Project 1: InHANCE: Novel Biomedical Imaging Approaches to Address Radiation-Induced Toxicity for Head and Neck Cancer Patients

University Of Tx Md Anderson Can Ctr, Houston TX

Investigators

Abstract

ABSTRACT: Project 1 Current standard-of-care external beam radiotherapy (EBRT) for head and neck cancer (HNC) is associated with high rates of severe toxicities affecting patients’ quality of life. Given the excellent outcomes for human papillomavirus (HPV)-associated HNC and long-term survival of these typically younger patients, normal tissue sparing, and prevention of long-term toxicities aimed at improving survivorship, while maintaining excellent disease control, represents a major healthcare challenge. The aims of this proposal are focused on the overarching hypothesis of this application that the use of novel biomedical dose-imaging approaches will facilitate the prevention, monitoring, and treatment of RT- induced osteoradionecrosis (ORN) for HNC patients. Our group has recently identified mandibular dose- volume parameters associated with higher likelihood of ORN development. The first project of this proposal aims to prevent post-EBRT bone toxicity by using the identified mandibular dose-volume parameters as IMRT plan constraints. We will also develop and validate high-dimensional risk assessment models that may be more accurate for ORN risk stratification. The second project aims to use a novel combination of MRI sequences to quantitatively assess mandibular cortical bone microstructural integrity. Novel and validated MRI sequences will be used to assess the effects of pharmacologic therapy on vascular integrity of the mandible. The final project aims to reduce surgical morbidity for patients who have already developed ORN by functional image-guided pre- surgical bone injury mapping for surgical planning to optimize the resection volume and achieve better surgical outcomes. The successful implementation of the study aims will directly leverage the efforts from a previously funded NIDCR award (R01DE025248) and complement ongoing validation studies (U01DE032168) for the incorporation of MRI assessment into routine clinical practice for improved prevention, early detection, and treatment of a devastating radiation-induced morbidity such as ORN for HNC survivors. The study will also develop improved risk assessment models and a novel MRI sequence combinations to assess mandibular bone integrity. Finally, the study will demonstrate the potential of controlling surgical morbidity for patients with established toxicity through better surgical planning using innovative functional imaging guidance.