Abstract
Osteoradionecrosis (ORN) is a major side-effect of radiation therapy in oropharyngeal cancer (OPC) patients. In this study, we demonstrate that early prediction of ORN is possible by analyzing the temporal evolution of mandibular subvolumes receiving radiation. For our analysis, we use computed tomography (CT) scans from 21 OPC patients treated with Intensity Modulated Radiation Therapy (IMRT) with subsequent radiographically-proven ≥ grade II ORN, at three different time points: pre-IMRT, 2-months, and 6-months post-IMRT. For each patient, radiomic features were extracted from a mandibular subvolume that developed ORN and a control subvolume that received the same dose but did not develop ORN. We used a Multivariate Functional Principal Component Analysis (MFPCA) approach to characterize the temporal trajectories of these features. The proposed MFPCA model performs the best at classifying ORN vs. Control subvolumes with an area under curve (AUC) = 0.74 [95% confidence interval (C.I.): 0.61–0.90], significantly outperforming existing approaches such as a pre-IMRT features model or a delta model based on changes at intermediate time points, i.e., at 2- and 6-month follow-up. This suggests that temporal trajectories of radiomics features derived from sequential pre- and post-RT CT scans can provide markers that are correlates of RT-induced mandibular injury, and consequently aid in earlier management of ORN.
Highlights
Radiotherapy (RT) is a highly utilized modality in the treatment of head and neck (H&N) cancers with well-established local control and survival benefits (Pan et al, 2016)
Radiomics Can Distinguish Between ORN and Non-ORN An initial set of 1,628 radiomic features were computed for each ORN and Control volume of interest (VOI) obtained from the 21 eligible patients across 3 time points of interest representing baseline, 2-month postIMRT, and 6-month post-intensity-modulated radiotherapy (IMRT)
As an initial exploratory step, we computed which of these 16 radiomic features were significantly different between the ORN and Control volumes of interest (VOIs) using a Mann-Whitney test
Summary
Radiotherapy (RT) is a highly utilized modality in the treatment of head and neck (H&N) cancers with well-established local control and survival benefits (Pan et al, 2016). Osteoradionecrosis is a late complication from radiation to the mandibular bone with a serious impact on the quality of life for a growing population of younger surviving head and neck cancer patients (Oh et al, 2004). Different risk factors were identified to play a role in the development of ORN following radiotherapy treatments (Allison et al, 2013; Zhang et al, 2017). Osteoradionecrosis has a great impact on the patients’ quality of life if not detected and managed properly (Tucker et al, 2016; Wong et al, 2017). Diagnosis of ORN mainly relies on clinical and radiological tools such as computed tomography (CT) and magnetic resonance imaging (MRI) with their limited capacity for early detection (Tsien et al, 2014)
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