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Can Pretreatment CT Perfusion Predict Response of Advanced Squamous Cell Carcinoma of the Upper Aerodigestive Tract Treated with Induction Chemotherapy?

A. Zimaa, R. Carlosa, D. Gandhia, I. Casea, T. Teknosb and S.K. Mukherjia

a Department of Radiology, University of Michigan, Ann Arbor, Mich
b Department of Otorhinoloryngology, University of Michigan, Ann Arbor, Mich


Figure 1
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  		Fig 1. Examples of CT perfusion images for a patient with squamous cell carcinoma of the epiglottis.

A, Regions of interest are drawn within the ipsilateral internal carotid artery (1), internal jugular vein (2), and around the tumor margins (3).

B, Concentration curves of the previously selected regions of interest are plotted with Hounsfield units on the y-axis and time on the x-axis.

C, Corresponding BF map of the neck at the level of the epiglottic tumor.

D, Corresponding BV map of the neck at the level of the epiglottic tumor.


Figure 2
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  		Fig 2. The relationship to BV values as a function response, defined as >50% reduction in tumor volume as assessed by endoscopy.


Figure 3
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  		Fig 3. The relationship to BF values as a function response, defined as >50% reduction in tumor volume as assessed by endoscopy.


Figure 4
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  		Fig 4. The area under the ROC curve for the predictive model.


Figure 5
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  		Fig 5. The probability of response to induction chemotherapy as a function of BV.


Figure 6
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  		Fig 6. The potential use of the prediction model using the 17 patients in this study in clinical practice.

A, Actual response. In our patient population, all 17 patients underwent induction chemotherapy. Twelve patients responded (+) and received additional chemotherapy and radiation; 5 patients underwent surgery and radiation.

B, Using ≥90% pretest probability as a threshold. In this hypothetical application of the prediction rule, 10 patients would be directed immediately to organ preservation, whereas 7 patients would undergo induction chemotherapy. Of those 7 patients, 2 patients would respond and proceed to organ preservation therapy, and the remaining 5 patients would proceed to surgery and radiation.

C, Using ≥10% pretest probability as a threshold. In this hypothetical application, 2 patients would receive immediate surgery and radiation, whereas 15 would undergo induction chemotherapy. Using this low threshold, 3 patients would not respond to induction chemotherapy with potential delay in more invasive, but appropriate, surgery and radiation therapy.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X