title: The Predictive Value of Early Assessment After 1 Cycle of Induction Chemotherapy with 18F-FDG PET/CT and Diffusion-Weighted MRI for Response to Radical Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma.
abstract: The objective of this study was to assess the predictive value of early assessment (after 1 cycle of induction chemotherapy [IC]) with18F-FDG PET/CT and diffusion-weighted (DW) MRI for subsequent response to radical chemoradiotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Twenty patients with stage III-IVa HNSCC prospectively underwent18F-FDG PET/CT and DW MRI before and 2 wk after each cycle of IC (first cycle, IC1; second cycle, IC2). Response was assessed 3 mo after completion of chemoradiotherapy with clinical examination, MRI, and18F-FDG PET/CT. Patients with persistent disease were classed as nonresponders. Changes in functional and molecular imaging parameters after IC1 were compared between responders and nonresponders with the Mann-Whitney U test. The significance threshold was set at a P value of less than 0.05.
  
  
  RESULTS
  Responders showed a significantly greater reduction in metabolic tumor volume (P = 0.03) and total lesion glycolysis (P = 0.04) after IC1 than nonresponders. Responders also showed a tendency toward a larger but statistically nonsignificant increase in apparent diffusion coefficient after IC1. There was no significant difference in the changes from baseline between the IC1 and IC2 for all functional and molecular imaging parameters, indicating that most biologic response to IC measured by18F-FDG PET/CT and DW MRI was observed early after the first cycle of IC.
  
  
  CONCLUSIONS
  Our preliminary data indicate that the18F-FDG PET/CT-derived metabolic tumor volume or total lesion glycolysis, acquired after IC1, are early predictive biomarkers for ultimate response to subsequent chemoradiotherapy. These early biomarkers enable identification of patients at risk of treatment failure at an early time point, permitting treatment individualization and consideration of alternative strategies such as radiotherapy dose escalation or surgery.
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and kee.wong@icr.ac.uk.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Kee H
authors.initials: KH
authors.lastname: Wong
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Rafal
authors.initials: R
authors.lastname: Panek
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Liam
authors.initials: L
authors.lastname: Welsh
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Dualta
authors.initials: D
authors.lastname: Mcquaid
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Alex
authors.initials: A
authors.lastname: Dunlop
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Angela
authors.initials: A
authors.lastname: Riddell
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Iain
authors.initials: I
authors.lastname: Murray
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Yong
authors.initials: Y
authors.lastname: Du
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Sue
authors.initials: S
authors.lastname: Chua
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Dow-Mu
authors.initials: DM
authors.lastname: Koh
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Shreerang
authors.initials: S
authors.lastname: Bhide
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Chris
authors.initials: C
authors.lastname: Nutting
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Wim J G
authors.initials: WJ
authors.lastname: Oyen
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.|The Institute of Cancer Research, Sutton and London, United Kingdom.
authors.forename: Kevin
authors.initials: K
authors.lastname: Harrington
authors.affiliation: The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Newbold
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D059248:Chemoradiotherapy; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; diffusion-weighted MRI; head and neck squamous cell carcinoma; induction chemotherapy