Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study

Joint Head and Neck Radiotherapy-MRI Development Cooperative

doi:10.1016/j.radonc.2023.109641

Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study

Joint Head and Neck Radiotherapy-MRI Development Cooperative

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Purpose: To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT). Methods: HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify ADC threshold associated with relapse. Cox proportional hazards models were done for clinical vs. clinical and imaging parameters and internal validation was done using bootstrapping technique. Results: Eighty-one patients were included. Median follow-up was 31 months. For patients with post-RT CR, there was a significant increase in mean ADC at mid-RT compared to baseline ((1.8 ± 0.29) × 10^–3 mm²/s vs. (1.37 ± 0.22) × 10^–3 mm²/s, p < 0.0001), while patients with non-CR had no significant increase (p > 0.05). RPA identified GTV-P delta (Δ)ADC_mean < 7% at mid-RT as the most significant parameter associated with worse LC and RFS (p = 0.01). Uni- and multi-variable analysis showed that GTV-P ΔADC_mean at mid-RT ≥ 7% was significantly associated with better LC and RFS. The addition of ΔADC_mean significantly improved the c-indices of LC and RFS models compared with standard clinical variables (0.85 vs. 0.77 and 0.74 vs. 0.68 for LC and RFS, respectively, p < 0.0001 for both). Conclusion: ΔADC_mean at mid-RT is a strong predictor of oncologic outcomes in HNC. Patients with no significant increase of primary tumor ADC at mid-RT are at high risk of disease relapse.

Original language	English (US)
Article number	109641
Journal	Radiotherapy and Oncology
Volume	183
DOIs	https://doi.org/10.1016/j.radonc.2023.109641
State	Published - Jun 2023
Externally published	Yes

Keywords

DWI
Head and neck cancer
Imaging Biomarker
Oncologic outcomes
Radiation Therapy
Tumor response

ASJC Scopus subject areas

Hematology
Oncology
Radiology Nuclear Medicine and imaging

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10.1016/j.radonc.2023.109641

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Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study. / Joint Head and Neck Radiotherapy-MRI Development Cooperative.
In: Radiotherapy and Oncology, Vol. 183, 109641, 06.2023.

Research output: Contribution to journal › Article › peer-review

@article{3c097451a6da4b4cbd3e159edf409d3e,

title = "Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study",

abstract = "Purpose: To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT). Methods: HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify ADC threshold associated with relapse. Cox proportional hazards models were done for clinical vs. clinical and imaging parameters and internal validation was done using bootstrapping technique. Results: Eighty-one patients were included. Median follow-up was 31 months. For patients with post-RT CR, there was a significant increase in mean ADC at mid-RT compared to baseline ((1.8 ± 0.29) × 10–3 mm2/s vs. (1.37 ± 0.22) × 10–3 mm2/s, p < 0.0001), while patients with non-CR had no significant increase (p > 0.05). RPA identified GTV-P delta (Δ)ADCmean < 7% at mid-RT as the most significant parameter associated with worse LC and RFS (p = 0.01). Uni- and multi-variable analysis showed that GTV-P ΔADCmean at mid-RT ≥ 7% was significantly associated with better LC and RFS. The addition of ΔADCmean significantly improved the c-indices of LC and RFS models compared with standard clinical variables (0.85 vs. 0.77 and 0.74 vs. 0.68 for LC and RFS, respectively, p < 0.0001 for both). Conclusion: ΔADCmean at mid-RT is a strong predictor of oncologic outcomes in HNC. Patients with no significant increase of primary tumor ADC at mid-RT are at high risk of disease relapse.",

keywords = "DWI, Head and neck cancer, Imaging Biomarker, Oncologic outcomes, Radiation Therapy, Tumor response",

author = "{Joint Head and Neck Radiotherapy-MRI Development Cooperative} and Mohamed, {Abdallah S.R.} and Abdelrahman Abusaif and Renjie He and Wahid, {Kareem A.} and Vivian Salama and Sara Youssef and McDonald, {Brigid A.} and Mohamed Naser and Yao Ding and Salzillo, {Travis C.} and AboBakr, {Moamen A.} and Jihong Wang and Lai, {Stephen Y.} and Fuller, {Clifton D.}",

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = jun,

doi = "10.1016/j.radonc.2023.109641",

language = "English (US)",

volume = "183",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer

T2 - Results from an observational biomarker pre-qualification study

AU - Joint Head and Neck Radiotherapy-MRI Development Cooperative

AU - Mohamed, Abdallah S.R.

