Tumor volume reduction rate measured during adaptive definitive radiation therapy as a potential prognosticator of locoregional control in patients with oropharyngeal cancer

Lee, Hyebin; Ahn, Yong Chan; Oh, Dongryul; Nam, Heerim; Kim, Young Il; Park, Suyeon

doi:10.1002/hed.23328

Cited by 32 publications

(33 citation statements)

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“…Previous studies have shown that tumor regression during radiotherapy is an independent predictive factor of local control in several malignancies (38,39) and also for patients with head and neck cancer (40). Recently, the tumor regression rate at midtreatment has been shown to predict locoregional control in patients with oropharyngeal cancer (29). Although we plan to confirm whether local/regional control is, over the long term, predicted by IVIM as a treatment response bio-indicator, the goal of the current study was to determine whether patients might be selected for adaptive re-planning applications.…”

Section: Discussionmentioning

confidence: 99%

Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study

et al. 2015

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This study aims to identify the temporal kinetics of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in patients with human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma. Patients were enrolled under an IRB-approved protocol as part of ongoing prospective clinical trial. All patients underwent two MRI studies, a baseline scan before chemoradiotherapy and a midtreatment scan 3–4 weeks of treatment initiation. Parametric maps representing pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were generated. The Mann-Whitney U test was used to assess temporal variation of IVIM metrics. Bayesian quadratic discriminant analysis (QDA) was used to evaluate the extent to which midtreatment changes in IVIM metrics could be combined to predict sites that would achieve complete response (CR) in multivariate analysis. A total of 31 patients were included in the final analysis with 59 lesions. Pretreatment ADC and D values of the complete response (CR) lesions (n=19) were significantly lower than non-CR lesions (n=33). Midtreatment ADC, D, and f values were significantly higher (P < .0001) than pretreatment values for all lesions. Each increase in normalized ΔADC of size 0.1 yielded a 1.45-fold increase in the odds of CR (P<.0003), each increase in normalized ΔD of size 0.1 yielded a 1.53-fold increase in the odds of CR (P<.0002), and each unit increase in Δf yielded a 2.29-fold increase in the odds of CR (P < .02). Combined ΔD and ΔADC were integrated into a multivariate prediction model and attained an AUC=0.87 (95% CI: 0.79, 0.96) as well as sensitivity=0.63, specificity=0.85, and accuracy=0.78 under leave-one-out cross-validation. In conclusion, IVIM is feasible and potentially useful in prediction and assessment of early response of HPV+ oropharyngeal squamous cell carcinoma to chemoradiotherapy.

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Section: Discussionmentioning

confidence: 99%

Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study

et al. 2015

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“…However, few studies investigating changes in tumor volume during RT as a prognostic factor have been reported [ 7 - 10 ]. We previously reported on the prognostic impact of tumor volume reduction rate (TVRR) measured during adaptive RT for oropharyngeal cancer [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Tumor Volume Reduction Rate during Adaptive Radiation Therapy as a Prognosticator for Nasopharyngeal Cancer

Lee

Ahn

et al. 2016

Cancer Res Treat

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PurposeThe purpose of this study is to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) for nasopharyngeal cancer (NPC).Materials and MethodsWe reviewed the RT records of 159 NPC patients treated with definitive RT with or without concurrent chemotherapy between January 2006 and February 2013. Adaptive re-planning was performed in all patients at the third week of RT. The pre- and mid-RT gross tumor volumes (GTVs) of the primary tumor and the metastatic lymph nodes were measured and analyzed for prognostic implications.ResultsAfter a median follow-up period of 41.5 months (range, 11.2 to 91.8 months) for survivors, there were 43 treatment failures. The overall survival and progression-free survival (PFS) rates at 5 years were 89.6% and 69.7%, respectively. The mean pre-RT GTV, mid-RT GTV, and TVRR were 45.9 cm3 (range, 1.5 to 185.3 cm3), 26.7 cm3 (1.0 to 113.8 cm3), and –41.9% (range, –87% to 78%), respectively. Patients without recurrence had higher TVRR than those with recurrence (44.3% in the no recurrence group vs. 34.0% in the recurrence group, p=0.004), and those with TVRR > 35% achieved a significantly higher rate of PFS at 5 years (79.2% in TVRR > 35% vs. 53.2% in TVRR ≤ 35%; p < 0.001). In multivariate analysis, TVRR was a significant factor affecting PFS (hazard ratio, 2.877; 95% confidence interval, 1.555 to 5.326; p=0.001).ConclusionTVRR proved to be a significant prognostic factor in NPC patients treated with definitive RT, and could be used as a potential indicator for early therapeutic modification during the RT course.

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“…Lee et al. demonstrated that patients achieving a volume reduction rate >35% had higher locoregional control than those with a volume reduction rate ≤35% in a study of patients with oropharyngeal cancer treated with RT . The time point of resimulation CT was at a median of 17 fractions after RT initiation, which was earlier than the 23 fractions of our study, resulting in a lower cutoff value of reduction rate.…”

Section: Discussionmentioning

confidence: 99%

Using primary tumor volumetry to predict treatment outcome for patients with oropharyngeal cancer who were treated with definitive chemoradiotherapy

Lee

Song

Choi

et al. 2017

Asia-Pac J Clncl Oncology

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Tumor volume reduction rate measured during adaptive definitive radiation therapy as a potential prognosticator of locoregional control in patients with oropharyngeal cancer

Abstract: The TVRR measured during adaptive RT proved a significant prognosticator on locoregional disease control in patients with oropharyngeal cancer, based on which a few therapeutic modifications may be considered.

Cited by 32 publications

References 20 publications

Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study

Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study

Tumor Volume Reduction Rate during Adaptive Radiation Therapy as a Prognosticator for Nasopharyngeal Cancer

Using primary tumor volumetry to predict treatment outcome for patients with oropharyngeal cancer who were treated with definitive chemoradiotherapy

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