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Rossi E, Boldrini L, Maratta MG, Gatta R, Votta C, Tortora G, Schinzari G. Radiomics to predict immunotherapy efficacy in advanced renal cell carcinoma: A retrospective study. Hum Vaccin Immunother 2023; 19:2172926. [PMID: 36723981 PMCID: PMC10012916 DOI: 10.1080/21645515.2023.2172926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Immunotherapy has become a cornerstone for the treatment of renal cell carcinoma. Nevertheless, some patients are resistant to immune checkpoint inhibitors. The possibility to identify patients who cannot benefit from immunotherapy is a relevant clinical challenge. We analyzed the association between several radiomics features and response to immunotherapy in 53 patients treated with checkpoint inhibitors for advanced renal cell carcinoma. We found that the following features are associated with progression of disease as best tumor response: F_stat.range (p < .0004), F_stat.max (p < .0007), F_stat.var (p < .0016), F_stat.uniformity (p < .0020), F_stat.90thpercentile (p < .0050). Gross tumor volumes characterized by high values of F_stat.var and F_stat.max (greater than 60,000 and greater than 300, respectively) are most likely related to a high risk of progression. Further analyses are warranted to confirm these results. Radiomics, together with other potential predictive factors, such as gut microbiota, genetic features or circulating immune molecules, could allow a personalized treatment for patients with advanced renal cell carcinoma.
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Affiliation(s)
- Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Grazia Maratta
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Gatta
- Dipartimento di Scienze Cliniche e Sperimentali, Universitá degli Studi di Brescia, Brescia, Italy.,Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Claudio Votta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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Lococo F, Boldrini L, Diepriye CD, Evangelista J, Nero C, Flamini S, Minucci A, De Paolis E, Vita E, Cesario A, Annunziata S, Calcagni ML, Chiappetta M, Cancellieri A, Larici AR, Cicchetti G, Troost EGC, Ádány R, Farré N, Öztürk E, Van Doorne D, Leoncini F, Urbani A, Trisolini R, Bria E, Giordano A, Rindi G, Sala E, Tortora G, Valentini V, Boccia S, Margaritora S, Scambia G. Lung cancer multi-omics digital human avatars for integrating precision medicine into clinical practice: the LANTERN study. BMC Cancer 2023; 23:540. [PMID: 37312079 PMCID: PMC10262371 DOI: 10.1186/s12885-023-10997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The current management of lung cancer patients has reached a high level of complexity. Indeed, besides the traditional clinical variables (e.g., age, sex, TNM stage), new omics data have recently been introduced in clinical practice, thereby making more complex the decision-making process. With the advent of Artificial intelligence (AI) techniques, various omics datasets may be used to create more accurate predictive models paving the way for a better care in lung cancer patients. METHODS The LANTERN study is a multi-center observational clinical trial involving a multidisciplinary consortium of five institutions from different European countries. The aim of this trial is to develop accurate several predictive models for lung cancer patients, through the creation of Digital Human Avatars (DHA), defined as digital representations of patients using various omics-based variables and integrating well-established clinical factors with genomic data, quantitative imaging data etc. A total of 600 lung cancer patients will be prospectively enrolled by the recruiting centers and multi-omics data will be collected. Data will then be modelled and parameterized in an experimental context of cutting-edge big data analysis. All data variables will be recorded according to a shared common ontology based on variable-specific domains in order to enhance their direct actionability. An exploratory analysis will then initiate the biomarker identification process. The second phase of the project will focus on creating multiple multivariate models trained though advanced machine learning (ML) and AI techniques for the specific areas of interest. Finally, the developed models will be validated in order to test their robustness, transferability and generalizability, leading to the development of the DHA. All the potential clinical and scientific stakeholders will be involved in the DHA development process. The main goals aim of LANTERN project are: i) To develop predictive models for lung cancer diagnosis and histological characterization; (ii) to set up personalized predictive models for individual-specific treatments; iii) to enable feedback data loops for preventive healthcare strategies and quality of life management. DISCUSSION The LANTERN project will develop a predictive platform based on integration of multi-omics data. This will enhance the generation of important and valuable information assets, in order to identify new biomarkers that can be used for early detection, improved tumor diagnosis and personalization of treatment protocols. ETHICS COMMITTEE APPROVAL NUMBER 5420 - 0002485/23 from Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore Ethics Committee. TRIAL REGISTRATION clinicaltrial.gov - NCT05802771.