AU - Abusaif, Abdelrahman

AU - He, Renjie

AU - Wahid, Kareem A.

AU - Salama, Vivian

AU - Youssef, Sara

AU - McDonald, Brigid A.

AU - Naser, Mohamed

AU - Ding, Yao

AU - Salzillo, Travis C.

AU - AboBakr, Moamen A.

AU - Wang, Jihong

AU - Lai, Stephen Y.

AU - Fuller, Clifton D.

PY - 2023/6

Y1 - 2023/6

N2 - Purpose: To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT). Methods: HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify ADC threshold associated with relapse. Cox proportional hazards models were done for clinical vs. clinical and imaging parameters and internal validation was done using bootstrapping technique. Results: Eighty-one patients were included. Median follow-up was 31 months. For patients with post-RT CR, there was a significant increase in mean ADC at mid-RT compared to baseline ((1.8 ± 0.29) × 10–3 mm2/s vs. (1.37 ± 0.22) × 10–3 mm2/s, p < 0.0001), while patients with non-CR had no significant increase (p > 0.05). RPA identified GTV-P delta (Δ)ADCmean < 7% at mid-RT as the most significant parameter associated with worse LC and RFS (p = 0.01). Uni- and multi-variable analysis showed that GTV-P ΔADCmean at mid-RT ≥ 7% was significantly associated with better LC and RFS. The addition of ΔADCmean significantly improved the c-indices of LC and RFS models compared with standard clinical variables (0.85 vs. 0.77 and 0.74 vs. 0.68 for LC and RFS, respectively, p < 0.0001 for both). Conclusion: ΔADCmean at mid-RT is a strong predictor of oncologic outcomes in HNC. Patients with no significant increase of primary tumor ADC at mid-RT are at high risk of disease relapse.

AB - Purpose: To determine DWI parameters associated with tumor response and oncologic outcomes in head and neck (HNC) patients treated with radiotherapy (RT). Methods: HNC patients in a prospective study were included. Patients had MRIs pre-, mid-, and post-RT completion. We used T2-weighted sequences for tumor segmentation which were co-registered to respective DWIs for extraction of apparent diffusion coefficient (ADC) measurements. Treatment response was assessed at mid- and post-RT and was defined as: complete response (CR) vs. non-complete response (non-CR). The Mann-Whitney U test was used to compare ADC between CR and non-CR. Recursive partitioning analysis (RPA) was performed to identify ADC threshold associated with relapse. Cox proportional hazards models were done for clinical vs. clinical and imaging parameters and internal validation was done using bootstrapping technique. Results: Eighty-one patients were included. Median follow-up was 31 months. For patients with post-RT CR, there was a significant increase in mean ADC at mid-RT compared to baseline ((1.8 ± 0.29) × 10–3 mm2/s vs. (1.37 ± 0.22) × 10–3 mm2/s, p < 0.0001), while patients with non-CR had no significant increase (p > 0.05). RPA identified GTV-P delta (Δ)ADCmean < 7% at mid-RT as the most significant parameter associated with worse LC and RFS (p = 0.01). Uni- and multi-variable analysis showed that GTV-P ΔADCmean at mid-RT ≥ 7% was significantly associated with better LC and RFS. The addition of ΔADCmean significantly improved the c-indices of LC and RFS models compared with standard clinical variables (0.85 vs. 0.77 and 0.74 vs. 0.68 for LC and RFS, respectively, p < 0.0001 for both). Conclusion: ΔADCmean at mid-RT is a strong predictor of oncologic outcomes in HNC. Patients with no significant increase of primary tumor ADC at mid-RT are at high risk of disease relapse.

KW - DWI

KW - Head and neck cancer

KW - Imaging Biomarker

KW - Oncologic outcomes

KW - Radiation Therapy

KW - Tumor response

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U2 - 10.1016/j.radonc.2023.109641

DO - 10.1016/j.radonc.2023.109641

M3 - Article

C2 - 36990394

AN - SCOPUS:85151551341

SN - 0167-8140

VL - 183

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 109641

ER -

Prospective validation of diffusion-weighted MRI as a biomarker of tumor response and oncologic outcomes in head and neck cancer: Results from an observational biomarker pre-qualification study

Abstract

Keywords

ASJC Scopus subject areas

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