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Intrinsic radiomic expression patterns after 20 Gy demonstrate early metabolic response of oropharyngeal cancers.

Publication ,  Journal Article
Lafata, KJ; Chang, Y; Wang, C; Mowery, YM; Vergalasova, I; Niedzwiecki, D; Yoo, DS; Liu, J-G; Brizel, DM; Yin, F-F
Published in: Med Phys
July 2021

PURPOSE: This study investigated the prognostic potential of intra-treatment PET radiomics data in patients undergoing definitive (chemo) radiation therapy for oropharyngeal cancer (OPC) on a prospective clinical trial. We hypothesized that the radiomic expression of OPC tumors after 20 Gy is associated with recurrence-free survival (RFS). MATERIALS AND METHODS: Sixty-four patients undergoing definitive (chemo)radiation for OPC were prospectively enrolled on an IRB-approved study. Investigational 18 F-FDG-PET/CT images were acquired prior to treatment and 2 weeks (20 Gy) into a seven-week course of therapy. Fifty-five quantitative radiomic features were extracted from the primary tumor as potential biomarkers of early metabolic response. An unsupervised data clustering algorithm was used to partition patients into clusters based only on their radiomic expression. Clustering results were naïvely compared to residual disease and/or subsequent recurrence and used to derive Kaplan-Meier estimators of RFS. To test whether radiomic expression provides prognostic value beyond conventional clinical features associated with head and neck cancer, multivariable Cox proportional hazards modeling was used to adjust radiomic clusters for T and N stage, HPV status, and change in tumor volume. RESULTS: While pre-treatment radiomics were not prognostic, intra-treatment radiomic expression was intrinsically associated with both residual/recurrent disease (P = 0.0256, χ 2 test) and RFS (HR = 7.53, 95% CI = 2.54-22.3; P = 0.0201). On univariate Cox analysis, radiomic cluster was associated with RFS (unadjusted HR = 2.70; 95% CI = 1.26-5.76; P = 0.0104) and maintained significance after adjustment for T, N staging, HPV status, and change in tumor volume after 20 Gy (adjusted HR = 2.69; 95% CI = 1.03-7.04; P = 0.0442). The particular radiomic characteristics associated with outcomes suggest that metabolic spatial heterogeneity after 20 Gy portends complete and durable therapeutic response. This finding is independent of baseline metabolic imaging characteristics and clinical features of head and neck cancer, thus providing prognostic advantages over existing approaches. CONCLUSIONS: Our data illustrate the prognostic value of intra-treatment metabolic image interrogation, which may potentially guide adaptive therapy strategies for OPC patients and serve as a blueprint for other disease sites. The quality of our study was strengthened by its prospective image acquisition protocol, homogenous patient cohort, relatively long patient follow-up times, and unsupervised clustering formalism that is less prone to hyper-parameter tuning and over-fitting compared to supervised learning.

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Published In

Med Phys

DOI

EISSN

2473-4209

Publication Date

July 2021

Volume

48

Issue

7

Start / End Page

3767 / 3777

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prospective Studies
  • Positron Emission Tomography Computed Tomography
  • Oropharyngeal Neoplasms
  • Nuclear Medicine & Medical Imaging
  • Humans
  • Fluorodeoxyglucose F18
  • 5105 Medical and biological physics
  • 4003 Biomedical engineering
  • 1112 Oncology and Carcinogenesis
 

Citation

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MLA
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Lafata, K. J., Chang, Y., Wang, C., Mowery, Y. M., Vergalasova, I., Niedzwiecki, D., … Yin, F.-F. (2021). Intrinsic radiomic expression patterns after 20 Gy demonstrate early metabolic response of oropharyngeal cancers. Med Phys, 48(7), 3767–3777. https://doi.org/10.1002/mp.14926
Lafata, Kyle J., Yushi Chang, Chunhao Wang, Yvonne M. Mowery, Irina Vergalasova, Donna Niedzwiecki, David S. Yoo, Jian-Guo Liu, David M. Brizel, and Fang-Fang Yin. “Intrinsic radiomic expression patterns after 20 Gy demonstrate early metabolic response of oropharyngeal cancers.Med Phys 48, no. 7 (July 2021): 3767–77. https://doi.org/10.1002/mp.14926.
Lafata KJ, Chang Y, Wang C, Mowery YM, Vergalasova I, Niedzwiecki D, et al. Intrinsic radiomic expression patterns after 20 Gy demonstrate early metabolic response of oropharyngeal cancers. Med Phys. 2021 Jul;48(7):3767–77.
Lafata, Kyle J., et al. “Intrinsic radiomic expression patterns after 20 Gy demonstrate early metabolic response of oropharyngeal cancers.Med Phys, vol. 48, no. 7, July 2021, pp. 3767–77. Pubmed, doi:10.1002/mp.14926.
Lafata KJ, Chang Y, Wang C, Mowery YM, Vergalasova I, Niedzwiecki D, Yoo DS, Liu J-G, Brizel DM, Yin F-F. Intrinsic radiomic expression patterns after 20 Gy demonstrate early metabolic response of oropharyngeal cancers. Med Phys. 2021 Jul;48(7):3767–3777.

Published In

Med Phys

DOI

EISSN

2473-4209

Publication Date

July 2021

Volume

48

Issue

7

Start / End Page

3767 / 3777

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Prospective Studies
  • Positron Emission Tomography Computed Tomography
  • Oropharyngeal Neoplasms
  • Nuclear Medicine & Medical Imaging
  • Humans
  • Fluorodeoxyglucose F18
  • 5105 Medical and biological physics
  • 4003 Biomedical engineering
  • 1112 Oncology and Carcinogenesis