Predictive Potential of Dynamic Contrast-Enhanced MRI and Plasma-derived Angiogenic Factors for Response to Concurrent Chemoradiotherapy in Human Papillomavirus-negative Oropharyngeal Cancer

Abstract

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess tumour vascularity, which depends on the process of angiogenesis and affects tumour response to treatment. Our study explored the associations between DCE-MRI parameters and the expression of plasma angiogenic factors in HPV-negative head and neck cancer, as well as their predictive value for response to concurrent chemoradiotherapy (cCRT).

METHODS: 25 patients with locally advanced HPV-negative oropharyngeal carcinoma were prospectively enrolled in the study. DCE-MRI and blood plasma sampling were conducted before, at 20 Gy, and after the completion of cCRT. Perfusion parameters k_trans, k_ep, V_e, iAUC and plasma expression levels of angiogenic factors VEGF, CTGF, PDGF-AB, ANG, END and THBS1 were measured at each time-point. Patients were stratified into responders and non-responders based on clinical evaluation. Differences and correlations between measures were used to generate prognostic models for response prediction.

RESULTS: Higher k_trans and higher plasma VEGF levels successfully discriminated responders from non-responders across all measured time-points, whereas higher iAUC and higher plasma PDGF-AB levels were also discriminative at selected time points. Using early intra-treatment measurements of k_trans and VEGF, a predictive model was created with cut-off values of 0.259 min⁻¹ for k_trans and 62.5 pg/mL for plasma VEGF.

CONCLUSIONS: Early intra-treatment DCE-MRI parameter k_trans and plasma VEGF levels may be valuable early predictors of response to cCRT in HPV-negative oropharyngeal cancer.