Response measurement after intraarterial chemoradiation in advanced head and neck carcinoma : Magnetic resonance imaging and evaluation under general anesthesia?

• Published in: Cancer 2006-04, Vol.106 (8), p.1722-1729
• Main Authors: VAN DEN BROEK, Guido B, RASCH, Coen R. N, PAMEIJER, Frank A, PETER, Ellen, VAN DEN BREKEL, Michiel W. M, BALM, Alfons J. M
• Format: Article
• Language: English
• Subjects: Anesthesia, General; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Biopsy; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Cisplatin - administration & dosage; Combined Modality Therapy; Female; Humans; Infusions, Intra-Arterial; Magnetic Resonance Imaging; Male; Medical sciences; Mouth Neoplasms - drug therapy; Mouth Neoplasms - pathology; Mouth Neoplasms - radiotherapy; Neoplasm, Residual - pathology; Otorhinolaryngologic Neoplasms - drug therapy; Otorhinolaryngologic Neoplasms - pathology; Otorhinolaryngologic Neoplasms - radiotherapy; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Predictive Value of Tests; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21786

The objectives of this prospective trial were to evaluate the diagnostic accuracy and predictive value of magnetic resonance imaging (MRI) and to use MRI evaluation under general anesthesia (EGA) 6 to 8 weeks after chemoradiation to determine local control. Eighty-two consecutive patients with advanced-stage squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or supraglottic larynx were treated with selective targeted chemoradiation. All patients who completed treatment and survived had a minimum follow-up of 3 years. MRI and EGA were performed from 6 to 8 weeks after treatment. Posttreatment MRI findings were compared with pretreatment MRI findings and were graded for risk of local recurrence/residual disease on a 4-point scale. The diagnosis of treatment failure was based on tissue biopsies, which were obtained during EGA or later during follow-up. The predictive value of MRI was analyzed by using a Cox proportional hazards model. Only 1 patient with MRI Grade 0 or 1 findings (discrete mass < 10 mm; n = 62 patients) had residual disease 6 to 8 weeks after treatment that was detected during EGA. In 5 patients with MRI findings of Grade 2a and 2b (mass > 10 mm; n = 20 patients), residual disease was detected. After 2 years, 23 patients had a local failure (28%). Twelve local failures were found among 62 patients who had MRI findings of Grade 0 and 1. Posttreatment MRI emerged as an independent predictive factor (hazard ratio, 3.0; P = .014) for local control. Posttreatment MRI studies provided predictive information on local control in addition to pretreatment predictors. In patients with focal masses < 10 mm, the combination of response evaluation under general anesthesia and posttreatment MRI from 6 to 8 weeks after chemoradiation hardly provided more information on the local control than posttreatment MRI alone.