More than 55,000 Americans will develop cancer of the head and neck (HN) this year accounting for nearly 3% of all cancers in the United States. These cancers are more common in men and in people over age 50. More than 85% of these cancers are related to tobacco and alcohol consumption. Despite aggressive surgery and radiotherapy (RT), which may result in significant functional loss, the survival rate of patients with head and neck cancer has remained relatively unchanged over the past three decades. The predictive indices based on tumor morphology or clinical characteristics are generally less accurate in defining outcome of response. Hence, there is an urgent need for a reliable predictor of early response in these tumors. Magnetic resonance spectroscopy (MRS) and imaging (MRI) can non-invasively identify specific metabolic patterns and tissue physiology that may be used as markers for predicting and monitoring early treatment response. Preliminary studies on 41 cases of non-Hodgkins Lymphomas and 12 cases of HN tumors indicate that 31p MRS can predict response prior to initiation of therapy. 1H MRS and MRI provides higher sensitivity and spatial resolution than 31p MRS and would thus facilitate studying smaller tumors and investigating heterogeneous tumor response. The overall goal for this proposal is to test the hypothesis that NMR spectroscopy and imaging can predict and monitor early response to treatment of head and neck tumors. This hypothesis will be tested with the following specific aims:
Aim 1 : To evaluate the utility of the PME/13 NTP ratio in predicting and detecting treatment response by 31p MRS, Aim 2: To determine if total choline (Cho) and lactate (Lac) levels can predict and monitor treatment response and Aim 3: To use physiological MRI parameters (T2, ADC and DCE) as predictors/monitors of local tumor response to chemotherapy and radiation therapy of HN tumors. 31p MRS studies will be performed using proton decoupled and NOE enhanced 3D CSI sequence. 1H MRS studies will be performed by implementing a selective multi-quantum coherence transfer pulse sequence (Sel-MQC), for detection of lactate (Lac) and total choline (TCho) on the clinical scanner. Standard MRI pulse sequences for implementing dynamic contrast enhanced (DCE), diffusion weighted imaging (DWI) and T2 weighted imaging (T2WI) imaging will be streamlined so that a complete examination consisting of 31p MRS or 1H MRS combined with DCE, DWI and T2WI can be implemented on human HN patients within one hour.
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