Change in diffusion weighted imaging after induction chemotherapy outperforms RECIST guideline for long-term outcome prediction in advanced nasopharyngeal carcinoma

Abstract

Purpose To investigate change in diffusion weighted imaging (DWI) between pre-treatment (pre-) and after induction chemotherapy (post-IC) for long-term outcome prediction in advanced nasopharyngeal carcinoma (adNPC). Materials and methods Mean apparent diffusion coefficients (ADCs) of two DWIs (ADC(pre) and ADC(post-IC)) and changes in ADC between two scans (Delta ADC%) were calculated from 64 eligible patients with adNPC and correlated with disease free survival (DFS), locoregional recurrence free survival (LRRFS), distant metastases free survival (DMFS), and overall survival (OS) using Cox regression analysis. C-indexes of the independent parameters for outcome were compared with that of RECIST response groups. Survival rates between two patient groups were evaluated and compared. Results Univariable analysis showed that high Delta ADC% predicted good DFS, LRRFS, and DMFS p < 0.05), but did not predict OS (p = 0.40). Neither ADCpre nor ADCpost-IC (p = 0.07 to 0.97) predicted outcome. Multivariate analysis showed that Delta ADC% independently predicted DFS, LRRFS, and DMFS (p < 0.01 to 0.03). Compared with the RECIST groups, the Delta ADC% groups (threshold of 34.2%) showed a higher c-index for 3-year (0.47 vs. 0.71, p < 0.01) and 5-year DFS (0.51 vs. 0.72, p < 0.01). Compared with patients with Delta ADC%<34.2%, patients with Delta ADC%>= 34.2% had higher 3-year DFS, LRRFS and DMFS of 100%, 100% and 100%, respectively (p < 0.05). Conclusion Results suggest that Delta ADC% was an independent predictor for long-term outcome and was superior to RECIST guideline for outcome prediction in adNPC. A Delta ADC% threshold of >= 34.2% may be valuable for selecting patients who respond to treatment for de-escalation of treatment or post-treatment surveillance.