: Department of Radiology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Carrington
authors.affiliation: Translational Radiobiology Group, Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: Catharine M
authors.initials: CM
authors.lastname: West
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000098:blood supply* / Q000188:drug therapy / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D003287:Contrast Media
keywords: Dynamic contrast-enhanced magnetic resonance imaging (DCE–MRI); Head and neck squamous cell carcinoma; Induction chemotherapy; Plasma flow; Treatment response