Asok Aswathi, Chandrashekhara S H, Sharma Raju, Thulkar Sanjay, Bhalla Ashu Seith, Sudhakaran Dipin, Kandasamy Devasenathipathy, Kumar Lalit, Kumar Sunil, Arava Sudheer
Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India.
Department of Radio-Diagnosis (IRCH) , All India Institute of Medical Sciences, New Delhi, India.
Indian J Otolaryngol Head Neck Surg. 2025 Jun;77(6):2352-2362. doi: 10.1007/s12070-025-05511-7. Epub 2025 May 2.
To downstage the locally advanced or inoperable oral cancer, neoadjuvant chemotherapy (NACT) is required. Early response assessment to chemoradiotherapy is needed to avoid unnecessary treatment in patients who are nonresponders. We conducted a prospective study to evaluate the role of diffusion weighted imaging (DWI) in predicting the response after NACT in locally advanced carcinoma of oral cavity. After ethical approval, A total of 19 patients were enrolled for the study. MRI were performed using T1W, T2W, T1W post contrast and DW images (b values b0, 100, 500, and 1000 sec/mm). Timing of scans were fixed as- pretreatment, 2 weeks after the initiation of first cycle of NACT after 3rd cycle of NACT. ADC values of the tumors were assessed in each scan. The mean age of the population was 46 years and majority were males. In our study, most patients had buccal mucosal cancer (13 patients). Patients with stable disease and progressive disease were labelled as non-responders, whereas patients with partial response and complete response were designated as responders. In our study, 11 patients were responders and 8 patients were non-responders. There was a significant difference between the baseline ADC values of responders and non-responders (p value = 0. 017). The increase in the mean absolute ADC and nADC values at the early time point was greater in the responders than the non-responders, and the difference was statistically significant (p values = 0.05 and 0.04 respectively). There was a significant difference between the baseline ADC values of responders and non-responders (p value = 0. 017). ADC values of diffusion weighted MRI can be utilized to predict the response to neoadjuvant chemotherapy in squamous cell carcinoma of oral cavity as masses with high baseline ADC values are less likely to respond to chemotherapy.
对于局部晚期或无法手术切除的口腔癌，需要进行新辅助化疗（NACT）。需要对放化疗进行早期反应评估，以避免对无反应患者进行不必要的治疗。我们进行了一项前瞻性研究，以评估扩散加权成像（DWI）在预测口腔局部晚期癌新辅助化疗后反应中的作用。经伦理批准后，共有19例患者纳入本研究。使用T1加权像、T2加权像、T1加权像增强扫描及扩散加权像（b值为b0、100、500和1000秒/毫米²）进行磁共振成像（MRI）检查。扫描时间固定为：治疗前、新辅助化疗第一周期开始后2周、第三周期新辅助化疗后。在每次扫描中评估肿瘤的表观扩散系数（ADC）值。研究人群的平均年龄为46岁，大多数为男性。在我们的研究中，大多数患者患有颊黏膜癌（13例）。疾病稳定和疾病进展的患者被标记为无反应者，而部分缓解和完全缓解的患者被指定为反应者。在我们的研究中，11例患者为反应者，8例患者为无反应者。反应者和无反应者的基线ADC值之间存在显著差异（p值=0.017）。反应者在早期时间点的平均绝对ADC值和标准化ADC值的增加大于无反应者，差异具有统计学意义（p值分别为0.05和0.04）。反应者和无反应者的基线ADC值之间存在显著差异（p值=0.017）。扩散加权MRI的ADC值可用于预测口腔鳞状细胞癌对新辅助化疗的反应，因为基线ADC值高的肿块对化疗反应的可能性较小。
