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

BACKGROUND AND PURPOSE: ADC provides a measure of water molecule diffusion in tissue. The aim of this study was to evaluate whether the fractional change in ADC during therapy can be used as a valid predictive indicator of treatment response in head and neck squamous cell carcinoma treated with chemoradiotherapy. MATERIALS AND METHODS: Forty patients underwent DWI at pretreatment and 3 weeks after the start of treatment. The pretreatment ADC, fractional change in ADC, tumor regression rate, and other clinical variables were compared with locoregional control and locoregional failure and were analyzed by using logistic regression analysis and receiver operating characteristic analysis. Furthermore, progression-free survival curves divided by the corresponding threshold value were compared by means of the log-rank test. RESULTS: The fractional change in ADCprimary, the fractional change in ADCnode, primary tumor volume, nodal volume, tumor regression ratenode, N stage, and tumor location revealed significant differences between locoregional failure and locoregional control (P < .05). In univariate analysis, the fractional change in ADCprimary, fractional change in ADCnode, tumor regression ratenode, N stage, and tumor location showed significant association with locoregional control (P < .05). In multivariate analysis, however, only the fractional change in ADCprimary was identified as a significant and independent predictor of locoregional control (P = .04). A threshold fractional change in ADCprimary of 0.24 revealed a sensitivity of 100%, specificity of 78.7%, and overall accuracy of 84.8% for the prediction of locoregional control. Progression-free survival of the 2 groups divided by the fractional change in ADCprimary at 0.24 showed a significant difference (P < .05). CONCLUSIONS: The results suggest that the fractional change in ADCprimary is a valid imaging biomarker for predicting treatment response in head and neck squamous cell carcinoma treated with chemoradiotherapy.

[1]  K. Jung,et al.  Clinical Efficacy of Primary Tumor Volume Measurements: Comparison of Different Primary Sites , 2009, Clinical and experimental otorhinolaryngology.

[2]  P. Choyke,et al.  Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. , 2009, Neoplasia.

[3]  S. Maier,et al.  High-b-value diffusion-weighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice. , 2004, Radiology.

[4]  B. Ross,et al.  Diffusion magnetic resonance imaging: a biomarker for treatment response in oncology. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  Bradford A Moffat,et al.  Functional diffusion map: a noninvasive MRI biomarker for early stratification of clinical brain tumor response. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[6]  J. Horiot,et al.  Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. , 1997, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[7]  S. Taylor.  Head and neck cancer. , 1991, Cancer chemotherapy and biological response modifiers.

[8]  A. Garden,et al.  Controversies in surgical management of the node-positive neck after chemoradiation. , 2009, Seminars in radiation oncology.

[9]  R F Labadie,et al.  Nodal volume reduction after concurrent chemo- and radiotherapy: correlation between initial CT and histopathologic findings. , 2000, AJNR. American journal of neuroradiology.

[10]  A. Garden,et al.  Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. , 2002, International journal of radiation oncology, biology, physics.

[11]  J. Andrle,et al.  Surfing prognostic factors in head and neck cancer at the millennium. , 1999, Oral oncology.

[12]  J. Bourhis,et al.  Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data , 2000, The Lancet.

[13]  A. Cmelak,et al.  Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. , 2008, Journal of the National Cancer Institute.

[14]  G. Weinstein,et al.  Diffusion-Weighted Magnetic Resonance Imaging for Predicting and Detecting Early Response to Chemoradiation Therapy of Squamous Cell Carcinomas of the Head and Neck , 2009, Clinical Cancer Research.

[15]  Sandra Nuyts,et al.  Diffusion-weighted magnetic resonance imaging early after chemoradiotherapy to monitor treatment response in head-and-neck squamous cell carcinoma. , 2012, International journal of radiation oncology, biology, physics.

[16]  G. Delouya,et al.  The role of computed tomography in the management of the neck after chemoradiotherapy in patients with head-and-neck cancer. , 2012, International journal of radiation oncology, biology, physics.

[17]  M. Kanematsu,et al.  Head and neck squamous cell carcinoma: usefulness of diffusion-weighted MR imaging in the prediction of a neoadjuvant therapeutic effect , 2008, European Radiology.

[18]  Bradford A Moffat,et al.  A feasibility study of parametric response map analysis of diffusion-weighted magnetic resonance imaging scans of head and neck cancer patients for providing early detection of therapeutic efficacy. , 2009, Translational oncology.

[19]  T. Chenevert,et al.  Diffusion magnetic resonance imaging: an imaging treatment response biomarker to chemoradiotherapy in a mouse model of squamous cell cancer of the head and neck. , 2008, Translational oncology.

[20]  J. M. Taylor,et al.  Diffusion magnetic resonance imaging: an early surrogate marker of therapeutic efficacy in brain tumors. , 2000, Journal of the National Cancer Institute.

[21]  T. Yoshiura,et al.  Pretreatment apparent diffusion coefficient of the primary lesion correlates with local failure in head-and-neck cancer treated with chemoradiotherapy or radiotherapy. , 2011, International journal of radiation oncology, biology, physics.

[22]  R. Hermans,et al.  Predictive value of diffusion-weighted magnetic resonance imaging during chemoradiotherapy for head and neck squamous cell carcinoma , 2010, European Radiology.

[23]  A. Garden,et al.  Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer , 2001 .

[24]  D. Collins,et al.  Diffusion-weighted MRI in the body: applications and challenges in oncology. , 2007, AJR. American journal of roentgenology.

[25]  Ann D. King,et al.  Squamous cell carcinoma of the head and neck: diffusion-weighted MR imaging for prediction and monitoring of treatment response , 2010, European Radiology.

[26]  Jacques Bernier,et al.  Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. , 1997, Radiotherapy and Oncology.