Pre-treatment tumour perfusion parameters and initial RECIST response do not predict long-term survival outcomes for patients with head and neck squamous cell carcinoma treated with induction chemotherapy

Induction chemotherapy in locally advanced head and neck cancers, is there a best choice?

Locally advanced stages of squamous cancers of the head and neck (LAHNCs) acquire high propensity for local and systemic relapse. Addition of systemic therapy as an induction (IC) to the standard concurrent chemoradiotherapy (CCRT) has become an approach of many practitioners. This strategy has shown to reduce metastases but did not affect survival in unselected populations. Meanwhile, the induction regimen including docetaxel, cisplatin, 5-FU (TPF) has shown superiority over other combinations, however, a survival advantage was not detected when compared to CCRT alone. This may be attributed to its high toxicity profile, inducing treatment delay, resistance, or variations in tumor sites and responses. Currently, newer systemic therapy combinations are being tested and indicators of benefit are being identified. The focus of this review is on the development of the choice of combination regimen for induction. Subsequently, proposed alternatives and strategies for patient selection will be introduced.

Tumor Volume Reduction Rate to Induction Chemotherapy is a Prognostic Factor for Locally Advanced Head and Neck Squamous Cell Carcinoma: A Retrospective Cohort Study

Introduction: Aim of this retrospective cohort study is to evaluate the prognostic value of tumor volume reduction rate status post-induction chemotherapy in locally advanced head and neck squamous cell carcinoma. Methods: Patients newly diagnosed from year 2007 to 2016 at a single center were included in this retrospective study. All patients had received induction Taxotere, Platinum, Fluorouracil followed by daily definitive intensity-modulated radiotherapy for 70 Gy in 35 fractions concurrent with or without cisplatin-based chemotherapy. Tumor volume reduction rate was measured and calculated by contrast-enhanced computed tomography images at diagnosis, and after at least 1 cycle of induction chemotherapy, and analyzed though a univariate and multivariate Cox regression model. Results: Ninety patients of the primary cancer sites at hypopharynx (31/90, 34.4%), oropharynx (29/90, 32.2%), oral cavity (19/90, 21.1%), and larynx (11/90, 12.2%) were included in this study, with a median follow-up time interval of 3.9 years. In multivariate Cox regression analysis, the tumor volume reduction rate of the primary tumor (TVRR-T) was also an independently significant prognostic factor for disease-free survival (DFS) (hazard ratio 0.77, 95% confidence interval 0.62-0.97; P-value = .02). Other factors including patient's age at diagnosis, the primary cancer site, and RECIST (Response Evaluation Criteria in Solid Tumors), were not significantly related. At a cutoff value using 50% in Kaplan–Meier survival analysis, the DFS was higher with TVRR-T ≥ 50% group (log-rank test, P = .024), and a trend of improved overall survival. (log-rank test, P = .069). Conclusion: TVRR-T is a probable prognostic factor for DFS. With a cut-off point of 50%, TVRR-T may indicate better DFS.

Prognostic functional MR imaging parameters in head and neck squamous cell carcinoma: A systematic review

OBJECTIVE

Functional MR imaging has demonstrated potential for predicting treatment response. This systematic review gives an extensive overview of the current level of evidence for pre-treatment MR-based perfusion and diffusion imaging parameters that are prognostic for treatment outcome in head and neck squamous cell carcinoma (HNSCC) (PROSPERO registrationCRD42020210689).

MATERIALS AND METHODS

According to the PRISMA statements, Medline, Embase and Scopus were queried for articles with a maximum date of October 19th, 2020. Studies investigating the predictive performance of pre-treatment MR-based perfusion and/or diffusion imaging parameters in HNSCC treatment response were included. All prognosticators were extracted from the primary tumor. Risk of bias was assessed using the QUIPS tool. Results were summarized in tables and forest plots.

RESULTS

31 unique studies met the inclusion criteria; among them, 11 articles described perfusion (n = 529 patients) and 28 described diffusion (n = 1626 patients) MR-imaging, eight studies were included in both categories. Higher K^trans and K_ep were associated with better treatment response for OS and DFS, respectively. Study findings for V_p and V_e were inconsistent or not significant. High-level controversy was observed between studies examining the MR diffusion parameters mean and median ADC.

