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• W2550157788 abstract "Radiation therapy (RT) for nasopharyngeal carcinoma (NPC) is often effective at curing disease but can injure the surrounding organs at risk, including the muscles responsible for swallowing, with possible resultant short-term or long-term dysphagia. However, no study has tracked serial (ie, acute and late) quantitative dose-response magnetic resonance imaging (MRI) parameter kinetics in a uniform NPC dataset. We aim to characterize serial MRI signal intensity (SI) changes in dysphagia-associated volumes of interest (VOIs) as a function of the radiathin therapy dose. In this retrospective study, we extracted data on 77 patients with stage III-IV NPC who had been treated with curative intensity modulated RT (IMRT). The mean T1- and T2-weighted MRI SIs were recorded for the superior pharyngeal constrictor (SPC) and soft palate (SP) at baseline, early-after IMRT, and last follow-up, with normalization to reference structures receiving <5 Gy. RT dose grids were restored for dose response analysis. Statistical methods included a nonparametric analysis test and recursive partitioning analysis (RPA). The median time to early post-RT follow-up was 4 months, and the median time to late post-RT follow-up was 41 months. The mean dose to the SPC was 62.4 Gy (standard deviation [SD], 8.7 Gy), and the mean dose to the SP was 66.8 Gy (SD, 7.3 Gy). All structures had a significant increase in T2 SIs early after treatment compared to baseline, irrespective of the mean dose given (SPC and SP, 0.47±0.12 and 0.56±0.12 at baseline vs 0.73±0.18 and 0.82±0.17, respectively, P<.0001 for both). At last follow-up, the increase in T2 SI subsided completely for SPC and partially for SP. The T1 SI did not change significantly in early follow-up images of both structures; on late follow-up, patients with mean doses >62.25 Gy had significant decrease in the corresponding T1 SI for SPC (1.6 ± 0.4 vs 1.3 ± 0.4, P=.007) compared to baseline but decreased nonsignificantly for SP (1.7±0.5 vs 1.6±0.5, P=.09). No significant changes in T1 SI were noted with doses below 62.25 Gy for both structures. Continuous RPA showed a cutoff value of magnitude 0.57 for alterations in T1 SI, with a Dmean of 63.8 Gy (95% confidence interval [CI], 61.6-66.0) for those with decrease >0.57 compared to 56.7 Gy (95% CI, 52.2-61.1) for those not achieving threshold. A sigmoidal fit was used to create a normal tissue complication probability curve for T1 alterations as a function of dose (observed R2=0.928). Serial MRI acquisitions enable the identification of both early and late radiation-induced changes in swallowing structures after definitive IMRT for NPC. Decreased SI on late T1 images may indicate muscle fibrosis and is associated with higher RT doses to the SPC, while increased SI on early T2 images is associated with acute edema that subsides after therapy." @default.
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• W2550157788 date "2016-03-01" @default.
• W2550157788 modified "2023-09-26" @default.
• W2550157788 title "Longitudinal Characterization of MRI Kinetics in Irradiated Dysphagia-Related Structures for Nasopharyngeal Carcinoma Patients Receiving IMRT" @default.
• W2550157788 doi "https://doi.org/10.1016/j.ijrobp.2015.12.161" @default.
• W2550157788 hasPublicationYear "2016" @default.
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