Abstract IA14: Optimizing head and neck cancer treatment outcomes with MRI
Authors: Sandulache Vlad C. , Mohamed Abdallah S.R. , Chen Yunyun , Hutcheson Katherine A. , Hobbs Brian P. , Chambers Mark S. , Johnson Jason M. , Williams Michelle D. , Bankson James A. , Fuller Clifton D. , Lai Stephen Y. 
Published: December 2017

Changes in the epidemiology of head and neck cancers have resulted in an increasing number of younger and healthier patients being treated with definitive external beam radiotherapy (EBRT). The long-term consequences of radiotherapy in a patient population with good clinical outcomes and extended life expectancy are becoming increasingly relevant in the management of treatment-associated morbidity and mortality.

Osteoradionecrosis (ORN) of the mandible is a challenging issue related to irradiation, occurring in up to 16% of patients with various types of head and neck cancers. Altered bone vascularity and opportunistic infections within the oral cavity contribute to the development of ORN, leading to an inexorable process of bone destruction that does not follow the normal sequence of healing events. Early-stage ORN is often managed using antibiotics, local wound care, and hyperbaric oxygen (HBO). Advanced ORN requires surgical resection and reconstruction with healthy nonirradiated tissue. Successful management of this disease process requires an enhanced ability to identify patients at risk for ORN, monitor the effectiveness of conservative management, and improve preoperative planning to ensure clear margins at the time of resection. However, a standardized, objective staging and monitoring system for ORN is not currently available.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a clinically available quantitative imaging method that is increasingly employed to assess microvascular function in the study of solid tumors of the head and neck. At our institution, DCE-MRI is integrated into a multimodality clinical algorithm aimed at improving the diagnosis, staging, and oncologic surveillance of head and neck tumors. DCE-MRI can detect altered bone vascularity associated with bone healing, necrosis, and metastatic involvement, with excellent spatial resolution. We hypothesize that DCE-MRI can be used to detect alterations in bone vascularity following irradiation to monitor ORN clinical progression and response to treatment. We are evaluating the potential of DCE-MRI to identify patients at risk for mandibular ORN, monitor response to conservative management, and determine the extent of advanced mandibular ORN to assist in surgical planning.

This work has the potential to revolutionize the diagnosis and management of mandibular ORN. For the first time, clinicians will be able to identify patients at risk for ORN and manage post-radiotherapy care appropriately. The effectiveness of currently employed conservative measures could be tested using an objective measure and improved preoperative planning could reduce the rate of surgical failure due to residual compromised bone.

Citation Format: Vlad C. Sandulache, Abdallah S.R. Mohamed, Yunyun Chen, Katherine A. Hutcheson, Brian P. Hobbs, Mark S. Chambers, Jason M. Johnson, Michelle D. Williams, James A. Bankson, Clifton D. Fuller, Stephen Y. Lai. Optimizing head and neck cancer treatment outcomes with MRI [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr IA14.