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Affiliation(s)
- Filippo Lococo
- Catholic University of the Sacred Heart, Rome, Italy.
- Thoracic Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy.
| | - Luca Boldrini
- Catholic University of the Sacred Heart, Rome, Italy
- Radiotherapy Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | | | - Jessica Evangelista
- Catholic University of the Sacred Heart, Rome, Italy
- Thoracic Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Camilla Nero
- Catholic University of the Sacred Heart, Rome, Italy
- Division of Oncological Gynecology, Department of Woman and Child Health and Public Health, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Sara Flamini
- Thoracic Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Angelo Minucci
- Catholic University of the Sacred Heart, Rome, Italy
- Departmental Unit of Molecular and Genomic Diagnostics, Genomics Core Facility, Gemelli Science and Technology Park (G-STeP), A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Elisa De Paolis
- Departmental Unit of Molecular and Genomic Diagnostics, Genomics Core Facility, Gemelli Science and Technology Park (G-STeP), A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Emanuele Vita
- Catholic University of the Sacred Heart, Rome, Italy
- Medical Oncology, A. Gemelli University Hospital Foundation IRCCS, Largo A. Gemelli 8, Rome, Italy
| | - Alfredo Cesario
- Catholic University of the Sacred Heart, Rome, Italy
- Open Innovation, Scientific Directorate, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- CEO, Gemelli Digital Medicine & Health Srl, Rome, Italy
| | - Salvatore Annunziata
- Catholic University of the Sacred Heart, Rome, Italy
- Nuclear Medicine Unit, GsteP Radiopharmacy TracerGLab, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Maria Lucia Calcagni
- Catholic University of the Sacred Heart, Rome, Italy
- Nuclear Medicine Unit, GsteP Radiopharmacy TracerGLab, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Marco Chiappetta
- Catholic University of the Sacred Heart, Rome, Italy
- Thoracic Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Alessandra Cancellieri
- Catholic University of the Sacred Heart, Rome, Italy
- Institute of Pathology, A. Gemelli University Hospital Foundation IRCCS, Roma, Italy
| | - Anna Rita Larici
- Catholic University of the Sacred Heart, Rome, Italy
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Giuseppe Cicchetti
- Catholic University of the Sacred Heart, Rome, Italy
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Rossendorf, Germany
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, OncoRay - National Center for Radiation Research in Oncology, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Róza Ádány
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Núria Farré
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau (IR-HSCSP), Barcelona, Spain
| | - Ece Öztürk
- School of Medicine, Turkey and Koç University Research Center for Translational Medicine (KUTTAM), Sariyer, Koç University, Istanbul, Turkey
| | - Dominique Van Doorne
- Department of Philosophy and Educational Sciences, University of Turin - Academy of the Expert Patient ADPEE - EUPATI, Turin, Italy
| | - Fausto Leoncini
- Catholic University of the Sacred Heart, Rome, Italy
- Interventional Pulmonology Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Andrea Urbani
- Catholic University of the Sacred Heart, Rome, Italy
- Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Catholic University of Sacred Heart, Rome, Italy
| | - Rocco Trisolini
- Catholic University of the Sacred Heart, Rome, Italy
- Interventional Pulmonology Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Emilio Bria
- Catholic University of the Sacred Heart, Rome, Italy
- Medical Oncology, A. Gemelli University Hospital Foundation IRCCS, Largo A. Gemelli 8, Rome, Italy
| | - Alessandro Giordano
- Catholic University of the Sacred Heart, Rome, Italy
- Nuclear Medicine Unit, GsteP Radiopharmacy TracerGLab, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Guido Rindi
- Catholic University of the Sacred Heart, Rome, Italy
- Institute of Pathology, A. Gemelli University Hospital Foundation IRCCS, Roma, Italy
| | - Evis Sala
- Catholic University of the Sacred Heart, Rome, Italy
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Giampaolo Tortora
- Catholic University of the Sacred Heart, Rome, Italy
- Medical Oncology, A. Gemelli University Hospital Foundation IRCCS, Largo A. Gemelli 8, Rome, Italy
| | - Vincenzo Valentini
- Catholic University of the Sacred Heart, Rome, Italy
- Radiotherapy Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Stefania Boccia
- Catholic University of the Sacred Heart, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Stefano Margaritora
- Catholic University of the Sacred Heart, Rome, Italy
- Thoracic Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Giovanni Scambia
- Catholic University of the Sacred Heart, Rome, Italy
- Division of Oncological Gynecology, Department of Woman and Child Health and Public Health, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
