Department of Imaging and International Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
Br J Radiol. 2010 Nov;83(995):964-70. doi: 10.1259/bjr/27631720.
Although previous studies have documented correlations between pre-treatment or post-treatment primary tumour volumes and local outcome following definitive concomitant chemoradiotherapy (CCRT) in head and neck squamous cell carcinoma (HNSCC), no study has included and compared tumour volumes during CCRT. We reviewed the MRIs of 69 HNSCC patients treated with a 6 weeks course of CCRT and who underwent successful MRI pre-treatment (n = 69), 2 weeks intra-treatment (n = 48) and 6 weeks post-treatment (n = 61). Primary tumour volumes on MRI at the three time points were calculated and compared for their predictive value for primary site outcome. Volume thresholds optimised to predict failure with the highest accuracy and positive predictive value (PPV) were calculated. The mean pre-treatment volume was 24.6 cm³ (range, 1.1-187.9 cm³) and the mean follow-up interval was 41 months (range, 12-100 months). 23 primary tumours failed treatment (33%). Volumes before, during and after CCRT were positively associated with local failure (p = 0.015, p = 0.009, p<0.0001). Volume reductions during and after CCRT were negatively associated with local failure (p = 0.021, p = 0.001). Pre-treatment and intra-treatment volume thresholds achieved the highest accuracy and produced intermediate PPVs (51-64%) for predicting local failure. Optimised intra-treatment thresholds did not identify any more treatment failures than the pre-treatment thresholds. By comparison, a 6 weeks post-treatment volume reduction (<35%) achieved 100% PPV for failure, albeit with 26% sensitivity. In conclusion, primary tumour volumetry performed early in CCRT provides minimal additional information compared with pre-treatment volumetry, with respect to predicting post-treatment local failures. Therefore, volumetry during CCRT is unlikely to be useful for guiding individual response-based therapeutic modifications.
尽管先前的研究已经记录了头颈部鳞状细胞癌（HNSCC）根治性同期放化疗（CCRT）前后原发肿瘤体积与局部疗效之间的相关性，但没有研究包括 CCRT 期间的肿瘤体积。我们回顾了 69 例接受 6 周 CCRT 治疗的 HNSCC 患者的 MRI，这些患者成功进行了 MRI 治疗前（n=69）、2 周内治疗（n=48）和 6 周后治疗（n=61）。在三个时间点计算 MRI 上的原发肿瘤体积，并比较其对原发部位疗效的预测价值。计算出最佳预测失败的最佳阈值，并具有最高准确性和阳性预测值（PPV）。治疗前平均体积为 24.6cm³（范围为 1.1-187.9cm³），平均随访时间为 41 个月（范围为 12-100 个月）。23 例原发肿瘤治疗失败（33%）。CCRT 前后的体积与局部失败呈正相关（p=0.015，p=0.009，p<0.0001）。CCRT 期间和治疗后体积减少与局部失败呈负相关（p=0.021，p=0.001）。治疗前和治疗期间的体积阈值预测局部失败的准确性最高，产生中等的 PPV（51-64%）。优化的治疗期间阈值没有比治疗前阈值识别出更多的治疗失败。相比之下，6 周后治疗体积减少（<35%）对失败的 PPV 为 100%，尽管敏感性为 26%。总之，与治疗前容积相比，CCRT 早期进行的原发肿瘤容积测量在预测治疗后局部失败方面提供的信息很少。因此，CCRT 期间的容积测量不太可能用于指导基于个体反应的治疗修改。
