Ashok Srinivasan

We are transitioning into an era where personalized medicine, in terms of individualized treatment options, will play a pivotal role in the management of head and neck cancer. It has been recognized for some time that anatomic imaging (conventional CT and MRI) has its limitations in characterizing the functional or physiologic status of cancer, which is an important determinant of treatment response and prognosis. Hence, we sought to study the role of diffusion MRI in head and neck cancer with the hypothesis that this biologic technique may serve as a biomarker for tissue cellularity. Our initial studies utilizing diffusion MRI showed that apparent diffusion coefficient could distinguish benign and malignant neck lesions, and could also predict response to chemoradiation in head and neck cancer. Other studies in the literature utilizing different magnets and protocols have also shown that both diffusion and perfusion imaging can predict response to chemoradiation in head and neck cancer and could be useful tools for early monitoring of therapy. While studies in this field have been performed across many different institutions in the United States and abroad, the time is ripe for a collaborative multi-institutional study that can firmly establish the role of biologic imaging and also help develop clinically relevant qualitative and quantitative metrics derived from these techniques.

As the first step toward the long-term goal of integrating biologic imaging techniques in head and neck cancer management, several institutions have started utilizing diffusion imaging clinically for the assessment of tumor recurrence. This has significantly helped in determining the appropriate course of management in patients with post therapy neck masses.

In the past few years, there has been a lot of enthusiasm in this field from many investigators, which we hope will translate into multi-institutional collaborations. We have expanded our research further and are planning to study how we can best utilize diffusion and perfusion MR to determine the need for escalated radiation doses. We have also explored the feasibility of using dual-energy spectral CT in distinguishing benign and malignant neck tumors, and have published our preliminary results with this technique. We look forward to the day when any patient presenting with head and neck cancer can be offered individualized therapeutic options based on the their clinical presentation and imaging findings, particularly the information gained from biologic imaging techniques, to optimize the chances for therapeutic success.

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