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Triumbari EKA, Gatta R, Maiolo E, De Summa M, Boldrini L, Mayerhoefer ME, Hohaus S, Nardo L, Morland D, Annunziata S. Baseline 18F-FDG PET/CT Radiomics in Classical Hodgkin's Lymphoma: The Predictive Role of the Largest and the Hottest Lesions. Diagnostics (Basel) 2023; 13:1391. [PMID: 37189492 PMCID: PMC10137254 DOI: 10.3390/diagnostics13081391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
This study investigated the predictive role of baseline 18F-FDG PET/CT (bPET/CT) radiomics from two distinct target lesions in patients with classical Hodgkin's lymphoma (cHL). cHL patients examined with bPET/CT and interim PET/CT between 2010 and 2019 were retrospectively included. Two bPET/CT target lesions were selected for radiomic feature extraction: Lesion_A, with the largest axial diameter, and Lesion_B, with the highest SUVmax. Deauville score at interim PET/CT (DS) and 24-month progression-free-survival (PFS) were recorded. Mann-Whitney test identified the most promising image features (p < 0.05) from both lesions with regards to DS and PFS; all possible radiomic bivariate models were then built through a logistic regression analysis and trained/tested with a cross-fold validation test. The best bivariate models were selected based on their mean area under curve (mAUC). A total of 227 cHL patients were included. The best models for DS prediction had 0.78 ± 0.05 maximum mAUC, with a predominant contribution of Lesion_A features to the combinations. The best models for 24-month PFS prediction reached 0.74 ± 0.12 mAUC and mainly depended on Lesion_B features. bFDG-PET/CT radiomic features from the largest and hottest lesions in patients with cHL may provide relevant information in terms of early response-to-treatment and prognosis, thus representing an earlier and stronger decision-making support for therapeutic strategies. External validations of the proposed model are planned.
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Affiliation(s)
- Elizabeth Katherine Anna Triumbari
- Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Radiology, UC Davis, Sacramento, CA 95817, USA;
| | - Roberto Gatta
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy;
- Department of Oncology, Lausanne University Hospital, 1011 Lausanne, Switzerland
- Radiomics, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Elena Maiolo
- Ematologia, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Marco De Summa
- Medipass S.p.a. Integrative Service PET/CT–Radiofarmacy TracerGLab, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Luca Boldrini
- Radiomics, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Marius E. Mayerhoefer
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Wien, Austria;
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stefan Hohaus
- Ematologia, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
- Hematology Section, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Lorenzo Nardo
- Department of Radiology, UC Davis, Sacramento, CA 95817, USA;
| | - David Morland
- Unità di Medicina Nucleare, GSTeP Radiofarmacia, TracerGLab, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
- Médecine Nucléaire, Institut Godinot, 51100 Reims, France
- CReSTIC EA 3804 et Laboratoire de Biophysique, Université de Reims Champagne-Ardenne, 51100 Reims, France
| | - Salvatore Annunziata
- Unità di Medicina Nucleare, GSTeP Radiofarmacia, TracerGLab, Dipartimento di Radiologia, Radioterapia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
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Abler D, Schaer R, Oreiller V, Verma H, Reichenbach J, Aidonopoulos O, Evéquoz F, Jreige M, Prior JO, Depeursinge A. QuantImage v2: a comprehensive and integrated physician-centered cloud platform for radiomics and machine learning research. Eur Radiol Exp 2023; 7:16. [PMID: 36947346 PMCID: PMC10033788 DOI: 10.1186/s41747-023-00326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Radiomics, the field of image-based computational medical biomarker research, has experienced rapid growth over the past decade due to its potential to revolutionize the development of personalized decision support models. However, despite its research momentum and important advances toward methodological standardization, the translation of radiomics prediction models into clinical practice only progresses slowly. The lack of physicians leading the development of radiomics models and insufficient integration of radiomics tools in the clinical workflow contributes to this slow uptake. METHODS We propose a physician-centered vision of radiomics research and derive minimal functional requirements for radiomics research software to support this vision. Free-to-access radiomics tools and frameworks were reviewed to identify best practices and reveal the shortcomings of existing software solutions to optimally support physician-driven radiomics research in a clinical environment. RESULTS Support for user-friendly development and evaluation of radiomics prediction models via machine