Dynamic contrast enhanced magnetic resonance scanning as a predictor of response to accelerated radiotherapy for advanced head and neck cancer.

Abstract

Tumour perfusion has been assessed in patients with advanced head and neck cancer using dynamic contrast enhanced MRI prior to and at completion of accelerated radiotherapy, and related to local tumour control. Sequential MRI scans, at 3 s intervals after intravenous injection of gadolinium using a dynamic scan sequence through a tumour region of interest (ROI), were performed in 13 patients with advanced head and neck cancer before and on completion of radiotherapy. The scans have been analysed in terms of maximum tumour enhancement (E), slope of the enhancement versus time curve and the time taken to reach maximum tumour enhancement (Tmax), and these parameters related to tumour outcome after radiotherapy. Local tumour control was related to the value of E on a post-radiotherapy scan and the difference in Tmax between a pre- and post-radiotherapy scan. Durable local control was seen in those tumours with a post-radiotherapy value for E of less than 8 and a mean fall in Tmax of 27.3 s. These results imply that tumours with diminished tumour perfusion at the end of radiotherapy are those most sensitive to treatment and that those tumours which show greater tumour enhancement after accelerated radiotherapy are likely to fail locally. This may reflect the persistence of viable perfused tumour at completion of radiotherapy.

Perfusion CT in Squamous Cell Carcinoma of the Upper Aerodigestive Tract: Long-Term Predictive Value of Baseline Perfusion CT Measurements

“…9,10 Early proponents of perfusion studies have also demonstrated in a clinical setting that semi-or quantitatively estimated tumor perfusion might predict the outcome after definitive radiation therapy. 11,12 A recent study also reported the significant predictive value of PCT studies in a small patient population treated with surgery and adjuvant chemoradiation. 13 However, to the best of our knowledge, there is no large-scale study examining the longterm predictive value of baseline PCT studies in patients treated with neoadjuvant chemoradiation or chemoradiation with curative intent.…”

Prediction of Disease-Free Survival in Patients with Squamous Cell Carcinomas of the Head and Neck Using Dynamic Contrast-Enhanced MR Imaging

“…Patients with HNSCC with elevated tumor blood flow/ blood volume respond more favorably to chemoradiation therapy than patients with low blood flow/volume. [5][6][7][8][9] DCE-MRI studies yield a parameter called K trans , which is a measure of the first-order bidirectional volume transfer constant of contrast agent exchange between the intravascular plasma and tumor interstitium compartments. The pretreatment K trans , which reflects tumor perfusion/permeability, has been shown to predict nodal treatment response to chemoradiation therapy in patients with HNSCC.…”

DCEMRI monitoring of canine tumors during fractionated radiotherapy

“…Increased tumor enhancement during early therapy has been found to correlate with tumor regression [11] and to be a favorable prognostic factor for local control [9]. However, at the completion of therapy, patients who achieved local control had significantly lower tumor signal enhancement than patients with local failure [13,15]. It has been suggested that the different correlations between signal enhancement and treatment outcome represent different phases of the tumor physiological response to radiotherapy [13].…”