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Background <p>The impact of diffusion-weighted magnetic resonance imaging guided dose-painting intensity-modulated radiation therapy on head and neck squamous cell carcinoma remains unclear. Our objective aimed at comparing the outcomes and toxicities of DWI-guided DP-IMRT for HNSCC.</p> Methods and materials <p>Between June 2018 and November 2022, we conducted a retrospective analysis of 260 HNSCC patients. Among them, 126 received chemoradiotherapy using DWI-guided dose painting intensity-modulated radiation therapy (DWI group), and the remaining 134 underwent chemoradiotherapy using conventional MRI-based intensity-modulated radiation therapy (Standard group). In DWI group, DW-MRI-guided gross tumor volume (GTV) received escalation to 77&#xa0;Gy/35 fx in 2.2&#xa0;Gy per fraction, while in Standard group, the GTV of HNSCC was irradiated at 70&#xa0;Gy/35 fx at 2.0&#xa0;Gy per fraction. All patients received induction chemotherapy. Survival rates were compared, and multivariate analyses were conducted.</p> Results <p>The median follow-up duration was 23 months. Compared to conventional MRI-based intensity-modulated radiation therapy, DWI-guided dose painting intensity-modulated radiation therapy showed improved 2-year disease-free survival (75.2% vs. 63.8%; <i>P</i> =.011) and locoregional recurrence-free survival (75.9% vs.64.7%; <i>P</i> =.013). Overall survival did not show significant difference between DWI group and Standard group (<i>P</i> =.442). Grade 3–5 toxicities were similar between the two groups. Multivariate analysis showed that DWI-guided dose painting was an independent prognostic factor for DFS (HR 0.559, 95% CI 0.324–0.966, <i>P</i> =.037).</p> Conclusion <p>DWI-guided dose escalation has a benefit in DFS for patients with HNSCC without increasing acute adverse events.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月23日

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  • Chao Tan,
  • Yuyi Li,
  • Cuihong Jiang,
  • Lili He,
  • Shuai Xiao,
  • Changgen Fan,
  • Xu Ye,
  • Qi Zhao,
  • Wenqiong Wu,
  • Yanxian Li,
  • Feng Liu

摘要

Background

The impact of diffusion-weighted magnetic resonance imaging guided dose-painting intensity-modulated radiation therapy on head and neck squamous cell carcinoma remains unclear. Our objective aimed at comparing the outcomes and toxicities of DWI-guided DP-IMRT for HNSCC.

Methods and materials

Between June 2018 and November 2022, we conducted a retrospective analysis of 260 HNSCC patients. Among them, 126 received chemoradiotherapy using DWI-guided dose painting intensity-modulated radiation therapy (DWI group), and the remaining 134 underwent chemoradiotherapy using conventional MRI-based intensity-modulated radiation therapy (Standard group). In DWI group, DW-MRI-guided gross tumor volume (GTV) received escalation to 77 Gy/35 fx in 2.2 Gy per fraction, while in Standard group, the GTV of HNSCC was irradiated at 70 Gy/35 fx at 2.0 Gy per fraction. All patients received induction chemotherapy. Survival rates were compared, and multivariate analyses were conducted.

Results

The median follow-up duration was 23 months. Compared to conventional MRI-based intensity-modulated radiation therapy, DWI-guided dose painting intensity-modulated radiation therapy showed 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 show significant difference between DWI group and Standard group (P =.442). Grade 3–5 toxicities were similar between the two groups. Multivariate analysis showed that DWI-guided dose painting was an independent prognostic factor for DFS (HR 0.559, 95% CI 0.324–0.966, P =.037).

Conclusion

DWI-guided dose escalation has a benefit in DFS for patients with HNSCC without increasing acute adverse events.