Fractional Change in Apparent Diffusion Coefficient as an Imaging Biomarker for Predicting Treatment Response in Head and Neck Cancer Treated with Chemoradiotherapy

Matoba, Munetaka; Tuji, Hiroyuki; Shimode, Yuzo; Toyoda, Ichiro; Kuginuki, Yasuaki; Miwa, Koki; Tonami, Hisao

doi:10.3174/ajnr.a3706

Cited by 66 publications

(72 citation statements)

References 25 publications

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“…DW MRI studies, in the context of chemoradiotherapy alone, have demonstrated an increase in ADC in responders and a lower increase or decrease 1-3 wk into radiotherapy in nonresponders (13,26,27). Although our DW MRI data with IC showed similar trends, it was unable to distinguish eventual responders from nonresponders.…”

Section: Discussioncontrasting

confidence: 53%

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

et al. 2016

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The objective of this study was to assess the predictive value of early assessment (after 1 cycle of induction chemotherapy [IC]) with 18 F-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 underwent 18 F-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, and 18 F-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 5 0.03) and total lesion glycolysis (P 5 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 by 18 F-FDG PET/CT and DW MRI was observed early after the first cycle of IC. Conclusion: Our preliminary data indicate that the 18 F-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.

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Section: Discussioncontrasting

confidence: 53%

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

et al. 2016

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“…Overall, there were conflicting results over the value of pre-treatment ADC at predicting response to treatment (Table 1). Five studies failed to distinguish patients with unfavourable disease based on pretreatment ADC, [35][36][37][38][39] whereas six studies found high pretreatment tumour ADC to be predictive of poor outcome following RT. [40][41][42][43][44][45] As illustrated in Table 1, there are heterogeneities between the studies in scanning protocol, analytical methods and measured clinical end points, which may be Figure 3.…”

Section: Functional Mri Sequencesmentioning

confidence: 98%

“…36,37,40,49 The cumulative results suggest that tumours that show a lower increase or even a decrease in ADC 1-4 weeks into radiotherapy (ΔADC ,14-24%) are more likely to fail treatment. It is speculated that tumours with a good treatment response show a higher frequency of apoptosis or necrosis earlier in the course of treatment than those with a poor response.…”

Section: Functional Mri Sequencesmentioning

confidence: 99%

The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective

Wong

Panek

Bhide

et al. 2017

The British Journal of Radiology

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Head and neck cancer (HNC) is a challenging tumour site for radiotherapy delivery owing to its complex anatomy and proximity to organs at risk (OARs) such as the spinal cord and optic apparatus. Despite significant advances in radiotherapy planning techniques, radiation-induced morbidities remain substantial. Further improvement would require high-quality imaging and tailored radiotherapy based on intratreatment response. For these reasons, the use of MRI in radiotherapy planning for HNC is rapidly gaining popularity. MRI provides superior soft-tissue contrast in comparison with CT, allowing better definition of the tumour and OARs. The lack of additional radiation exposure is another attractive feature for intratreatment monitoring. In addition, advanced MRI techniques such as diffusion-weighted, dynamic contrast-enhanced and intrinsic susceptibility-weighted MRI techniques are capable of characterizing tumour biology further by providing quantitative functional parameters such as tissue cellularity, vascular permeability/perfusion and hypoxia. These functional parameters are known to have radiobiological relevance, which potentially could guide treatment adaptation based on their changes prior to or during radiotherapy. In this article, we first present an overview of the applications of anatomical MRI sequences in head and neck radiotherapy, followed by the potentials and limitations of functional MRI sequences in personalizing therapy. INTRODUCTIONRadical radiotherapy (RT) is integral to the management of head and neck cancer (HNC) in both the primary and adjuvant settings. Advances in computer-assisted radiological techniques over the past two decades have in turn revolutionized radiotherapy planning. Development of advanced radiotherapy planning techniques such as intensity-modulated radiotherapy (IMRT) and volumetricmodulated arc therapy have allowed for better dose conformation to the tumour target and sparing of surrounding normal tissues. HNC was one of the first tumour sites where IMRT was widely implemented owing to a significant reduction in radiation-induced xerostomia in comparison with three-dimensional conformal planning.

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“…The ADC increase within/ after the treatment of complete responders is also significant when compared to the pre-treatment ADC, while nonresponders are more associated with a lower increase or even a decrease of ADC during the treatment (28,(31)(32)(33)(34)(35). In addition, The ADC change might be a more sensitive and accurate biomarker to predict locoregional control (LRC) than the volume change of tumors (36).…”

Section: Diffusion-weighted Imaging (Dwi)mentioning

confidence: 99%

Functional magnetic resonance imaging techniques and their development for radiation therapy planning and monitoring in the head and neck cancers

Yuan¹,

Lo²,

King³

2016

Quant. Imaging Med. Surg.

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Radiation therapy (RT), in particular intensity-modulated radiation therapy (IMRT), is becoming a more important nonsurgical treatment strategy in head and neck cancer (HNC). The further development of IMRT imposes more critical requirements on clinical imaging, and these requirements cannot be fully fulfilled by the existing radiotherapeutic imaging workhorse of X-ray based imaging methods. Magnetic resonance imaging (MRI) has increasingly gained more interests from radiation oncology community and holds great potential for RT applications, mainly due to its non-ionizing radiation nature and superior soft tissue image contrast. Beyond anatomical imaging, MRI provides a variety of functional imaging techniques to investigate the functionality and metabolism of living tissue. The major purpose of this paper is to give a concise and timely review of some advanced functional MRI techniques that may potentially benefit conformal, tailored and adaptive RT in the HNC. The basic principle of each functional MRI technique is briefly introduced and their use in RT of HNC is described. Limitation and future development of these functional MRI techniques for HNC radiotherapeutic applications are discussed. More rigorous studies are warranted to translate the hypotheses into credible evidences in order to establish the role of functional MRI in the clinical practice of head and neck radiation oncology.

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Fractional Change in Apparent Diffusion Coefficient as an Imaging Biomarker for Predicting Treatment Response in Head and Neck Cancer Treated with Chemoradiotherapy

Cited by 66 publications

References 25 publications

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

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

The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective

Functional magnetic resonance imaging techniques and their development for radiation therapy planning and monitoring in the head and neck cancers

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Fractional Change in Apparent Diffusion Coefficient as an Imaging Biomarker for Predicting Treatment Response in Head and Neck Cancer Treated with Chemoradiotherapy

Cited by 66 publications

References 25 publications

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

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

The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective

Functional magnetic resonance imaging techniques and their development for radiation therapy planning and monitoring in the head and neck cancers

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Product

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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

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