Abstract
ObjectivesTo identify an imaging signature predicting local recurrence for locally advanced cervical cancer (LACC) treated by chemoradiation and brachytherapy from baseline 18F-FDG PET images, and to evaluate the possibility of gathering images from two different PET scanners in a radiomic study.Methods118 patients were included retrospectively. Two groups (G1, G2) were defined according to the PET scanner used for image acquisition. Eleven radiomic features were extracted from delineated cervical tumors to evaluate: (i) the predictive value of features for local recurrence of LACC, (ii) their reproducibility as a function of the scanner within a hepatic reference volume, (iii) the impact of voxel size on feature values.ResultsEight features were statistically significant predictors of local recurrence in G1 (p < 0.05). The multivariate signature trained in G2 was validated in G1 (AUC=0.76, p<0.001) and identified local recurrence more accurately than SUVmax (p=0.022). Four features were significantly different between G1 and G2 in the liver. Spatial resampling was not sufficient to explain the stratification effect.ConclusionThis study showed that radiomic features could predict local recurrence of LACC better than SUVmax. Further investigation is needed before applying a model designed using data from one PET scanner to another.
Highlights
Cervical cancer is a significant cause of morbidity and mortality, being the fourth most common cancer in women worldwide and the sixth in Europe [1]
This study, performed in two cohorts of patients scanned with positron emission tomography (PET) scanners having different properties, showed that several textural features were predictive of recurrence in a cohort scanned with the same PET machine (G1), and that a multivariate signature trained in G2 identified local recurrence with area under receiver operating characteristic curve (AUC) of 0.86 in the training set and 0.76 in the validation set
Treatment consisted of concurrent chemo-radiation followed by brachytherapy. 3D-conformationnal external beam radiotherapy was delivered in 25 daily fractions of 1.8 Gy each to reach a total dose of 45 Gy to the pelvis +/- the para-aortic area depending on the results of the primary para-aortic surgical staging
Summary
Cervical cancer is a significant cause of morbidity and mortality, being the fourth most common cancer in women worldwide and the sixth in Europe [1]. Castelnau-Marchand et al studied clinical outcomes of chemoradiation followed by image guided adaptive brachytherapy for 225 patients with cervical cancers (65% with a FIGO stage ≥ IIB) and observed a local recurrence rate of 13% [3]. Several factors have been associated with the probability of local control, such as the tumor size at diagnosis, the volume of the high-risk clinical target volume at time of brachytherapy, or the overall treatment time. In the era of image guided adaptive brachytherapy, it remains necessary to refine the prediction of outcome, and more to more thoroughly identify patients who are at high risk of local recurrence and who would require intensification of treatment, such as dose escalation or who would be candidates for clinical trials of radiosensitizing agents. It might be clinically relevant to identify patients with a lower risk of local relapse, and who are less likely to benefit from dose escalation
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