<p>Bio-physic constraint model using spatial registration of delta 18F-fluorodeoxyglucose positron emission tomography/computed tomography images for predicting radiation pneumonitis in esophageal squamous cell carcinoma patients receiving neoadjuvant chemoradiation</p>

Abstract

Purpose This study integrated clinical outcomes and radiomics of advanced thoracic esophageal squamous cell carcinoma patients receiving neoadjuvant concurrent chemoradiotherapy (NACCRT) to establish a novel constraint model for predicting radiation pneumonitis (RP). Patients and methods We conducted a retrospective review for thoracic advanced esophageal cancer patients who received NACCRT. From 2013 to 2018, 89 patients were eligible for review. Staging workup and response evaluation included positron emission tomography/computed tomography (PET/CT) scans and endoscopic ultrasound. Patients received RT with 48 Gy to gross tumor and 43.2 Gy to elective nodal area in simultaneous integrated boost method divided in 24 fractions. Weekly platinum-based chemotherapy was administered concurrently. Side effects were evaluated using CTCAE v4. Images of 2-fluoro-2-deoxyglucose PET/CT before and after NACCRT were registered to planning CT images to create a region of interest for dosimetry parameters that spatially matched RP-related regions, including V 10 , V 20 , V 50% , V 27 , and V 30 . Correlation between bio-physic parameters and toxicity was used to establish a constraint model for avoiding RP. Results Among the investigated cohort, clinical downstaging, complete pathological response, and 5-year overall survival rates were 59.6%, 40%, and 34.4%, respectively. Multivariate logistic regression analysis demonstrated that each individual set standardized uptake value ratios (SUVRs), neither pre- nor post-NACCRT, was not predictive. Interestingly, cutoff increments of 6.2% and 8.9% in SUVRs (delta-SUVR) in registered V 20 and V 27 regions were powerful predictors for acute and chronic RP, respectively. Conclusion Spatial registration of metabolic and planning CT images with delta-radiomics analysis using fore-and-aft image sets can establish a unique bio-physic prediction model for avoiding RP in esophageal cancer patients receiving NACCRT.

Imaging Biomarkers to Predict and Evaluate the Effectiveness of Immunotherapy in Advanced Non-Small-Cell Lung Cancer

“…Nevertheless, further evaluation needs to be carried out in translating such research into clinical practice because most literature in the field had a multi-localization/multi-type tumor cohort design. Deltaradiomics features (Delta-RFs) which capture therapy-induced changes in radiomics features are now being evaluated as a complement to Response Evaluation Criteria in Solid Tumor (RECIST) criteria for monitoring therapeutic response in several tumor types (25)(26)(27)(28)(29)(30)(31). Khorrami et al showed preliminary evidence for clinical use of Delta-radiomics calculated from contrast-enhanced CT images as predictive biomarkers of response to ICIs therapy in NSCLC (31).…”

Efficacy and prognostic value of delta radiomics on dual-energy computed tomography for gastric cancer with neoadjuvant chemotherapy: a preliminary study

“…Delta radiomics reveals the difference in radiomics parameters before and after treatment, thus providing dynamic changes in radiomics during therapy. The role of delta radiomics has been investigated in a variety of diseases, such as pancreatic cancer, rectal cancer, high-grade osteosarcoma, and esophageal squamous cell carcinoma (32)(33)(34)(35). However, delta radiomics is rarely used for GC, except for one.…”

Delta-volume radiomics of induction chemotherapy to predict outcome of subsequent chemoradiotherapy for locally advanced hypopharyngeal cancer

“…This concept has been accepted in similar clinical scenarios, including in neoadjuvant CCRT for rectal and esophageal cancer. 17,34…”

“…This concept has been accepted in similar clinical scenarios, including in neoadjuvant CCRT for rectal and esophageal cancer. 17,34 Concurrent cisplatin is the preferred chemotherapy regimen used in definitive CCRT for LAHC with survival benefit. 35 Additional or alternative regimens may have stronger radiosensitizing or antitumor effects, but the trade-off can be more severe toxicity.…”