learning was found to be missing in most tools. QuantImage v2 (QI2) was designed and implemented to address these shortcomings. QI2 relies on well-established existing tools and open-source libraries to realize and concretely demonstrate the potential of a one-stop tool for physician-driven radiomics research. It provides web-based access to cohort management, feature extraction, and visualization and supports "no-code" development and evaluation of machine learning models against patient-specific outcome data. CONCLUSIONS QI2 fills a gap in the radiomics software landscape by enabling "no-code" radiomics research, including model validation, in a clinical environment. Further information about QI2, a public instance of the system, and its source code is available at https://medgift.github.io/quantimage-v2-info/ . Key points As domain experts, physicians play a key role in the development of radiomics models. Existing software solutions do not support physician-driven research optimally. QuantImage v2 implements a physician-centered vision for radiomics research. QuantImage v2 is a web-based, "no-code" radiomics research platform.
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Affiliation(s)
- Daniel Abler
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Roger Schaer
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Oreiller
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Himanshu Verma
- Knowledge and Intelligence Design Group, Delft University of Technology, Delft, The Netherlands
| | - Julien Reichenbach
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland
| | - Orfeas Aidonopoulos
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland
| | - Florian Evéquoz
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland
| | - Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Adrien Depeursinge
- Institute of Informatics, School of Management, HES-SO Valais-Wallis, Sierre, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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5
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Chiesa S, Russo R, Beghella Bartoli F, Palumbo I, Sabatino G, Cannatà MC, Gigli R, Longo S, Tran HE, Boldrini L, Dinapoli N, Votta C, Cusumano D, Pignotti F, Lupattelli M, Camilli F, Della Pepa GM, D’Alessandris GQ, Olivi A, Balducci M, Colosimo C, Gambacorta MA, Valentini V, Aristei C, Gaudino S. MRI-derived radiomics to guide post-operative management of glioblastoma: Implication for personalized radiation treatment volume delineation. Front Med (Lausanne) 2023; 10:1059712. [PMID: 36744131 PMCID: PMC9892450 DOI: 10.3389/fmed.2023.1059712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
Background The glioblastoma's bad prognosis is primarily due to intra-tumor heterogeneity, demonstrated from several studies that collected molecular biology, cytogenetic data and more recently radiomic features for a better prognostic stratification. The GLIFA project (GLIoblastoma Feature Analysis) is a multicentric project planned to investigate the role of radiomic analysis in GB management, to verify if radiomic features in the tissue around the resection cavity may guide the radiation target volume delineation. Materials and methods We retrospectively analyze from three centers radiomic features extracted from 90 patients with total or near total resection, who completed the standard adjuvant treatment and for whom we had post-operative images available for features extraction. The Manual segmentation was performed on post gadolinium T1w MRI sequence by 2 radiation oncologists and reviewed by a neuroradiologist, both with at least 10 years of experience. The Regions of interest (ROI) considered for the analysis were: the surgical cavity ± post-surgical residual mass (CTV_cavity); the CTV a margin of 1.5 cm added to CTV_cavity and the volume resulting from subtracting the CTV_cavity from the CTV was defined as CTV_Ring. Radiomic analysis and modeling were conducted in RStudio. Z-score normalization was applied to each radiomic feature. A radiomic model was generated using features extracted from the Ring to perform a binary classification and predict the PFS at 6 months. A 3-fold cross-validation repeated five times was implemented for internal validation of the model. Results Two-hundred and seventy ROIs were contoured. The proposed radiomic model was given by the best fitting logistic regression model, and included the following 3 features: F_cm_merged.contrast, F_cm_merged.info.corr.2, F_rlm_merged.rlnu. A good agreement between model predicted probabilities and observed outcome probabilities was obtained (p-value of 0.49 by Hosmer and Lemeshow statistical test). The ROC curve of the model reported an AUC of 0.78 (95% CI: 0.68-0.88). Conclusion This is the first hypothesis-generating study which applies a radiomic analysis focusing on healthy tissue ring around the surgical cavity on post-operative MRI. This study provides a preliminary model for a decision support tool for a customization of the radiation target volume in GB patients in order to achieve a margin reduction strategy.
