Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer
Abstract Background For radiotherapy of head and neck cancer (HNC) magnetic resonance imaging (MRI) plays a pivotal role due to its high soft tissue contrast. Moreover, it offers the potential to acquire functional information through diffusion weighted imaging (DWI) with the potential to personaliz...
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BMC
2025-01-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-025-02589-9 |
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| author | Simon Boeke Jonas Habrich Sarah Kübler Jessica Boldt Fritz Schick Konstantin Nikolaou Jens Kübler Cihan Gani Maximilian Niyazi Daniel Zips Daniela Thorwarth |
| author_facet | Simon Boeke Jonas Habrich Sarah Kübler Jessica Boldt Fritz Schick Konstantin Nikolaou Jens Kübler Cihan Gani Maximilian Niyazi Daniel Zips Daniela Thorwarth |
| author_sort | Simon Boeke |
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| description | Abstract Background For radiotherapy of head and neck cancer (HNC) magnetic resonance imaging (MRI) plays a pivotal role due to its high soft tissue contrast. Moreover, it offers the potential to acquire functional information through diffusion weighted imaging (DWI) with the potential to personalize treatment. The aim of this study was to acquire repetitive DWI during the course of online adaptive radiotherapy on an 1.5 T MR-linear accelerator (MR-Linac) for HNC patients and to investigate temporal changes of apparent diffusion coefficient (ADC) values of the tumor and subvolume levels. Methods 27 patients treated with curative RT on the 1.5 T MR-Linac with at least weekly DWI in treatment position were included into this prospective analysis and divided in four risk groups (HPV-status and localisation). Tumor and lymph node volumes (GTV-P/GTV-N) were delineated on b = 500 s/mm2 images while ADC maps were calculated using b = 150/200 and 500 s/mm2 images. Absolute and relative temporal changes of mean ADC values, tumor volumes and a high-risk subvolume (HRS) defined by low ADC tumor voxels (600 < ADC < 900 × 10−6 mm2/s) were analyzed. Relative changes of mean ADC values, tumor volumes and HRS were statistically tested using Wilcoxon-signed-rank test. Results Median pretreatment ADC value for all patients resulted in 1167 × 10−6 mm2/s for GTV-P and 1002 × 10−6 mm2/s for GTV-N while absolute pretreatment tumor volume yielded 9.1 cm3 for GTV-P and 6.0 cm3 for GTV-N, respectively. Pretreatment HRS volumes were 1.5 cm3 for GTV-P and 1.3 cm3 for GTV-P and GTV-N. Median ADC values increase during 35 fractions of RT was 49% for GTV-P and 24% for GTV-N during RT. Median tumor volume decrease was 68% and 52% for GTV-P and GTV-N with a median HRS decrease of 93% and 87%. Significant differences from 0 for mean ADC were observed starting from week 1, for tumor volumes from week 2 for GTV-P and week 1 for GTV-N and for HRS in week 1 for GTV-P and week 2 for GTV-N. Conclusion Longitudinal DWI acquisition in HNC is feasible on a MR-Linac during the course of online adaptive MR-guided radiotherapy. Changes in ADC and volumes can be assessed, but future work needs to explore the potential for biologically guided treatment individualization. Trial registration: NCT04172753, actual study start: 09.05.2018. |
| format | Article |
| id | doaj-art-5f5e5612ee5841fbbbe0caed42adbfa2 |
| institution | Kabale University |
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| publishDate | 2025-01-01 |
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| series | Radiation Oncology |
