WUSTL 2026: Imaging Biomarkers in Head and Neck Cancer
Year: 2026
Type: article
Abstract: Delivered at Washington University in St. Louis, MO, USA, 2026-06-30T1200.PrécisThis presentation traces how successive technological paradigm shifts in head and neck cancer therapy have outpaced our ability to assess their consequences, and argues that quantitative imaging biomarkers (QIBs) are the tool needed to close that gap. The field has moved from 3DCRT to IMRT (parotid-sparing), to IMPT (proton dose reduction), and most recently to high-frequency, MR-Linac–based daily imaging. With each shift, the toxicity profile has become less uniform and harder to characterize—spanning xerostomia, dysphagia, lymphedema/fibrosis, osteoradionecrosis (ORN), sarcopenia, and carotid injury—evolving across acute, sub-acute, chronic, and late phases.For radiation oncologists, the differentiating need is spatial dose-response data. Fuller argues the ideal QIB is accurate (in time and 3D space), anticipatory, actionable, and additive. The talk distinguishes biomarker quantification (technical/metrological performance) from qualification (biological utility under the FDA-BEST framework and a structured Context of Use statement), and walks through specific modalities: diffusion-weighted imaging (DWI/IVIM) predicting mid-therapy complete response, dynamic contrast-enhanced (DCE) MRI mapping tumor and normal-tissue vascular change (Ktrans, ve), and biomarker-guided adaptive dose escalation to radioresistant subvolumes.A recurring theme is reproducibility failure: multi-site DCE digital reference object and in-vivo challenges showed algorithms disagree substantially, motivating rigorous hardware, software, and post-processing standardization. Applied work covers lymphedema/fibrosis QIBs and embedded Bayesian intervention trials (STOP-LATE-FIBROSE, REVERSE), carotid remodeling and stroke risk, and an ORN program using CT radiomics plus NTCP modeling to predict ORN before clinical onset, advancing toward FDA monitoring-biomarker qualification. Novel MRI bone sequences (Black Bone, UTE, porosity index, synthetic MR) aim to visualize cortical bone for ORN surveillance.The closing message: imaging remains the central challenge—and opportunity.
Source: Figshare
Author: Clifton D. Fuller
Subfield: Radiation
Field: Physics and Astronomy
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W7166716366
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