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Affiliation(s)
- S. Chiesa
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - R. Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - F. Beghella Bartoli
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - I. Palumbo
- Radiation Oncology Section, University of Perugia, Perugia, Italy,Perugia General Hospital, Perugia, Italy
| | - G. Sabatino
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy,Department of Neurosurgery, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
| | - M. C. Cannatà
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy,*Correspondence: M. C. Cannatà,
| | - R. Gigli
- Medical Physics, Mater Olbia Hospital, Olbia, Italy
| | - S. Longo
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - H. E. Tran
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - L. Boldrini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - N. Dinapoli
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - C. Votta
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - D. Cusumano
- Medical Physics, Mater Olbia Hospital, Olbia, Italy
| | - F. Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy,Department of Neurosurgery, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
| | | | - F. Camilli
- Radiation Oncology Section, University of Perugia, Perugia, Italy
| | - G. M. Della Pepa
- Department of Neurosurgery, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
| | - G. Q. D’Alessandris
- Department of Neurosurgery, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
| | - A. Olivi
- Department of Neurosurgery, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
| | - M. Balducci
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - C. Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - M. A. Gambacorta
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - V. Valentini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - C. Aristei
- Radiation Oncology Section, University of Perugia, Perugia, Italy,Perugia General Hospital, Perugia, Italy
| | - S. Gaudino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Institute of Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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Cilla S, Macchia G, Lenkowicz J, Tran EH, Pierro A, Petrella L, Fanelli M, Sardu C, Re A, Boldrini L, Indovina L, De Filippo CM, Caradonna E, Deodato F, Massetti M, Valentini V, Modugno P. CT angiography-based radiomics as a tool for carotid plaque characterization: a pilot study. Radiol Med 2022; 127:743-753. [DOI: 10.1007/s11547-022-01505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022]
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Massaccesi M, Dinapoli N, Fuga V, Rupe C, Panfili M, Calandrelli R, Settimi S, Olivieri M, Bartoli FB, Mazzarella C, Longo S, Lajolo C, Boldrini L, Gambacorta MA, Valentini V, Miccichè F. A predictive nomogram for trismus after radiotherapy for head and neck cancer. Radiother Oncol 2022; 173:231-239. [PMID: 35662658 DOI: 10.1016/j.radonc.2022.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study is to develop a prediction model for trismus (maximal interincisal distance equal to or less than 35 millimeters) based on a multivariable analysis of dosimetric and clinical factors METHODS: The Maximum inter-incisal opening (MIO) of HNC patients who underwent radiotherapy (RT) +/- concurrent chemotherapy with radical intent was prospectively measured prior to RT (baseline) and 6 months post-RT. The outcome variable is trismus. The potential risk factors (clinical and dosimetric) were first screened by univariate analysis and then by multivariate analysis. At the end of this process, we used the features identified as relevant to fit a logistic regression model and calculate the probability of observed trismus during the 6-month follow-up after radiation treatment. RESULTS One hundred and four consecutive patients were included (mean age 63 years, range 25-87), 68 were males, 36 females. In the univariate analysis, the MIO at baseline, as an independent variable, and several Vdoses of different masticatory structures were found as significant. Additionally, using a bivariate model, a feature selection process was performed. Finally, we considered as best performing model the MIO at baseline and V42 at Masseter Muscle. The area under curve (AUC) of Receiver Operating Characteristic (ROC) curve value of 0,8255 (95% CI 0.74-0.9). The Hosmer and Lemeshow goodness-of-fit test, used to calibrate our model, is non-significant. CONCLUSIONS A prediction nomogram was developed to assess trismus risk in planning process. An external validation of the model is required to apply it for current clinical use.