| spelling | doaj-art-5f5e5612ee5841fbbbe0caed42adbfa22025-02-02T12:35:37ZengBMCRadiation Oncology1748-717X2025-01-0120111410.1186/s13014-025-02589-9Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancerSimon Boeke0Jonas Habrich1Sarah Kübler2Jessica Boldt3Fritz Schick4Konstantin Nikolaou5Jens Kübler6Cihan Gani7Maximilian Niyazi8Daniel Zips9Daniela Thorwarth10Department of Radiation Oncology, University Hospital TübingenSection for Biomedical Physics, Department of Radiation Oncology, University Hospital TübingenDepartment of Radiation Oncology, University Hospital TübingenDepartment of Radiation Oncology, University Hospital TübingenSection for Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital TübingenDepartment of Diagnostic and Interventional Radiology, University Hospital TübingenDepartment of Diagnostic and Interventional Radiology, University Hospital TübingenDepartment of Radiation Oncology, University Hospital TübingenDepartment of Radiation Oncology, University Hospital TübingenDepartment of Radiation Oncology, University Hospital TübingenGerman Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ)Abstract Background For radiotherapy of head and neck cancer (HNC) magnetic resonance imaging (MRI) plays a pivotal role due to its high soft tissue contrast. Moreover, it offers the potential to acquire functional information through diffusion weighted imaging (DWI) with the potential to personalize treatment. The aim of this study was to acquire repetitive DWI during the course of online adaptive radiotherapy on an 1.5 T MR-linear accelerator (MR-Linac) for HNC patients and to investigate temporal changes of apparent diffusion coefficient (ADC) values of the tumor and subvolume levels. Methods 27 patients treated with curative RT on the 1.5 T MR-Linac with at least weekly DWI in treatment position were included into this prospective analysis and divided in four risk groups (HPV-status and localisation). Tumor and lymph node volumes (GTV-P/GTV-N) were delineated on b = 500 s/mm2 images while ADC maps were calculated using b = 150/200 and 500 s/mm2 images. Absolute and relative temporal changes of mean ADC values, tumor volumes and a high-risk subvolume (HRS) defined by low ADC tumor voxels (600 < ADC < 900 × 10−6 mm2/s) were analyzed. Relative changes of mean ADC values, tumor volumes and HRS were statistically tested using Wilcoxon-signed-rank test. Results Median pretreatment ADC value for all patients resulted in 1167 × 10−6 mm2/s for GTV-P and 1002 × 10−6 mm2/s for GTV-N while absolute pretreatment tumor volume yielded 9.1 cm3 for GTV-P and 6.0 cm3 for GTV-N, respectively. Pretreatment HRS volumes were 1.5 cm3 for GTV-P and 1.3 cm3 for GTV-P and GTV-N. Median ADC values increase during 35 fractions of RT was 49% for GTV-P and 24% for GTV-N during RT. Median tumor volume decrease was 68% and 52% for GTV-P and GTV-N with a median HRS decrease of 93% and 87%. Significant differences from 0 for mean ADC were observed starting from week 1, for tumor volumes from week 2 for GTV-P and week 1 for GTV-N and for HRS in week 1 for GTV-P and week 2 for GTV-N. Conclusion Longitudinal DWI acquisition in HNC is feasible on a MR-Linac during the course of online adaptive MR-guided radiotherapy. Changes in ADC and volumes can be assessed, but future work needs to explore the potential for biologically guided treatment individualization. Trial registration: NCT04172753, actual study start: 09.05.2018.https://doi.org/10.1186/s13014-025-02589-9MR-guided radiotherapyApparent diffusion coefficientQuantitative magnetic resonance imagingHead and neck cancer |
| spellingShingle | Simon Boeke Jonas Habrich Sarah Kübler Jessica Boldt Fritz Schick Konstantin Nikolaou Jens Kübler Cihan Gani Maximilian Niyazi Daniel Zips Daniela Thorwarth Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer Radiation Oncology MR-guided radiotherapy Apparent diffusion coefficient Quantitative magnetic resonance imaging Head and neck cancer |
| title | Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer |
| title_full | Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer |
| title_fullStr | Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer |
| title_full_unstemmed | Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer |
| title_short | Longitudinal assessment of diffusion-weighted imaging during magnetic resonance-guided radiotherapy in head and neck cancer |
| title_sort | longitudinal assessment of diffusion weighted imaging during magnetic resonance guided radiotherapy in head and neck cancer |
| topic | MR-guided radiotherapy Apparent diffusion coefficient Quantitative magnetic resonance imaging Head and neck cancer |
| url | https://doi.org/10.1186/s13014-025-02589-9 |
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