Institute of Clinical Radiology, University Medical Centre Ljubljana, Slovenia.
Division of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
Radiol Oncol. 2019 Mar 3;53(1):39-48. doi: 10.2478/raon-2019-0010.
Background In the study, the value of pre-treatment dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI-derived parameters as well as their changes early during treatment was evaluated for predicting disease-free survival (DFS) and overall survival (OS) in patients with locoregionally advanced head and neck squamous carcinoma (HNSCC) treated with concomitant chemoradiotherapy (cCRT) with cisplatin. Patients and methods MRI scans were performed in 20 patients with locoregionally advanced HNSCC at baseline and after 10 Grays (Gy) of cCRT. Tumour apparent diffusion coefficient (ADC) and DCE parameters (volume transfer constant [Ktrans], extracellular extravascular volume fraction [ve], and plasma volume fraction [Vp]) were measured. Relative changes in parameters from baseline to 10 Gy were calculated. Univariate and multivariate Cox regression analysis were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify parameters with the best diagnostic performance. Results None of the parameters was identified to predict for DFS. On univariate analysis of OS, lower pre-treatment ADC (p = 0.012), higher pre-treatment Ktrans (p = 0.026), and higher reduction in Ktrans (p = 0.014) from baseline to 10 Gy were identified as significant predictors. Multivariate analysis identified only higher pre-treatment Ktrans (p = 0.026; 95% CI: 0.000-0.132) as an independent predictor of OS. At ROC curve analysis, pre-treatment Ktrans yielded an excellent diagnostic accuracy (area under curve [AUC] = 0.95, sensitivity 93.3%; specificity 80 %). Conclusions In our group of HNSCC patients treated with cisplatin-based cCRT, pre-treatment Ktrans was found to be a good predictor of OS.
背景 在这项研究中，评估了治疗前动态对比增强（DCE）和弥散加权（DW）MRI 衍生参数及其在治疗早期的变化值，以预测接受顺铂同期放化疗（cCRT）的局部晚期头颈部鳞状细胞癌（HNSCC）患者的无病生存（DFS）和总生存（OS）。
患者和方法 20 例局部晚期 HNSCC 患者在基线和接受 10Gy cCRT 后进行 MRI 扫描。测量肿瘤表观弥散系数（ADC）和 DCE 参数（容积转移常数 [Ktrans]、细胞外血管外容积分数 [ve]和血浆容积分数 [Vp]）。计算从基线到 10Gy 的参数相对变化。进行单变量和多变量 Cox 回归分析。采用受试者工作特征（ROC）曲线分析确定具有最佳诊断性能的参数。
结果 没有一个参数可预测 DFS。在 OS 的单变量分析中，治疗前 ADC 较低（p=0.012）、治疗前 Ktrans 较高（p=0.026）和 Ktrans 从基线到 10Gy 的降低幅度较高（p=0.014）被确定为显著预测因子。多变量分析仅确定治疗前 Ktrans 较高（p=0.026；95%CI：0.000-0.132）是 OS 的独立预测因子。在 ROC 曲线分析中，治疗前 Ktrans 具有优异的诊断准确性（曲线下面积 [AUC] = 0.95，敏感性 93.3%；特异性 80%）。
结论 在接受顺铂为基础的 cCRT 治疗的 HNSCC 患者中，治疗前 Ktrans 是 OS 的良好预测因子。