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Affiliation(s)
- Mariangela Massaccesi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Fuga
- Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Largo Agostino Gemelli, Roma, Italy
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica Per Immagini, 00168 Rome, Italy
| | - Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica Per Immagini, Radioterapia, Oncologia ed Ematologia, Area Diagnostica Per Immagini, 00168 Rome, Italy
| | - Stefano Settimi
- Division of Otorhinolaryngology, Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvia Longo
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Francesco Miccichè
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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CT-Based Radiomics and Deep Learning for BRCA Mutation and Progression-Free Survival Prediction in Ovarian Cancer Using a Multicentric Dataset. Cancers (Basel) 2022; 14:cancers14112739. [PMID: 35681720 PMCID: PMC9179845 DOI: 10.3390/cancers14112739] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/15/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Build predictive radiomic models for early relapse and BRCA mutation based on a multicentric database of high-grade serous ovarian cancer (HGSOC) and validate them in a test set coming from different institutions. METHODS Preoperative CTs of patients with HGSOC treated at four referral centers were retrospectively acquired and manually segmented. Hand-crafted features and deep radiomics features were extracted respectively by dedicated software (MODDICOM) and a dedicated convolutional neural network (CNN). Features were selected with and without prior harmonization (ComBat harmonization), and models were built using different machine learning algorithms, including clinical variables. RESULTS We included 218 patients. Radiomic models showed low performance in predicting both BRCA mutation (AUC in test set between 0.46 and 0.59) and 1-year relapse (AUC in test set between 0.46 and 0.56); deep learning models demonstrated similar results (AUC in the test of 0.48 for BRCA and 0.50 for relapse). The inclusion of clinical variables improved the performance of the radiomic models to predict BRCA mutation (AUC in the test set of 0.74). CONCLUSIONS In our multicentric dataset, representative of a real-life clinical scenario, we could not find a good radiomic predicting model for PFS and BRCA mutational status, with both traditional radiomics and deep learning, but the combination of clinical and radiomic models improved model performance for the prediction of BRCA mutation. These findings highlight the need for standardization through the whole radiomic pipelines and robust multicentric external validations of results.
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CT-based radiomics modeling for skull dysmorphology severity and surgical outcome prediction in children with isolated sagittal synostosis: a hypothesis-generating study. Radiol Med 2022; 127:616-626. [PMID: 35538388 PMCID: PMC9130191 DOI: 10.1007/s11547-022-01493-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/14/2022] [Indexed: 11/24/2022]
Abstract
Purpose To investigate the potentialities of radiomic analysis and develop radiomic models to predict the skull dysmorphology severity and post-surgical outcome in children with isolated sagittal synostosis (ISS). Materials and methods Preoperative high-resolution CT scans of infants with ISS treated with surgical correction were retrospectively reviewed. The sagittal suture (ROI_entire) and its sections (ROI_anterior/central/posterior) were segmented. Radiomic features extracted from ROI_entire were correlated to the scaphocephalic severity, while radiomic features extracted from ROI_anterior/central/posterior were correlated to the post-surgical outcome. Logistic regression models were built from selected radiomic features and validated to predict the scaphocephalic severity and post-surgical outcome. Results A total of 105 patients were enrolled in this study. The kurtosis was obtained from the feature selection process for both scaphocephalic severity and post-surgical outcome prediction. The model predicting the scaphocephalic severity had an area under the curve (AUC) of the receiver operating characteristic of 0.71 and a positive predictive value of 0.83 for the testing set. The model built for the post-surgical outcome showed an AUC (95% CI) of 0.75 (0.61;0.88) and a negative predictive value (95% CI) of 0.95 (0.84;0.99). Conclusion Our results suggest that radiomics could be useful in quantifying tissue microarchitecture along the mid-suture space and potentially provide relevant biological information about the sutural ossification processes to predict the onset of skull deformities and stratify post-surgical outcome.
