Tumor plasma flow determined by dynamic contrast-enhanced MRI predicts response to induction chemotherapy in head and neck cancer

Objectives: Non-response to induction chemotherapy (IC) occurs in 30% of head and neck squamous cell carcinoma (HNSCC) and has been predicted by tumor plasma flow (F-p) derived by perfusion computed tomography. The present study was designed to test whether baseline tumor F-p determined by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) would predict IC response. Materials and methods: A prospective open study powered to test the relationship between tumor F-p and response to IC (docetaxel, cisplatin, 5-fluorouracil) enrolled 50 patients with stage IV HNSCC. Response after two IC cycles was measured by MRI using Response Evaluation Criteria in Solid Tumors in 37 patients. Tumor F-p (primary end point) and multiple parameters in tumors and lymph nodes (secondary end points) were generated at baseline. Differences in baseline DCE-MRI parameters according to IC response were assessed by the Mann-Whitney U test, and predictive value by receiver operating characteristic (ROC) analysis. Results: Median baseline tumor F-p was 53.2 ml/100 ml/min in 25 responders and 23.9 in 12 non-responders (U 82; P = 0.027; area under ROC curve (AUC) 0.73). Median baseline F-p in lymph nodes was 25.8 ml/100 ml/min for 37 nodes in 25 responders and 17.1 for 15 nodes in 12 non-responders (U 186, P = 0.066; AUC 0.67). Frequency of IC response in 37 patients was 68% overall, 83% for tumor F-p above the median (40.6 ml/100 ml/min) and 45% below the median. Other DCE-MRI parameters were not associated with IC response. Conclusion: Pre-treatment tumor F-p determined by DCE-MRI predicts IC response in HNSCC. (C) 2015 Elsevier Ltd. All rights reserved.