Dual-energy and perfusion CT for predicting response to chemo-radiotherapy in head and neck cancer: an exploratory study

Introduction Head and neck cancer (HNC) is a major global health issue, often linked to smoking, alcohol, and viruses (HPV, EBV). HPV-driven oropharyngeal squamous cell carcinoma (OPSCC) showed distinct biology and better response to chemoradiotherapy (CRT) than HPV-negative HNC. Despite these differences, treatment remains uniform, emphasizing the need for predictive imaging biomarkers. Dual-energy computed tomography (DECT) and perfusion computed tomography (PCT) are promising techniques for predicting treatment response, though their clinical utility remains underexplored. This exploratory study investigates whether quantitative parameters (QPs) from DECT and PCT, can predict complete response (CR) 12 months after CRT. Materials and methods 36 HNC patients were enrolled and classified as CR or non-CR (NCR) based on RECIST 1.1 criteria at one year. Imaging was performed at baseline, 3 weeks, 3 months, and 12 months, measuring blood flow (BF), blood volume (BV), and contrast media attenuation (CMA). Statistical analyses compared CR and NCR groups, including subgroups based on HPV status. Results Patients with CR (n=26) showed significantly higher BF and BV at 3 weeks (p0.01), longer mean transit time (MTT) at 3 months (p0.03), and lower CMA at 3 months (p0.03) compared to NCR patients. In the HPV-positive subgroup, CR patients had higher BF and BV than NCR patients (p0.02). Delta analysis revealed no significant differences except for ΔCMA (3W–0), which was lower in HPV-negative patients (p0.04). Conclusion In this exploratory study, DECT and PCT QPs showed potential associations with treatment response in HNC, particularly at early stages. These hypothetical findings warrant further validation in dedicated prospective studies before integration into personalized treatment strategies. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04019548 , identifier NCT04019548.