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Chiloiro G, Boldrini L, Preziosi F, Cusumano D, Yadav P, Romano A, Placidi L, Lenkowicz J, Dinapoli N, Bassetti MF, Gambacorta MA, Valentini V. A Predictive Model of 2yDFS During MR-Guided RT Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients. Front Oncol 2022; 12:831712. [PMID: 35280799 PMCID: PMC8907443 DOI: 10.3389/fonc.2022.831712] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Distant metastasis is the main cause of treatment failure in locally advanced rectal cancer (LARC) patients, despite the recent improvement in treatment strategies. This study aims to evaluate the “delta radiomics” approach in patients undergoing neoadjuvant chemoradiotherapy (nCRT) treated with 0.35-T magnetic resonance-guided radiotherapy (MRgRT), developing a logistic regression model able to predict 2-year disease-free-survival (2yDFS). Methods Patients affected by LARC were enrolled in this multi-institutional study. A predictive model of 2yDFS was developed taking into account both clinical and radiomics variables. Gross tumour volume (GTV) was delineated on the magnetic resonance (MR) images acquired during MRgRT, and 1,067 radiomic features (RF) were extracted using the MODDICOM platform. The performance of RF in predicting 2yDFS was investigated in terms of the Wilcoxon–Mann–Whitney test and area under receiver operating characteristic (ROC) curve (AUC). Results 48 patients have been retrospectively enrolled, with 8 patients (16.7%) developing distant metastases at the 2-year follow-up. A total of 1,099 variables (1,067 RF and 32 clinical variables) were evaluated in two different models: radiomics and radiomics/clinical. The best-performing 2yDFS predictive model was a delta radiomics one, based on the variation in terms of area/surface ratio between biologically effective doses (BED) at 54 Gy and simulation (AUC of 0.92). Conclusions The results of this study suggest a promising role of delta radiomics analysis on 0.35-T MR images in predicting 2yDFS for LARC patients. Further analyses including larger cohorts of patients and an external validation are needed to confirm these preliminary results.
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Affiliation(s)
- Giuditta Chiloiro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luca Boldrini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Preziosi
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Cusumano
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Poonam Yadav
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Angela Romano
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lorenzo Placidi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Jacopo Lenkowicz
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Nicola Dinapoli
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Michael F Bassetti
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Maria Antonietta Gambacorta
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Chiloiro G, Cusumano D, Boldrini L, Romano A, Placidi L, Nardini M, Meldolesi E, Barbaro B, Coco C, Crucitti A, Persiani R, Petruzziello L, Ricci R, Salvatore L, Sofo L, Alfieri S, Manfredi R, Valentini V, Gambacorta MA. THUNDER 2: THeragnostic Utilities for Neoplastic DisEases of the Rectum by MRI guided radiotherapy. BMC Cancer 2022; 22:67. [PMID: 35033008 PMCID: PMC8760695 DOI: 10.1186/s12885-021-09158-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Neoadjuvant chemoradiation therapy (nCRT) is the standard treatment modality in locally advanced rectal cancer (LARC). Since response to radiotherapy (RT) is dose dependent in rectal cancer, dose escalation may lead to higher complete response rates. The possibility to predict patients who will achieve complete response (CR) is fundamental. Recently, an early tumour regression index (ERI) was introduced to predict pathological CR (pCR) after nCRT in LARC patients. The primary endpoints will be the increase of CR rate and the evaluation of feasibility of delta radiomics-based predictive MRI guided Radiotherapy (MRgRT) model. Methods Patients affected by LARC cT2-3, N0-2 or cT4 for anal sphincter involvement N0-2a, M0 without high risk features will be enrolled in the trial. Neoadjuvant CRT will be administered using MRgRT. The initial RT treatment will consist in delivering 55 Gy in 25 fractions on Gross Tumor Volume (GTV) plus the corresponding mesorectum and 45 Gy in 25 fractions on the drainage nodes. Chemotherapy with 5-fluoracil (5-FU) or oral capecitabine will be administered continuously. A 0.35 Tesla MRI will be acquired at simulation and every day during MRgRT. At fraction 10, ERI will be calculated: if ERI will be inferior than 13.1, the patient will continue the original treatment; if ERI will be higher than 13.1 the treatment plan will be reoptimized, intensifying the dose to the residual tumor at the 11th fraction to reach 60.1 Gy. At the end of nCRT instrumental examinations are to be performed in order to restage patients. In case of stable disease or progression, the patient will undergo surgery. In case of major or complete clinical response, conservative approaches may be chosen. Patients will be followed up to evaluate toxicity and quality of life. The number of cases to be enrolled will be 63: all the patients will be treated at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Discussion This clinical trial investigates the impact of RT dose escalation in poor responder LARC patients identified using ERI, with the aim of increasing the probability of CR and consequently an organ preservation benefit in this group of patients. Trial registration ClinicalTrials.gov Identifier: NCT04815694 (25/03/2021).
