Abstract
(1) Purpose: The objective was to evaluate CT perfusion and radiomic features for prediction of one year disease free survival in laryngeal and hypopharyngeal cancer. (2) Method and Materials: This retrospective study included pre and post therapy CT neck studies in 36 patients with laryngeal/hypopharyngeal cancer. Tumor contouring was performed semi-autonomously by the computer and manually by two radiologists. Twenty-six radiomic features including morphological and gray-level features were extracted by an internally developed and validated computer-aided image analysis system. The five perfusion features analyzed included permeability surface area product (PS), blood flow (flow), blood volume (BV), mean transit time (MTT), and time-to-maximum (Tmax). One year persistent/recurrent disease data were obtained following the final treatment of definitive chemoradiation or after total laryngectomy. We performed a two-loop leave-one-out feature selection and linear discriminant analysis classifier with generation of receiver operating characteristic (ROC) curves and confidence intervals (CI). (3) Results: 10 patients (28%) had recurrence/persistent disease at 1 year. For prediction, the change in blood flow demonstrated a training AUC of 0.68 (CI 0.47–0.85) and testing AUC of 0.66 (CI 0.47–0.85). The best features selected were a combination of perfusion and radiomic features including blood flow and computer-estimated percent volume changes-training AUC of 0.68 (CI 0.5–0.85) and testing AUC of 0.69 (CI 0.5–0.85). The laryngoscopic percent change in volume was a poor predictor with a testing AUC of 0.4 (CI 0.16–0.57). (4) Conclusions: A combination of CT perfusion and radiomic features are potential predictors of one-year disease free survival in laryngeal and hypopharyngeal cancer patients.
Highlights
The larynx is an important organ for performing vital functions such as swallowing, speaking, and breathing naturally [1]
During the 1990s, several larynx preservation clinical trials advanced the treatment of laryngeal cancer by demonstrating similar efficacy and improved quality of life with induction chemotherapy followed by definitive chemoradiation instead of total laryngectomy [4,5,6]
Selection of the appropriate management with definitive chemoradiation or total laryngectomy is an important phase in the treatment of advanced laryngeal cancer
Summary
The larynx is an important organ for performing vital functions such as swallowing, speaking, and breathing naturally [1]. Treatment of advanced laryngeal cancer is challenging due to the desire to achieve disease free survival and preserve laryngeal function. Surgical management with total laryngectomy is an effective treatment strategy, but it comes with decreased quality of life [2]. During the 1990s, several larynx preservation clinical trials advanced the treatment of laryngeal cancer by demonstrating similar efficacy and improved quality of life with induction chemotherapy followed by definitive chemoradiation instead of total laryngectomy [4,5,6]. Selection between different treatment options is performed by chemoselection [7], a strategy that determines the primary tumor’s response after induction chemotherapy; responders receive definitive chemoradiation and non-responders receive total laryngectomy [7]. No predictors exist in the literature to determine which patients will have persistent or recurrent disease after definitive treatment
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