Tumor plasma flow determined by dynamic contrast-enhanced MRI predicts response to induction chemotherapy in head and neck cancer

Summary Objectives Non-response to induction chemotherapy (IC) occurs in 30% of head and neck squamous cell carcinoma (HNSCC) and has been predicted by tumor plasma flow ( F p ) derived by perfusion computed tomography. The present study was designed to test whether baseline tumor F p determined by dynamic contrast-enhanced magnetic resonance imaging (DCE–MRI) would predict IC response. Materials and methods A prospective open study powered to test the relationship between tumor F p and response to IC (docetaxel, cisplatin, 5-fluorouracil) enrolled 50 patients with stage IV HNSCC. Response after two IC cycles was measured by MRI using Response Evaluation Criteria in Solid Tumors in 37 patients. Tumor F p (primary end point) and multiple parameters in tumors and lymph nodes (secondary end points) were generated at baseline. Differences in baseline DCE–MRI parameters according to IC response were assessed by the Mann-Whitney U test, and predictive value by receiver operating characteristic (ROC) analysis. Results Median baseline tumor F p was 53.2 ml/100 ml/min in 25 responders and 23.9 in 12 non-responders (U 82; P  = 0.027; area under ROC curve (AUC) 0.73). Median baseline F p in lymph nodes was 25.8 ml/100 ml/min for 37 nodes in 25 responders and 17.1 for 15 nodes in 12 non-responders (U 186, P  = 0.066; AUC 0.67). Frequency of IC response in 37 patients was 68% overall, 83% for tumor F p above the median (40.6 ml/100 ml/min) and 45% below the median. Other DCE–MRI parameters were not associated with IC response. Conclusion Pre-treatment tumor F p determined by DCE–MRI predicts IC response in HNSCC.