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Modelling tumour volume variations in head and neckcancer: contribution of magnetic resonance imaging for patients undergoing induction chemotherapy

View Article: PubMed Central - PubMed

ABSTRACT

Primary tumour volume evaluation has predictive value for estimating survival outcomes. Using volumetric data acquired by MRI in patients undergoing induction chemotherapy (IC) these outcomes were estimated before the radiotherapy course in head and neck cancer (HNC) patients. MRI performed before and after IC in 36 locally advanced HNC patients were analysed to measure primary tumour volume. The two volumes were correlated using the linear-log ratio (LLR) between the volume in the first MRI and the volume in the second. Cox's proportional hazards models (CPHM) were defined for loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS). Strict evaluation of the influence of volume delineation uncertainties on prediction of final outcomes has been defined. LLR showed good predictive value for all survival outcomes in CPHM. Predictive models for LRC and DFS at 24 months showed optimal discrimination and prediction capability. Evaluation of primary tumour volume variations in HNC after IC provides an example of modelling that can be easily used even for other adaptive treatment approaches. A complete assessment of uncertainties in covariates required for running models is a prerequisite to create reliable clinically models.

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Volumetric assessment of primary tumour volume. Squamous cell carcinoma of the oropharynx in a 73-year-old man. (a,d) Axial fat-saturated T2-weighted MR images. (b,e) Axial post-contrast T1-weighted fat-saturated MR images. (c,f) Coronal post-contrast T1-weighted fat-saturated MR images with 3D volumetric tumour reconstructions. Before induction chemotherapy (a,b,c): MR images show expansive/infiltrative tissue centred on the right glossopharyngeal fold, hyper-intense on T2- weighted image (a) with slight and faint enhancement on post-contrast T1-weighted fat-saturated MR image (b). The lesion was manually outlined (green closed line in a) to obtain a volumetric reconstruction of the tumour (blue volume in c). After induction chemotherapy (d,e,f) MR images show significant volumetric reduction of the lesion.
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Figure 1: Volumetric assessment of primary tumour volume. Squamous cell carcinoma of the oropharynx in a 73-year-old man. (a,d) Axial fat-saturated T2-weighted MR images. (b,e) Axial post-contrast T1-weighted fat-saturated MR images. (c,f) Coronal post-contrast T1-weighted fat-saturated MR images with 3D volumetric tumour reconstructions. Before induction chemotherapy (a,b,c): MR images show expansive/infiltrative tissue centred on the right glossopharyngeal fold, hyper-intense on T2- weighted image (a) with slight and faint enhancement on post-contrast T1-weighted fat-saturated MR image (b). The lesion was manually outlined (green closed line in a) to obtain a volumetric reconstruction of the tumour (blue volume in c). After induction chemotherapy (d,e,f) MR images show significant volumetric reduction of the lesion.

Mentions: Volumetric evaluation of primary tumours was performed using OsiriX Imaging Software (http://www.osirix-viewer.com): contours of primary lesions were manually outlined by two different radiologists who are expert in HNC imaging, in order to evaluate the impact of inter-observer differences in delineation. Volumes were delineated on axial T2w images, also using other sequences, mostly T1w images, before and after intravenous contrast injection, to better refine the delineation (Fig. 1). When both radiologists were satisfied with the outlines, tumour volumes were finally calculated.


Modelling tumour volume variations in head and neckcancer: contribution of magnetic resonance imaging for patients undergoing induction chemotherapy
Volumetric assessment of primary tumour volume. Squamous cell carcinoma of the oropharynx in a 73-year-old man. (a,d) Axial fat-saturated T2-weighted MR images. (b,e) Axial post-contrast T1-weighted fat-saturated MR images. (c,f) Coronal post-contrast T1-weighted fat-saturated MR images with 3D volumetric tumour reconstructions. Before induction chemotherapy (a,b,c): MR images show expansive/infiltrative tissue centred on the right glossopharyngeal fold, hyper-intense on T2- weighted image (a) with slight and faint enhancement on post-contrast T1-weighted fat-saturated MR image (b). The lesion was manually outlined (green closed line in a) to obtain a volumetric reconstruction of the tumour (blue volume in c). After induction chemotherapy (d,e,f) MR images show significant volumetric reduction of the lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384316&req=5

Figure 1: Volumetric assessment of primary tumour volume. Squamous cell carcinoma of the oropharynx in a 73-year-old man. (a,d) Axial fat-saturated T2-weighted MR images. (b,e) Axial post-contrast T1-weighted fat-saturated MR images. (c,f) Coronal post-contrast T1-weighted fat-saturated MR images with 3D volumetric tumour reconstructions. Before induction chemotherapy (a,b,c): MR images show expansive/infiltrative tissue centred on the right glossopharyngeal fold, hyper-intense on T2- weighted image (a) with slight and faint enhancement on post-contrast T1-weighted fat-saturated MR image (b). The lesion was manually outlined (green closed line in a) to obtain a volumetric reconstruction of the tumour (blue volume in c). After induction chemotherapy (d,e,f) MR images show significant volumetric reduction of the lesion.
Mentions: Volumetric evaluation of primary tumours was performed using OsiriX Imaging Software (http://www.osirix-viewer.com): contours of primary lesions were manually outlined by two different radiologists who are expert in HNC imaging, in order to evaluate the impact of inter-observer differences in delineation. Volumes were delineated on axial T2w images, also using other sequences, mostly T1w images, before and after intravenous contrast injection, to better refine the delineation (Fig. 1). When both radiologists were satisfied with the outlines, tumour volumes were finally calculated.

View Article: PubMed Central - PubMed

ABSTRACT

Primary tumour volume evaluation has predictive value for estimating survival outcomes. Using volumetric data acquired by MRI in patients undergoing induction chemotherapy (IC) these outcomes were estimated before the radiotherapy course in head and neck cancer (HNC) patients. MRI performed before and after IC in 36 locally advanced HNC patients were analysed to measure primary tumour volume. The two volumes were correlated using the linear-log ratio (LLR) between the volume in the first MRI and the volume in the second. Cox's proportional hazards models (CPHM) were defined for loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS). Strict evaluation of the influence of volume delineation uncertainties on prediction of final outcomes has been defined. LLR showed good predictive value for all survival outcomes in CPHM. Predictive models for LRC and DFS at 24 months showed optimal discrimination and prediction capability. Evaluation of primary tumour volume variations in HNC after IC provides an example of modelling that can be easily used even for other adaptive treatment approaches. A complete assessment of uncertainties in covariates required for running models is a prerequisite to create reliable clinically models.

No MeSH data available.


Related in: MedlinePlus