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Matteo Nardini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudio Coco
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Antonio Crucitti
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Lucio Petruzziello
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Ricci
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Lisa Salvatore
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Sofo
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Sergio Alfieri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Di Dio C, Chiloiro G, Cusumano D, Catucci F, Boldrini L, Romano A, Meldolesi E, Marazzi F, Corvari B, Barbaro B, Manfredi R, Valentini V, Gambacorta MA. Fractal-Based Radiomic Approach to Tailor the Chemotherapy Treatment in Rectal Cancer: A Generating Hypothesis Study. Front Oncol 2021; 11:774413. [PMID: 34956893 PMCID: PMC8695680 DOI: 10.3389/fonc.2021.774413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction The aim of this study was to create a radiomic model able to calculate the probability of 5-year disease-free survival (5yDFS) when oxaliplatin (OXA) is or not administered in patients with locally advanced rectal cancer (LARC) and treated with neoadjuvant chemoradiotherapy (nCRT), allowing physicians to choose the best chemotherapy (CT) regimen. Methods LARC patients with cT3–4 cN0 or cT1–4 cN1–2 were treated according to an nCRT protocol that included concomitant CT schedules with or without OXA and radiotherapy dose of 55 Gy in 25 fractions. Radiomic analysis was performed on the T2-weighted (T2-w) MR images acquired during the initial tumor staging. Statistical analysis was performed separately for the cohort of patients treated with and without OXA. The ability of every single radiomic feature in predicting 5yDFS as a univariate analysis was assessed using the Wilcoxon–Mann–Whitney (WMW) test or t-test. Two logistic models (one for each cohort) were calculated, and their performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results A total of 176 image features belonging to four families (morphological, statistical, textural, and fractal) were calculated for each patient. At the univariate analysis, the only feature showing significance in predicting 5yDFS was the maximum fractal dimension of the subpopulation identified considering 30% and 50% as threshold levels (maxFD30–50). Once the models were developed using this feature, an AUC of 0.67 (0.57–0.77) and 0.75 (0.56–0.95) was obtained for patients treated with and without OXA, respectively. A maxFD30–50 >1.6 was correlated to a higher 5yDFS probability in patients treated with OXA. Conclusion This study suggests that radiomic analysis of MR T2-w images can be used to define the optimal concomitant CT regimen for stage III LARC cancer patients. In particular, by providing an indication of the gross tumor volume (GTV) spatial heterogeneity at initial staging, maxFD30–50 seems to be able to predict the probability of 5yDFS. New studies including a larger cohort of patients and external validation sets are recommended to verify the results of this hypothesis-generating study.
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Affiliation(s)
- Carmela Di Dio
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | - Giuditta Chiloiro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Cusumano
- UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Luca Boldrini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angela Romano
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Barbara Corvari
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Brunella Barbaro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Chiloiro G, Cusumano D, de Franco P, Lenkowicz J, Boldrini L, Carano D, Barbaro B, Corvari B, Dinapoli N, