title: A review of the predictive role of functional imaging in patients with mucosal primary head and neck cancer treated with radiation therapy.
abstract: Advanced radiotherapy techniques, such as intensity-modulated radiotherapy, have been reported to reduce toxicities by improving the dose conformity in mucosal primary head and neck cancer (MPHNC). However, to further optimize the therapeutic ratio, details on individual patient and disease characteristics may be necessary to tailor treatments. This is likely to include identifying poor responders for treatment intensification and good responders for de-escalation strategies. Non-invasive, repeatable imaging biomarkers are attractive modalities in both pre-treatment and intra-treatment response prediction with a view to individualized treatment options. This review has assessed the current literature on the prognostic/predictive role of widely available functional imaging (FI) studies such as fMRI(functional magnetic resonance imaging), functional computed tomography (fCT) and positron-emission-tomography(PET). A literature search was carried out using Medline, Embase and PubMed. Studies were included if imaging was undertaken pre and/or during radiotherapy (with or without the addition of chemotherapy and/or surgery). A total of 99 relevant studies were identified: 14 fMRI, 10 fCT, 59 FDG-PET and 16 non-FDG-PET studies. These articles were reviewed to identify imaging parameters demonstrating a correlation with patient outcome or a factor considered to impact on patient outcome and thus likely to be of potential predictive value in MPHNC and associated future radiotherapy treatment directions. Several studies have demonstrated that both pre-treatment and mid-treatment FDG-PET is predictive of outcomes. However, further studies are required to confirm the role of other imaging studies including fMRI and PET using other tracers. There is large heterogeneity within and between published studies, including tumour sites, treatment options, outcome endpoints and parameters assessed. We propose a minimum set of factors that should be reported and make recommendations for studies evaluating the predictive utility in MPHNC.
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.|South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.
authors.forename: Myo
authors.initials: M
authors.lastname: Min
authors.affiliation: South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Department of Nuclear Medicine and Positron Emission Tomography, Liverpool Hospital, Liverpool, New South Wales, Australia.|University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Lin
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.|South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.|Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Liney
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.|South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Lee
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.|South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.
authors.forename: Dion
authors.initials: D
authors.lastname: Forstner
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.
authors.forename: Allan
authors.initials: A
authors.lastname: Fowler
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.|South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.|Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.|Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.|Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Lois
authors.initials: L
authors.lastname: Holloway
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D016896:Treatment Outcome
keywords: functional imaging; head and neck cancer; magnetic resonance imaging; positron emission tomography; predictive role