Table 1
The baseline clinical characteristics of all the patients
| Patient | Sex | Age (yrs) | Tumour location | TNM | Stage |
|---|---|---|---|---|---|
| 1 | M | 53 | Oropharynx | T4aN1 | IVA |
| 2 | M | 67 | Hypopharynx | T3N1 | III |
| 3 | M | 66 | Hypopharynx | T3N2b | IVA |
| 4 | M | 56 | Oropharynx | T3N2b | IVA |
| 5 | M | 49 | Oropharynx | T2N2b | IVA |
| 6 | M | 57 | Oropharynx | T4aN2c | IVA |
| 7 | M | 59 | Hypopharynx | T4aN2b | IVA |
| 8 | M | 60 | Oropharynx | T3N2b | IVA |
| 9 | M | 58 | Oropharynx | T4aN2b | IVA |
| 10 | M | 53 | Oropharynx | T4aN2c | IVA |
| 11 | M | 64 | Oropharynx | T3N2c | IVA |
| 12 | M | 56 | Hypopharynx | T3N2b | IVA |
| 13 | M | 65 | Oropharynx | T2N2b | IVA |
| 14 | M | 53 | Hypopharynx | T4aN2c | IVA |
| 15 | M | 66 | Oropharynx | T3N2b | IVA |
| 16 | M | 65 | Oropharynx | T3N2a | IVA |
| 17 | M | 46 | Oropharynx | T3N3 | IVB |
| 18 | M | 67 | Hypopharynx | T3N1 | III |
| 19 | F | 58 | Oropharynx | T3N1 | III |
| 20 | M | 48 | Hypopharynx | T3N1 | III |
[i] Yrs = years
Table 2
Absolute values of DWI and DCE-MRI derived parameters and tumour volumes before treatment and their relative changes after 10 Gy (expressed as median and range) for the entire cohort of the patients and separately for alive and deceased patients at the end of follow-up
| Parameters | The entire cohort of patients (n = 20, 100%) | Patients still alive at the end of follow-up (n = 15; 75%) | Deceased patients at the end of follow-up (n = 5; 25%) |
|---|---|---|---|
| Pre-treatment values | |||
| ADC (x 10-3 mm2/s) | 0.81 (0.62–1.07) | 0.76 (0.62–0.91) | 0.96 (0.76–1.07) |
| Ktrans (min-1) | 0.48 (0.13–0.79) | 0.57 (0.23–0.79) | 0.22 (0.13–0.35) |
| Ve | 0.32 (0.15–0.64) | 0.32 (0.17–0.64) | 0.22 (0.15–0.37) |
| Vp | 0.17 (0.06–0.43) | 0.15 (0.07–0.43) | 0.35 (0.06–0.41) |
| Tumour volume (ml) | 10.5 (2.6–54.9 ). | 8.8 (2.6–44.55) | 18.21 (6.6–54.9) |
| Relative changes after 10 Gy | |||
| ΔADC | 22.5% (1.7 to 52.4%) | 25.0 (4.7 to 51.4) | 9.2 (1.7 to 52.4) |
| ΔKtrans | -50.3% (-93.4 to 179.2%) | -60.0 (-93.0 to -43.2) | 4.2 (-37.1 to 179.2) |
| ΔVe | -35.2% (-88.9 to 126.8%) | -40.0 (-88.9 to 65.4) | -14.7 (-40. to 126.8) |
| ΔVp | 70% (73.2 to 357.14%) | 92.9 (-18.6 to 357.2) | 10.0 (-73.2 to 100) |
| ΔTumour volume | (-15.0%; -76.3 to 254.6%); | -14.0 (-76.3 to 254.6) | -19.6 (-37.7 to 114.72) |
[i] ADC = apparent diffusion coefficient; DCE-MRI = dynamic contrast-enhanced MRI; DWI = diffusion weighted imaging; Gy = gray; Ktrans = volume transfer constant; Ve = extracellular extravascular volume fraction; Vp = plasma volume fraction; Δ = relative change in the parameter
Figure 1
58 year old patient with oropharyngeal squamous cell carcinoma (T4a N2b) who was alive at the end of follow up with overall survival of 41.1 months. Axial post-contrast T1 images, co-registred and corresponding apparent diffusion coefficient (ADC) maps and color-coded dynamic contrast-enhanced MRI derived volume transfer constant (Ktrans), extracellular extravascular fraction (Ve) and plasma volume fraction (Vp) maps in the area of the tumour (arrows) are shown. Top: before treatment; bottom: after 10 Gray of chemo-radiotherapy.
Figure 2
65 year old patient with hypopharyngeal squamous cell carcinoma (T2 N2) who died 14 months of starting of chemo-radiotherapy due to disease relaps into the lungs. Axial post-contrast T1 images, co-registred and corresponding apparent diffusion coefficient (ADC) maps and color-coded dynamic contrast-enhanced MRI derived volume transfer constant (Ktrans), extracellular extravascular fraction (Ve) and plasma volume fraction (Vp) maps in the area of the tumour (arrows) are shown. Top: before treatment; bottom: after 10 Gray of chemo-radiotherapy.
Table 3
Univariate analysis of risk factors associated with disease-free survival and overall survival rates (n = 20)
| Parameters | Disease-free survival (p value) | Overall survival (p value) |
|---|---|---|
| Clinical parameters | ||
| Age | 0.338 | 0.556 |
| Tumour location | 0.396 | 0.752 |
| Stage | 1.000 | 0.198 |
| Pre-treatment values of functional parameters and tumour volume | ||
| ADC (x 10-3 mm2/s) | 0.856 | 0.012* |
| Ktrans (min-1) | 0.116 | 0.026* |
| Ve | 0.754 | 0.293 |
| Vp | 0.165 | 0.342 |
| Tumour volume | 0.959 | 0.048* |
| Relative changes after 10 Gy of functional parameters and tumour volume | ||
| ΔADC (%) | 0.740 | 0.061 |
| ΔKtrans | 0.688 | 0.014* |
| ΔVe | 0.957 | 0.405 |
| ΔVp | 0.672 | 0.077 |
| ΔTumour volume (ml) | 0.495 | 0.486 |
[i] * = significant predictor at univariate analysis; ADC = Apparent diffusion coefficient; Ktrans = volume transfer constant; Ve = extracellular extravascular volume fraction; Vp = plasma volume fraction; Δ = relative change in the parameter
Figure 3
Receiver operating characteristic (ROC) curves for dynamic contrast-enhanced MRI (DCE-MRI) derived parameter Ktrans (volume transfer constant) exhibiting area under ROC curve (AUC) of 0.95 with sensitivity 93.3% and specificity 80%. (p = 0.003).
Figure 4
Kaplan-Meier estimates of overall survival in HNSCC patients (20) stratified according to pre-treatement DCE-MRI derived parameter Ktrans (cutt-off value of ≥ 0.29 min-1, determined at ROC curve analysis).
DCE-MRI = dynamic contrast-enhanced MRI; Ktrans = volume transfer constant; ROC = receiver operating curve