Early responses assessment of neoadjuvant chemotherapy in nasopharyngeal carcinoma by serial dynamic contrast-enhanced MR imaging |
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| Affiliation: | 1. Department of Radiology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, People''s Republic of China;2. Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, People''s Republic of China;3. Philips Healthcare, Shanghai, People''s Republic of China;4. Philips Healthcare, Hong Kong, China;1. Department of Medical Imaging and Radiology, Phoenix Children''s Hospital, Phoenix, AZ, USA;2. Keller Center for Imaging Innovation, Barrow Neurological Institute, St. Joseph''s Hospital and Medical Center, Phoenix, AZ, USA;3. Philips HealthTech, Best, The Netherlands;1. Obstetrics, Gynaecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA;2. Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY 10016, USA;2. Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA |
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| Abstract: | PurposeTo evaluate the feasibility of utilizing serial dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) prospectively for early prediction of neoadjuvant chemotherapy (NAC) response in nasopharyngeal carcinoma (NPC) patients.Materials and methodsSixty-three advanced NPC patients were recruited and received three DCE-MRI exams before treatment (Pre-Tx), 3 days (Day3-Tx) and 20 days (Day20-Tx) after initiation of chemotherapy (one NAC cycle). Early response to NAC was determined based on the third MRI scan and classified partial response (PR) as responders and stable disease (SD) as non-responders. After intensity-modulated radiotherapy (IMRT), complete response (CR) patients were classified as responders. The kinetic parameters (Ktrans, Kep, ve, and vp) derived from extended Tofts' model analysis and their corresponding changes ΔMetrics(0–X) (X = 3 or 20 days) were compared between the responders and non-responders using the Student's T-test or Mann–Whitney U test.ResultsCompared to the SD group, the PR group after one NAC cycle presented significantly higher mean Ktrans values at baseline (P = 0.011) and larger ΔKtrans(0–3) and ΔKep(0–3) values (P = 0.003 and 0.031). For the above parameters, we gained acceptable sensitivity (range: 66.8–75.0%) and specificity (range: 60.0–66.7%) to distinguish the non-responders from the responders and their corresponding diagnosis efficacy (range: 0.703–0.767). The PR group patients after one NAC cycle showed persistent inhibition of tumor perfusion by NAC as explored by DCE-MRI parameters comparing to the SD group (P < 0.05) and presented a higher cure ratio after IMRT than those who did not (83.3% vs. 73.8%).ConclusionsThis primarily DCE-MRI based study showed that the early changes of the kinetic parameters during therapy were potential imaging markers to predicting response right after one NAC cycle for NPC patients. |
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