Prognostic MRI parameters in laryngeal cancer and lymphatic metastasis

Castelijns, J.A. [Promotor]Leemans, C.R. [Promotor]Langendijk, J.A. [Promotor]Hoekstra, O.S. [Copromotor

Pre- and post-radiotherapy MRI results as a predictive model for response in laryngeal carcinoma

The purpose was to determine if pre-radiotherapy (RT) and/or post-radiotherapy magnetic resonance (MR) imaging can predict response in patients with laryngeal carcinoma treated with RT. Pre- and post-RT MR examinations of 80 patients were retrospectively reviewed and associated with regard to local control. Pre-RT MR imaging parameters such as tumor involvement of specific laryngeal anatomic subsites including laryngeal cartilages and post-RT changes, i.e., complete resolution of the tumor or focal mass/asymmetric obliteration of laryngeal tissue and signal pattern on T2-weighted images, were evaluated. Local control was defined as absence of a recurrence at the primary site for 2 years. Local control rates based on pretreatment MR findings were 73% for low pre- RT risk-profile and 29% for high pre- RT risk-profile patients (p=0.0001). Based on posttreatment MR findings, local control rates were 100% score 1, 64% score 2, and 4% score 3 (p< 0.0001). Using post-RT T2-weighted images, significant association was found between differences in signal pattern and local control: 77% hypointense, 54% isointense and 15% hyperintense lesions (p<0.001). Differences between means of delay of post-MRI examination were significantly associated with regard to local control (p=0.003); recurrent tumors followed 5 months after RT were more easily detectable on MRI than recurrent tumors within 4 months after RT. Sensitivity, specificity, accuracy, negative and positive predictive values of post-RT score 3 were 96%, 76%, 83%, 98% and 66%. Pre- and post-RT MRI evaluation of the larynx can identify patients at high risk for developing local failure

Distant metastases in head and neck carcinoma:Identification of prognostic groups with MR imaging

Purpose: To evaluate retrospectively the prognostic significance of lymph node parameters assessed on pretreatment magnetic resonance (MR) images for development of distant metastases in patients with head and neck squamous cell carcinomas. Materials and methods: Pretreatment MR images of 311 patients were retrospectively reviewed for the presence of lymph nodes at specific neck node levels as well as the size and the presence of a number of lymph node characteristics including extranodal spread, central necrosis and number and volume of ipsi- and contralateral nodes. Of these patients, 174 (56%) had MRI-positive nodes (defined as nodes with minimum axial diameter >8 and >4 mm for paratracheal level and retropharyngeal nodes). Results: The 2-year distant-metastasis free survival rate (DMFSR) for patients without MRI-positive nodes was 94% compared to 75% for those patients with MRI-positive nodes. In patients with MRI-positive nodes, results of multivariate analysis with the Cox regression model yielded statistical significance for presence of extranodal spread (ENS), detected on MRI, as the only independent prognostic factor associated with the 2-year DMFSR (p = 0.002). Based on the analysis, three risk groups regarding the DMFSR could be identified. Low-risk group (DMFSR:94%) consisted of patients without MRI-positive nodes. Intermediate-risk group (DMFSR: 81%) consisted of patients with MRI-positive nodes without ENS. High-risk group (DMFSR:59%) consisted of patients with MRI-positive nodes and ENS as shown on MRI (p 5 cm(3) (larynx: p = 0.03; oral cavity: p = 0.02) to be significant predictors with regard to DMFSR. Conclusion: Especially patients with on MRI demonstrating extranodal spread and with suspicious nodes at lowjugular/posterior triangle (oropharyngeal cancer) or paratracheal level (laryngeal cancer), or with contralateral enlarged nodes (laryngeal and oral cavity cancer) are at high risk for developing distant metastases and this subset of patients might benefit from supplementary imaging screening (CT-chest, PET-scan). (C) 2006 Elsevier Ireland Ltd. All rights reserved

MR imaging predictors of local control of glottic squamous cell carcinoma treated with radiation alone

Purpose: To retrospectively evaluate the prognostic significance of magnetic resonance ( MR) imaging - determined tumor parameters, especially the presence of cartilage invasion, regarding local control of glottic squamous cell carcinoma treated with radiation therapy ( RT) alone. Materials and Methods: The study was performed with the approval of our institutional review board; direct patient consent was waived. Pretreatment MR images of 118 patients aged 41 - 86 years ( 110 men, eight women) with glottic carcinoma treated with RT alone were reviewed for tumor involvement of specific laryngeal anatomic subsites ( including laryngeal cartilage), tumor volume, and extralaryngeal tumor spread; these findings were compared with local control. Local control was defined as absence of a recurrence at the primary site for 2 years. Statistical significance of differences between curves for local control estimated with the Kaplan- Meier method was tested with log- rank test. Results: Results of univariate analysis showed all MR imaging determined parameters to be significant predictors of local control rate, compared with clinical parameters where T classification and vocal cord mobility were the only significant parameters associated with local control. Multivariate analysis ( Cox regression model) of clinical and radiologic parameters revealed that hypopharyngeal extension ( P = .04) and intermediate T2 signal intensity ( SI) in cartilage similar to tumor SI ( P <.001) were independent prognostic factors with regard to local control. Conclusion: Intermediate T2 SI in cartilage, which may suggest cartilage invasion, and hypopharyngeal extension of tumor, predict greater likelihood of local failure, whereas high T2 SI, which may suggest inflammatory tissue in cartilage, predicts lower likelihood of local failure. (c) RSNA, 2007