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Clinical Trial
. 2015 Mar 17:15:137.
doi: 10.1186/s12885-015-1154-8.

Alterations in anatomic and functional imaging parameters with repeated FDG PET-CT and MRI during radiotherapy for head and neck cancer: a pilot study

Manil Subesinghe  1   2 , Andrew F Scarsbrook  3   4 , Steven Sourbron  5 , Daniel J Wilson  6 , Garry McDermott  7 , Richard Speight  8 , Neil Roberts  9 , Brendan Carey  10 , Roan Forrester  11 , Sandeep Vijaya Gopal  12 , Jonathan R Sykes  13 , Robin J D Prestwich  14   15
Affiliations
Clinical Trial

Alterations in anatomic and functional imaging parameters with repeated FDG PET-CT and MRI during radiotherapy for head and neck cancer: a pilot study

Manil Subesinghe et al. BMC Cancer. .

Abstract

Background: The use of imaging to implement on-treatment adaptation of radiotherapy is a promising paradigm but current data on imaging changes during radiotherapy is limited. This is a hypothesis-generating pilot study to examine the changes on multi-modality anatomic and functional imaging during (chemo)radiotherapy treatment for head and neck squamous cell carcinoma (HNSCC).

Methods: Eight patients with locally advanced HNSCC underwent imaging including computed tomography (CT), Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT and magnetic resonance imaging (MRI) (including diffusion weighted (DW) and dynamic contrast enhanced (DCE)) at baseline and during (chemo)radiotherapy treatment (after fractions 11 and 21). Regions of interest (ROI) were drawn around the primary tumour at baseline and during treatment. Imaging parameters included gross tumour volume (GTV) assessment, SUVmax, mean ADC value and DCE-MRI parameters including Plasma Flow (PF). On treatment changes and correlations between these parameters were analysed using a Wilcoxon rank sum test and Pearson's linear correlation coefficient respectively. A p-value <0.05 was considered statistically significant.

Results: Statistically significant reductions in GTV-CT, GTV-MRI and GTV-DW were observed between all imaging timepoints during radiotherapy. Changes in GTV-PET during radiotherapy were heterogeneous and non-significant. Significant changes in SUVmax, mean ADC value, Plasma Flow and Plasma Volume were observed between the baseline and the fraction 11 timepoint, whilst only changes in SUVmax between baseline and the fraction 21 timepoint were statistically significant. Significant correlations were observed between multiple imaging parameters, both anatomical and functional; 20 correlations between baseline to the fraction 11 timepoint; 12 correlations between baseline and the fraction 21 timepoints; and 4 correlations between the fraction 11 and fraction 21 timepoints.

Conclusions: Multi-modality imaging during radiotherapy treatment demonstrates early changes (by fraction 11) in both anatomic and functional imaging parameters. All functional imaging modalities are potentially complementary and should be considered in combination to provide multi-parametric tumour assessment, to guide potential treatment adaptation strategies.

Trial registration: ISRCTN Registry: ISRCTN34165059 . Registered 2nd February 2015.

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Figures

Figure 1
Figure 1
Multi-modality imaging changes during radiotherapy. A case of a patient with a poorly differentiated squamous cell carcinoma of the base of tongue, T2N2bM0 treated with concurrent chemoradiotherapy to a dose of 70 Gy in 35 fractions over 7 weeks with concurrent cisplatin 100 mg/m2 days 1 and day 29. Imaging was acquired at baseline, fraction 11 and fraction 21 timepoints. Representative axial images at each timepoint are shown, illustrating CT, T2-weighted MRI, DW-MRI, DCE-MRI, and FDG PET-CT images. Colourwash panels show intensity of FDG uptake and PF.
Figure 2
Figure 2
Absolute changes in anatomical and functional imaging parameters during radiotherapy. Plots of GTV-CT, GTV-MRI, GTV-DW, GTV-PET, SUVmax, mean ADC value (ADC), Plasma Flow (PF), Plasma Volume (PV), Interstitial Volume (νe), Permeability Surface Area Product (PS), Extraction Fraction (EF) and Ktrans at baseline (B), fraction 11 (#11) and fraction 21 (#21) timepoints. ✶= median data point at each imaging timepoint. Coloured lines represent individual patients.
Figure 3
Figure 3
Percentage changes in anatomical and functional imaging parameters during radiotherapy. Plots of percentage change in GTV-CT, GTV-MRI, GTV-DW, GTV-PET, SUVmax, mean ADC value (ADC), Plasma Flow (PF), Plasma Volume (PV), Interstitial Volume (νe), Permeability Surface Area Product (PS), Extraction Fraction (EF) and Ktrans at baseline (B), fraction 11 (#11) and fraction 21 (#21) timepoints. ✶= median percentage change at each imaging timepoint. Coloured lines represent individual patients.
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References

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