Radiation and Cancer Physics

SS 32 - Physics 10 - Imaging for Response Assessment II

233 - Multiparametric MRI for Progression Assessment in a Prospective Randomized Adaptive Chemoradiotherapy Trial for Head and Neck Cancer

Wednesday, October 24
8:05 AM - 8:15 AM
Location: Room 217 A/B

Multiparametric MRI for Progression Assessment in a Prospective Randomized Adaptive Chemoradiotherapy Trial for Head and Neck Cancer
Y. Cao1, P. G. Hawkins1, M. P. Aryal1, C. Lee1, C. H. Chapman1, M. Schipper2, A. Eisbruch1, and M. Mierzwa1; 1Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 2University of Michigan, Department of Radiation Oncology, Ann Arbor, MI

Purpose/Objective(s): Tumor subvolumes characterized by low blood volume (LBV) with dynamic contrast-enhanced (DCE)-MRI and restricted diffusion (RD) with diffusion-weighted (DW)-MRI have been reported to be high-risk imaging biomarkers for tumor progression. In this image study, we aim to assess whether early changes in LBV and RD subvolumes during RT differentiate patients with progression disease from those with disease free.

Materials/Methods: Patients with either HPV (+), T4/N3 HNC, or HPV (-), T3-4/N3 HNC were enrolled in a randomized phase II trial. Multiparametric MRI were acquired at baseline, between fx 8-12 of radiation and within 2 days of fraction 35. LBV was defined as blood volume derived from DCE-MRI <0.076. RD was defined as apparent diffusion coefficient <1.2x10-3mm2/sec. Gross tumor volume (GTVp), LBV subvolume (LBVp), and RD subvolume (RDVp) of primary tumor at baseline (pre-), and their changes at early mid-treatment and at the end of RT were compared between patients with and without disease progression using one-tailed t-test.

Results: Forty-four patients (median age of 61 years) have been accrued: 18 randomized to receive boost and 26 treated by standard therapy. To date, at a median follow-up of 9 months, 4 patients have failed locally (LF), 3 regionally (RF), and 5 distantly (DF). Mean values of GTVp were decreased significantly from 1 to 10 fx by 15% for patients with no evidence of disease (NED), 28% for LF, and 7% for RF/DF (p<0.05). During the same time interval, mean values of RDVp were reduced significantly by 63% for NED, 44% for LF, and 55% for RF/DF (p<0.05); while mean values of LBVp were decreased significantly by 36% for NED and 54% for LF (p<0.05) but increased by 12% for RF/DF. The increase in LBVp for RF/DF was significantly different from the decrease for NED (p<0.05). None of early changes in GTVp, LBVp, and RDVp for LF were significantly different from those for NED. However, two patients with LF had increased LBVp from 10 to 35 fx.

Conclusion: Low blood volume changes at mid-treatment and the end of RT may be promising imaging biomarkers for regional and distant recurrence in poor prognosis head and neck cancer. As this study continues, we will assess LBV and RD characteristics in primary tumor and nodes independently and correlate with LF, RF, and DF.

Author Disclosure: Y. Cao: Research Grant; Siemens, NIH. P.G. Hawkins: None. M.P. Aryal: None. C. Lee: Research Grant; NIH, Varian. C.H. Chapman: Research Grant; National Cancer Institute. Vice Chair for Membership, Post Graduate Section; National Medical Association. M. Schipper: Research Grant; NIH. A. Eisbruch: Research Grant; NIH. Co-chair; NIH. M. Mierzwa: Research Grant; NIH.

Yue Cao, PhD

University of Michigan

Disclosure:
Employment
University of Michigan: Professor: Employee

Compensation
NIH: Research Grants; Siemens: Research Grants

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