American Journal of Neuroradiology 27:101-106, January 2006
© 2006 American Society of Neuroradiology
HEAD & NECK
Correlation between Initial and Early Follow-Up CT Perfusion Parameters with Endoscopic Tumor Response in Patients with Advanced Squamous Cell Carcinomas of the Oropharynx Treated with Organ-Preservation Therapy
a Department of Radiology, University of Michigan Health System, Ann Arbor, Mich
b Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Mich
c Department of Head Neck Surgery, Hematology-Oncology, University of Michigan Health System, Ann Arbor, Mich
d Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Mich
Address correspondence to: Dheeraj Gandhi, Department of Radiology, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-0030
Abstract
BACKGROUND AND PURPOSE: Current organ-preservation regimens for upper aerodigestive tract squamous cell carcinoma (SCCA) require endoscopic procedures under general anesthesia to evaluate the tumor response. The purpose of our study was to determine whether CT perfusion (CTP) parameters correlate with response to induction chemotherapy as assessed by endoscopy under general anesthesia.
METHODS: Nine patients with advanced (stage 3 or 4) SCCA of the oropharynx were enrolled in a nested phase 2 prospective trial in which induction chemotherapy was used to assess the tumor response. Patients underwent direct laryngoscopy and CTP before and 3 weeks after one cycle of induction chemotherapy. The outcome variables were the surgeon’s estimate of tumor volume during endoscopy with biopsy under anesthesia and CTP parameters (capillary permeability (CP), blood volume (BV), blood flow (BF), and mean transit time (MTT)). Wilcoxon rank sum analysis was used to correlate the baseline values of BF and BV with response to induction chemotherapy. Comparison of agreement between the reduction in tumor volume and change in CTP parameters was performed by using kappa estimates.
RESULTS: Seven of 9 patients demonstrated 
50% tumor volume reduction, representing positive response to induction chemotherapy. In the responder group, the following changes in mean pre- and postinduction chemotherapy values were noted: mean BF, 114.2 mL/100 g /min (preinduction) to 45.1 mL/100 g/min (postinduction); mean BV, 5.11 mL/100 g to 3.1 mL/100 g; mean CP, 25.6 mL/100 g /min (preinduction) to 18.3 mL/100 g / min (postinduction); mean MTT, 4.9 seconds (preinduction) to 8.0 seconds (postinduction). In the nonresponder group, the following changes were noted: mean BF, 56.9 mL/100 g/min to 75.9 mL/100 g/min; mean, BV 2.7 mL/100 g to 4.71 mL/100 g; mean CP, 24.1 mL/100 g/min to 23.7 mL/100 g/min; mean MTT, 4.3 seconds to 5.34 seconds. Higher baseline (pretherapy) values of BV showed significant correlation with endoscopic tumor response (P < .05). Reduction in the BV (by 20%) on follow-up studies also showed substantial agreement with clinical response as assessed with endoscopy (kappa = 0.73). The agreement between decreased BF, decreased CP, and increased MTT and clinical response was fair (kappa = 0.37).
CONCLUSION: These preliminary results show that deconvolution-based CTP technique offers potential for noninvasive monitoring of response to induction chemotherapy in patients with oropharyngeal cancers. Percentage reduction of BV is significantly correlated to endoscopic response to induction chemotherapy, though we acknowledge that the data correspond to short-term outcomes and long-term durability of response cannot be established. Nevertheless, validation of the use of deconvolution CTP parameters as predictors of tumor response may permit replacement of an invasive diagnostic procedure conducted under anesthesia currently used to assess response with noninvasive perfusion CT imaging.
This article has been cited by other articles:
 |
|
 |
|
  L. Faggioni, E. Neri, and C. Bartolozzi CT Perfusion of Head and Neck Tumors: How We Do It Am. J. Roentgenol., January 1, 2010; 194(1): 62 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Wang, N. Wu, M. D. Cham, and Y. Song Tumor Response in Patients With Advanced Non-Small Cell Lung Cancer: Perfusion CT Evaluation of Chemotherapy and Radiation Therapy Am. J. Roentgenol., October 1, 2009; 193(4): 1090 - 1096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Petralia, L. Preda, S. Raimondi, G. D'Andrea, P. Summers, G. Giugliano, F. Chiesa, and M. Bellomi Intra- and Interobserver Agreement and Impact of Arterial Input Selection in Perfusion CT Measurements Performed in Squamous Cell Carcinoma of the Upper Aerodigestive Tract AJNR Am. J. Neuroradiol., June 1, 2009; 30(6): 1107 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Tognolini, R. Schor-Bardach, O. S. Pianykh, C. J. Wilcox, V. Raptopoulos, and S. N. Goldberg Body Tumor CT Perfusion Protocols: Optimization of Acquisition Scan Parameters in a Rat Tumor Model Radiology, June 1, 2009; 251(3): 712 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Ash, T. N. Teknos, D. Gandhi, S. Patel, and S. K. Mukherji Head and Neck Squamous Cell Carcinoma: CT Perfusion Can Help Noninvasively Predict Intratumoral Microvessel Density Radiology, May 1, 2009; 251(2): 422 - 428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bisdas, Z. Rumboldt, J. Wagenblast, M. Baghi, T.S. Koh, M. Hambek, T.J. Vogl, and M.G. Mack Response and Progression-Free Survival in Oropharynx Squamous Cell Carcinoma Assessed by Pretreatment Perfusion CT: Comparison with Tumor Volume Measurements AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 793 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Goh, J. Liaw, C. I. Bartram, and S. Halligan Effect of Temporal Interval Between Scan Acquisitions on Quantitative Vascular Parameters in Colorectal Cancer: Implications for Helical Volumetric Perfusion CT Techniques Am. J. Roentgenol., December 1, 2008; 191(6): W288 - W292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bisdas, K. Spicer, and Z. Rumboldt Whole-Tumor Perfusion CT Parameters and Glucose Metabolism Measurements in Head and Neck Squamous Cell Carcinomas: A Pilot Study Using Combined Positron-Emission Tomography/CT Imaging AJNR Am. J. Neuroradiol., August 1, 2008; 29(7): 1376 - 1381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Zima, R. Carlos, D. Gandhi, I. Case, T. Teknos, and S.K. Mukherji Can Pretreatment CT Perfusion Predict Response of Advanced Squamous Cell Carcinoma of the Upper Aerodigestive Tract Treated with Induction Chemotherapy? AJNR Am. J. Neuroradiol., February 1, 2007; 28(2): 328 - 334. [Abstract] [Full Text] [PDF]
|
|