DWI-guided DP-IMRT and conventional MRI-based IMRT in head and neck squamous cell carcinoma: a comparative study

Area of Science:

• Radiation Oncology
• Oncology
• Medical Imaging

Background:

• Head and neck squamous cell carcinoma (HNSCC) management is complex.
• The role of diffusion-weighted imaging (DWI)-guided dose-painting intensity-modulated radiation therapy (DP-IMRT) in HNSCC is not well-defined.
• Comparing DWI-guided DP-IMRT with conventional MRI-based IMRT is crucial for optimizing treatment strategies.

Purpose of the Study:

• To compare the efficacy and toxicity of DWI-guided DP-IMRT versus standard MRI-based IMRT in HNSCC patients.
• To evaluate the impact of DWI-guided dose escalation on survival rates and recurrence.
• To identify prognostic factors influencing treatment outcomes in HNSCC.

Main Methods:

• Retrospective analysis of 260 HNSCC patients treated between June 2018 and November 2022.
• Two groups: 126 patients in the DWI group (77 Gy/35 fx to GTV) and 134 in the Standard group (70 Gy/35 fx to GTV).
• All patients received induction chemotherapy; survival rates and toxicities were compared using multivariate analyses.

Main Results:

• DWI-guided DP-IMRT demonstrated significantly improved 2-year disease-free survival (75.2% vs. 63.8%, P=.011) and locoregional recurrence-free survival (75.9% vs. 64.7%, P=.013).
• Overall survival did not differ significantly between groups (P=.442).
• Grade 3-5 toxicities were comparable; DWI-guided dose painting was an independent prognostic factor for DFS (HR 0.559, P=.037).

Conclusions:

• DWI-guided dose escalation offers a significant benefit in disease-free survival for HNSCC patients.
• This approach does not lead to an increase in acute adverse events.
• DWI-guided DP-IMRT represents a promising advancement in HNSCC treatment, improving recurrence-free survival.