Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy

• Published in: European journal of radiology 2019-04, Vol.113, p.39-50
• Main Authors: Martens, Roland M., Noij, Daniel P., Koopman, Thomas, Zwezerijnen, Ben, Heymans, Martijn, de Jong, Marcus C., Hoekstra, Otto S., Vergeer, Marije R., de Bree, Remco, Leemans, C. René, de Graaf, Pim, Boellaard, Ronald, Castelijns, Jonas A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy - methods; Diffusion Magnetic Resonance Imaging - methods; DWI; Female; Fluorodeoxyglucose F18; Head and neck; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Middle Aged; MRI; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; PET; Positron Emission Tomography Computed Tomography - methods; Prognosis; Radiopharmaceuticals; Retrospective Studies; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - diagnostic imaging; Squamous Cell Carcinoma of Head and Neck - pathology; Squamous Cell Carcinoma of Head and Neck - therapy; Treatment Failure
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2019.01.031

In head and neck squamous cell carcinoma (HNSCC) (chemo)radiotherapy is increasingly used to preserve organ functionality. The purpose of this study was to identify predictive pretreatment DWI- and 18F-FDG-PET/CT-parameters for treatment failure (TF), locoregional recurrence (LR) and death in HNSCC patients treated by (chemo)radiotherapy. We retrospectively included 134 histologically proven HNSCC patients treated with (chemo)radiotherapy between 2012-2017. In 58 patients pre-treatment DWI and 18F-FDG-PET/CT were performed, in 31 patients DWI only and in 45 patients 18F-FDG-PET/CT only. Primary tumor (PT) and largest lymph node (LN) metastasis were quantitatively assessed for TF, LR and death. Multivariate analysis was performed for 18F-FDG-PET/CT and DWI separately and thereafter combined. In patients with both imaging modalities, positive and negative predictive value in TF and differences in LR and death, were assessed. Mean follow-up was 25.6 months (interquartile-range; 14.0–37.1 months). Predictors of treatment failure, corrected for TNM-stage and HPV-status, were SUVmax-PT, ADCmax-PT, total lesion glycolysis (TLG-LN), ADCp20-LN (P = 0.049, P = 0.024, P = 0.031, P = 0.047, respectively). TLG-PT was predictive for LR (P = 0.003). Metabolic active tumor volume (MATV-PT) (P = 0.003), ADCGTV-PT (P