CONCLUSION

For HNSCC patients, the accurate and consistent results of pre-treatment MR-based perfusion parameters K^trans and K_ep are potential for clinical applicability predictive of OS and DFS and treatment decision guidance. Significant heterogeneity in study designs might affect high discrepancy in study results for parameters extracted from diffusion imaging. Furthermore, recommendations for future research were summarized.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for pretreatment prediction of neoadjuvant chemotherapy response in locally advanced hypopharyngeal cancer

Objective:The aim of this study was to predict response to neoadjuvant chemotherapy (NAC) in patients with locally advanced hypopharyngeal cancer by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).Methods:A retrospective study enrolled 46 diagnosed locally advanced hypopharyngeal cancer. DCE-MRI were performed prior to and after two cycles of NAC. The volume transfer constant (K^trans), extracellular extravascular volume fraction (V_e), and plasma volume fraction (K_ep) were computed from primary tumors. DCE-MRI parameters were used to measure tumor response according to the Response Evaluation Criteria in Solid Tumors criteria (RECIST).Results：After 2 NAC cycles, 30 out of 46 patients were categorized into the responder group, whereas the other 16 were categorized into non-responder group. Compared with the pretreatment value, the post-treatment K^trans and K_ep was significantly lower (P < 0.05), but no significant change in V_e (P > 0.05). Compared with non-responders, a notably higher pretreatment K^trans, K_ep, lower post-treatment K^trans, higher ΔK^trans and ΔK_ep were observed in responders (all P < 0.05). While the pretreatment V_e, post-treatment V_e, and ΔV_e did not differ significantly (P>0.05) between the two groups. The receiver operating characteristic curve analysis revealed that pretreatment K^trans of 0.202/min is the most optimal cut-off in predicting response to chemotherapy, resulting in an AUC of 0.837 and corresponding sensitivity and specificity of 76.7%, and 81.1%, respectively.Conclusion:DCE-MRI especially pretreatment K^trans can potentially predict the treatment response to neoadjuvant chemotherapy for hypopharyngeal cancer.Advances in knowledge:Few studies of DCE-MRI on hypopharyngeal cancer treated with chemoradiation reported. The results demonstrate that DCE-MRI especially pretreatment K^trans may be more potential value in predicting the treatment response to neoadjuvant chemotherapy for hypopharyngeal cancer.

Gefitinib as neoadjuvant therapy for resectable stage II-IIIA non-small cell lung cancer: A phase II study

INTRODUCTION

Currently, limited data on tyrosine kinase inhibitors as neoadjuvant therapy exist. This prospective study aimed to investigate the efficacy and safety of preoperative gefitinib in patients with stage II-IIIA operable non-small cell lung cancer (NSCLC).

METHODS

This was a single-arm, phase II trial performed in the Shanghai Cancer Center. Between August 2013 and October 2015, patients with operable stage II-IIIA NSCLC with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 L858R mutation were enrolled. Patients were treated with preoperative gefitinib (250 mg once daily for 42 days), followed by surgical resection. The primary endpoint was objective response rate (ORR); secondary endpoints were the rate of major pathologic response (MPR), disease-free survival (DFS), overall survival, and adverse events (AEs). ORR was defined as the proportion of patients achieving complete response or partial response radiologically. MPR was defined as no more than 10% viable tumor.

RESULTS

Of the 35 eligible patients, 33 were considered as intention-to-treat population. ORR, the primary endpoint, was 54.5% (95% confidence interval [CI], 37.7-70.7), and the rate of MPR was 24.2% (95% CI, 11.9-40.4). Median DFS was 33.5 months (95% CI, 19.7-47.3); median overall survival was not reached. Skin toxicity (24/35,68.6%) and gastrointestinal symptoms (17/35,48.6%) were the most common AEs; no patients reported grade 3 or 4 AEs. After surgery, 4 patients experienced chylothorax (4/33,12.1%). Patients with MPR had a prolonged survival compared with those without (DFS, P = .019).

CONCLUSIONS

Neoadjuvant therapy with gefitinib in patients with stage II-IIIA NSCLC is safe and may be a viable treatment for patients whose tumors have EGFR mutations. Patients with MPR were associated with improved survival.

Recent advances in MRI of the head and neck, skull base and cranial nerves: new and evolving sequences, analyses and clinical applications

MRI is an invaluable diagnostic tool in the investigation and management of patients with pathology of the head and neck. However, numerous technical challenges exist, owing to a combination of fine anatomical detail, complex geometry (that is subject to frequent motion) and susceptibility effects from both endogenous structures and exogenous implants. Over recent years, there have been rapid developments in several aspects of head and neck imaging including higher resolution, isotropic 3D sequences, diffusion-weighted and diffusion-tensor imaging as well as permeability and perfusion imaging. These have led to improvements in anatomic, dynamic and functional imaging. Further developments using contrast-enhanced 3D FLAIR for the delineation of endolymphatic structures and black bone imaging for osseous structures are opening new diagnostic avenues. Furthermore, technical advances in compressed sensing and metal artefact reduction have the capacity to improve imaging speed and quality, respectively. This review explores novel and evolving MRI sequences that can be employed to evaluate diseases of the head and neck, including the skull base.