A prospective longitudinal assessment of MRI signal intensity kinetics of non-target muscles in patients with advanced stage oropharyngeal cancer in relationship to radiotherapy dose and post-treatment radiation-associated dysphagia: Preliminary findings from a randomized trial

• Published in: Radiotherapy and oncology 2019-01, Vol.130, p.46-55
• Main Authors: Meheissen, Mohamed A.M., Mohamed, Abdallah S.R., Kamal, Mona, Hernandez, Mike, Volpe, Stefania, Elhalawani, Hesham, Barrow, Martha P., Ding, Yao, Wang, Jihong, Davuluri, Raj, Rostom, Yousri, Hegazy, Neamat, Gunn, G. Brandon, Lai, Stephen Y., Garden, Adam S., Lewin, Jan S., Rosenthal, David I., Frank, Steven J., Fuller, Clifton D., Hutcheson, Katherine A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Deglutition - radiation effects; Deglutition Disorders - diagnostic imaging; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Female; Head and neck cancer; HPV-associated oropharyngeal cancer; Humans; Imaging biomarkers; Longitudinal Studies; Magnetic Resonance Imaging - methods; Male; Middle Aged; MRI; Oropharyngeal Neoplasms - diagnostic imaging; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - radiotherapy; Pharyngeal Muscles - diagnostic imaging; Pharyngeal Muscles - physiopathology; Pharyngeal Muscles - radiation effects; Prospective Studies; Radiation Injuries - diagnostic imaging; Radiation Injuries - etiology; Radiation Injuries - physiopathology; Radiation-associated dysphagia; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated - methods
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2018.08.010

•We identified the MRI kinetics of muscles associated with radiation-induced dysphagia.•We compared mid- and post-RT SI relative to baseline based on dysphagia status.•Radiation injury can be quantified using serial MRI as early as the midpoint of RT.•Middle pharyngeal constrictor had the most significant changes among studied muscles. To assess quantitative signal intensity (SI) kinetics obtained from serial MRI of swallowing muscles as a potential imaging biomarker of radiation-induced dysphagia in oropharyngeal cancer (OPC) patients receiving radiotherapy (RT). Patients were enrolled under an IRB approved Phase II/III randomized trial. Patients underwent serial MRIs at pre-, mid-, and post-RT. Normalized T1, T1+ contrast (T1 + C), and T2 SI for swallowing muscle volumes-of-interest (VOIs) were collected and delta SI changes (Δ) were calculated. Mid- and post-RT SI relative to baseline were assessed and correlations between radiation dose and percent change in SI were calculated. Independent samples’ t-tests were used to compare the percent change of SI between patients divided into two groups based on dysphagia status post-RT. Forty-six patients with stage III/IV HPV+ OPC were included in this study. Relative to baseline, mean T2 and T1 + C SIs for middle pharyngeal constrictor were both significantly higher at mid- and post-RT (p