Clinical Utility of Multimodality Imaging with Dynamic Contrast-Enhanced MRI, Diffusion-Weighted MRI, and XXXX PET/CT for the Prediction of Neck Control in Oropharyngeal or @entity957 Treated with Chemoradiation.

@entity1 @entity957 @entity5 @entity419
The clinical usefulness of pretreatment imaging techniques for predicting neck control in @entity1 with oropharyngeal or @entity957 (OHSCC) treated with chemoradiation remains unclear. In this prospective study, we investigated the role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI), diffusion-weighted MR imaging (DWI), and @entity419 -positron emission tomography ( @entity419 PET)/CT derived imaging markers for the prediction of neck control in OHSCC @entity1 treated with chemoradiation. @entity1 with untreated OHSCC scheduled for chemoradiation between August, 2010 and July, 2012 were eligible for the study. Clinical variables and the following imaging parameters of metastatic neck lymph nodes were examined in relation to neck control: transfer constant, volume of blood plasma, and volume of extracellular extravascular space (Ve) on DCE-PWI; apparent diffusion coefficient (ADC) on DWI; maximum standardized uptake value, metabolic @entity5 volume, and total lesion glycolysis on @entity419 PET/CT. There were 69 @entity1 (37 with oropharynx SCC and 32 with hypopharynx SCC) with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 31 months, 25 (36.2%) @entity1 had neck failure. Multivariate analysis identified hemoglobin level <14.3 g/dL (P=0.019), Ve <0.23 (P=0.040), and ADC >1.14*10-3 mm2/s (P=0.003) as independent prognostic factors for 3-year neck control. A prognostic scoring system was formulated by summing up the three significant predictors of neck control. @entity1 with scores of 2-3 had significantly poorer neck control and overall survival rates than @entity1 with scores of 0-1. We conclude that hemoglobin levels, Ve, and ADC are independent pretreatment prognostic factors for neck control in OHSCC treated with chemoradiation. Their combination may identify a subgroup of @entity1 at high risk of developing neck failure.
