(S053) Nodal Surveillance With Diffusion-Weighted MRI After Definitive (Chemo) Radiotherapy for HPV-Predominant Squamous Cell Cancers of the Oropharynx and Unknown Primary

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Early surveillance imaging with diffusion-weighted MRI at 6–8 weeks following definitive treatment with radiotherapy is feasible and may be predictive of early nodal failure. Further validation in a prospective cohort is warranted.

Yao Yu, MD, Marc Mabray, MD, William Silveira, MD, PhD, Peter Y. Shen, MD, PhD, William Ryan, MD, Alina Uzelac, DO, Sue S. Yom; University of California, San Francisco

BACKGROUND: Diffusion-weighted MRI has been proposed as a method to differentiate treatment effect from persistent or recurrent nodal disease after definitive treatment with radiotherapy.

METHODS: Records and imaging were reviewed for 70 patients treated with definitive radiotherapy with or without chemotherapy for squamous cell carcinomas of the oropharynx or p16-positive unknown primary of the head and neck. A total of 40 patients were available for analysis. Surveillance imaging with magnetic resonance imaging (MRI) was obtained 6–8 weeks after treatment, followed by positron emission tomography/computed tomography (PET/CT) at 12 weeks after treatment. Apparent diffusion coefficient (ADC) values were calculated for each node and for each hemineck. PET/CT results and ADC values were correlated with regional control at 6 months based on histopathology and clinical follow-up.

RESULTS: The mean ADC was significantly lower for lymph nodes corresponding with recurrent disease compared with control at 6 months (1,301 μm2/s vs 2,049 μm2/s; P = .04). Using receiver operating characteristic (ROC) analysis, an optimal threshold of 1,600 μm2/s was identified; lymph nodes with ADC values below this threshold were found to be at higher risk for recurrent disease. Sensitivity and specificity were 100% and 84%, respectively, with positive and negative predictive values of 41% and 100%, respectively. When analyzed by hemineck, the sensitivity and specificity were 100% and 85%, respectively. PET/CT at 12 weeks yielded a sensitivity and specificity of 100% and 85%, respectively. On Kaplan-Meier analysis, ADC was predictive of nodal progression-free survival (P = .00023).

CONCLUSION: Early surveillance imaging with diffusion-weighted MRI at 6–8 weeks following definitive treatment with radiotherapy is feasible and may be predictive of early nodal failure. Further validation in a prospective cohort is warranted.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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