Journal
EUROPEAN RADIOLOGY
Volume -, Issue -, Pages -Publisher
SPRINGER
DOI: 10.1007/s00330-023-09843-2
Keywords
Biomarker; Radiotherapy; Head and neck neoplasms; Magnetic resonance imaging; Fluorodeoxyglucose F18
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Combining DWI MRI and FDG-PET/CT for measuring tumor changes during radiotherapy can predict treatment response in mucosal head and neck carcinoma. Evaluating ADC mean and MTV together improves the accuracy of predicting local recurrence.
Objectives To test if tumour changes measured using combination of diffusion-weighted imaging (DWI) MRI and FDG-PET/CT performed serially during radiotherapy (RT) in mucosal head and neck carcinoma can predict treatment response.Methods Fifty-five patients from two prospective imaging biomarker studies were analysed. FDG-PET/CT was performed at baseline, during RT (week 3), and post RT (3 months). DWI was performed at baseline, during RT (weeks 2, 3, 5, 6), and post RT (1 and 3 months). The ADC(mean) from DWI and FDG-PET parameters SUVmax, SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were measured. Absolute and relative change (%?) in DWI and PET parameters were correlated to 1-year local recurrence. Patients were categorised into favourable, mixed, and unfavourable imaging response using optimal cut-off (OC) values of DWI and FDG-PET parameters and correlated to local control.Results The 1-year local, regional, and distant recurrence rates were 18.2% (10/55), 7.3% (4/55), and 12.7% (7/55), respectively. ? Week 3 ADC(mean) (AUC 0.825, p = 0.003; OC ? > 24.4%) and ?MTV (AUC 0.833, p = 0.001; OC ? > 50.4%) were the best predictors of local recurrence. Week 3 was the optimal time point for assessing DWI imaging response. Using a combination of ?ADC(mean) and ?MTV improved the strength of correlation to local recurrence (p = 0.001). In patients who underwent both week 3 MRI and FDG-PET/CT, significant differences in local recurrence rates were seen between patients with favourable (0%), mixed (17%), and unfavourable (78%) combined imaging response.Conclusions Changes in mid-treatment DWI and FDG-PET/CT imaging can predict treatment response and could be utilised in the design of future adaptive clinical trials.
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