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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 30:793-799, April 2009
© 2009 American Society of Neuroradiology

HEAD & NECK

Response and Progression-Free Survival in Oropharynx Squamous Cell Carcinoma Assessed by Pretreatment Perfusion CT: Comparison with Tumor Volume Measurements

S. Bisdas^a,b, Z. Rumboldt^b, J. Wagenblast^c, M. Baghi^c, T.S. Koh^d, M. Hambek^c, T.J. Vogl^a and M.G. Mack^a

^a Department of Radiology, Johann Wolfgang Goethe University, Frankfurt, Germany
^b Department of Radiology, Medical University of South Carolina, Charleston, SC
^c Department of Otorhinolaryngology, Head and Neck Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
^d School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore

Please address correspondence to Sotirios Bisdas, MD, Department of Neuroradiology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; e-mail: Sotirios.Bisdas{at}med.uni-tuebingen.de

BACKGROUND AND PURPOSE: Perfusion CT (PCT) provides a rapid, reliable, and non-invasive technique for assessing tumor vascularity. The purpose of this study was to assess whether pretreatment dynamic perfusion CT (PCT) may predict response to induction chemotherapy and midterm progression-free survival (PFS) in advanced oropharynx squamous cell carcinoma (SCCA) and to compare the results with those derived by tumor volume measurements.

MATERIALS AND METHODS: Nineteen patients underwent routine contrast-enhanced CT (CECT), pretreatment PCT, and conventional endoscopy. Tumor response was determined according to radiologic (RECIST) criteria. The PCT parameters, tumor volume, radiologic response, and PFS were analyzed with use of Cox-proportional hazards model, receiver operating characteristic (ROC), and Kaplan-Meier analysis.

RESULTS: The baseline blood flow (BF), blood volume (BV), and permeability surface area product (PS) were significantly higher, whereas mean transit time (MTT) was significantly lower in the responders than in the nonresponders (P .002). BV showed 100% sensitivity, MTT and PS had the highest specificity (100%), and BF showed 84.2% sensitivity and 66.7% specificity for prediction of tumor response after induction chemotherapy. The pretreatment tumor volume correlated with PFS in the pooled patients group (r = 0.4; P < .0001), whereas postinduction tumor volume correlated significantly with PFS in the responders and nonresponders (r = 0.22–0.64; P .006). Pretreatment tumor volume (P = .0001) and BF (P = .001) were significant predictors for PFS.

CONCLUSIONS: Pretreatment PCT parameters may predict response after induction chemotherapy. Tumor volume and BF values may predict PFS in patients with advanced oropharyngeal SCCA.