Oxygen-Enhanced MRI Detects Incidence, Onset, and Heterogeneity of Radiation-Induced Hypoxia Modification in HPV-Associated Oropharyngeal Cancer.
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Authors
Dubec, MJ
Price, J
Berks, M
Gaffney, J
Little, RA
Porta, N
Sridharan, N
Datta, A
McHugh, DJ
Hague, CJ
Cheung, S
Manoharan, P
van Herk, M
Choudhury, A
Matthews, JC
Parker, GJM
Buckley, DL
Harrington, KJ
McPartlin, A
O'Connor, JPB
Price, J
Berks, M
Gaffney, J
Little, RA
Porta, N
Sridharan, N
Datta, A
McHugh, DJ
Hague, CJ
Cheung, S
Manoharan, P
van Herk, M
Choudhury, A
Matthews, JC
Parker, GJM
Buckley, DL
Harrington, KJ
McPartlin, A
O'Connor, JPB
Document Type
Journal Article
Date
2024-12-16
Date Accepted
2024-08-07
Abstract
PURPOSE: Hypoxia mediates treatment resistance in solid tumors. We evaluated if oxygen-enhanced MRI-derived hypoxic volume (HVMRI) is repeatable and can detect radiotherapy-induced hypoxia modification in human papillomavirus-associated oropharyngeal head and neck squamous cell cancer. EXPERIMENTAL DESIGN: A total of 27 patients were recruited prospectively between March 2021 and January 2024. HVMRI was measured in primary and nodal tumors prior to standard-of-care (chemo)radiotherapy and then at weeks 2 and 4 (W2 and W4) into therapy. Two pretreatment scans assessed biomarker within-subject coefficient of variation and repeatability coefficient (RC). Cohort treatment response was measured using mixed-effects modeling. Responding lesions were identified by comparing HVMRI change with RC limits of agreement. RESULTS: Oxygen-enhanced MRI identified hypoxia in all lesions. The HVMRI within-subject coefficient of variation was 24.6%, and RC limits of agreement were -45.7% to 84.1%. A cohort median pretreatment HVMRI of 11.3 cm3 reduced to 6.9 cm3 at W2 and 5.9 cm3 at W4 (both P < 0.001). HVMRI was reduced in 54.5% of individual lesions by W2 and in 88.2% by W4. All lesions with W2 hypoxia reduction showed persistent modification at W4. HVMRI reduced in some lesions that showed no overall volume change. Hypoxia modification was discordant between primary and nodal tumors in 50.0% of patients. CONCLUSIONS: Radiation-induced hypoxia modification can occur as early as W2, but onset varies between patients and was not necessarily associated with overall size change. Half of all patients had discordant changes in primary and nodal tumors. These findings have implications for patient selection and timing of dose de-escalation strategies in human papillomavirus-associated oropharyngeal carcinoma. See related commentary by Mason, p. 5503.
Citation
Clinical Cancer Research, 2024, 30 (24), pp. 5620 - 5629
Source Title
Clinical Cancer Research
Publisher
AMER ASSOC CANCER RESEARCH
ISSN
1078-0432
eISSN
1557-3265
Collections
Research Team
Clin Trials & Stats Unit
Quant Biomed Imaging
Targeted Therapy
Quant Biomed Imaging
Targeted Therapy