TY - JOUR
T1 - Longitudinal diffusion and volumetric kinetics of head and neck cancer magnetic resonance on a 1.5 T MR-linear accelerator hybrid system
T2 - A prospective R-IDEAL stage 2a imaging biomarker characterization/pre-qualification study
AU - the MR-Linac Consortium Head and Neck Tumor Site Group
AU - Joint Head and Neck Radiation Therapy-MRI Development Cooperative
AU - El-Habashy, Dina M.
AU - Wahid, Kareem A.
AU - He, Renjie
AU - McDonald, Brigid
AU - Rigert, Jillian
AU - Mulder, Samuel J.
AU - Lim, Tze Yee
AU - Wang, Xin
AU - Yang, Jinzhong
AU - Ding, Yao
AU - Naser, Mohamed A.
AU - Ng, Sweet Ping
AU - Bahig, Houda
AU - Salzillo, Travis C
AU - Preston, Kathryn E.
AU - Abobakr, Moamen
AU - Shehata, Mohamed A.
AU - Elkhouly, Enas A.
AU - Alagizy, Hagar A.
AU - Hegazy, Amira H.
AU - Mohammadseid, Mustefa
AU - Terhaard, Chris
AU - Philippens, Marielle
AU - Rosenthal, David I.
AU - Wang, Jihong
AU - Lai, Stephen Y.
AU - Dresner, Alex
AU - Christodouleas, John C.
AU - Mohamed, Abdallah Sherif Radwan
AU - Fuller, Clifton D.
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/9
Y1 - 2023/9
N2 - Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods: Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during and after RT, and the recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman's Rho test. Recursive partitioning analysis (RPA) identified the optimal ΔADC threshold associated with different oncologic outcomes. Results: There was a significant rise in all ADC parameters at different time points of RT compared to baseline for both gross primary disease (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5th percentile > 13% at the mid-RT as the most significant parameter associated with primary tumors’ CR during RT (p < 0.001). There was a significant decrease in residual volume of both GTV-P & GTV-N throughout the course of RT. A significant negative correlation between mean ΔADC and Δvolume for GTV-P at the 3rd and 4th week of RT was detected (r = −0.39, p = 0.044 & r = −0.45, p = 0.019, respectively). Conclusion: Assessment of ADC kinetics at regular intervals throughout RT seems to be correlated with RT response. Further studies with larger cohorts and multi-institutional data are needed for validation of ΔADC as a model for prediction of response to RT.
AB - Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods: Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during and after RT, and the recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman's Rho test. Recursive partitioning analysis (RPA) identified the optimal ΔADC threshold associated with different oncologic outcomes. Results: There was a significant rise in all ADC parameters at different time points of RT compared to baseline for both gross primary disease (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5th percentile > 13% at the mid-RT as the most significant parameter associated with primary tumors’ CR during RT (p < 0.001). There was a significant decrease in residual volume of both GTV-P & GTV-N throughout the course of RT. A significant negative correlation between mean ΔADC and Δvolume for GTV-P at the 3rd and 4th week of RT was detected (r = −0.39, p = 0.044 & r = −0.45, p = 0.019, respectively). Conclusion: Assessment of ADC kinetics at regular intervals throughout RT seems to be correlated with RT response. Further studies with larger cohorts and multi-institutional data are needed for validation of ΔADC as a model for prediction of response to RT.
KW - ADC
KW - Diffusion
KW - DWI
KW - Head and neck cancer
KW - MR-Linac
KW - Oncologic outcomes
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U2 - 10.1016/j.ctro.2023.100666
DO - 10.1016/j.ctro.2023.100666
M3 - Article
C2 - 37583808
AN - SCOPUS:85167394545
SN - 2405-6308
VL - 42
JO - Clinical and Translational Radiation Oncology
JF - Clinical and Translational Radiation Oncology
M1 - 100666
ER -