Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors

Background

This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.

Methods

320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.

Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60_median and AUC60_p95) were determined in the tumor volume.

Results

Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60_p95 (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.

In multivariable analysis, a Cox proportional hazard model showed that a AUC60_p95 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, P<.001). Tumor volume was prognostic for DC (HR=3.42, P<.001) and OS (HR=3.27, P<.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.

Conclusion

Low pretreatment AUC60_p95 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.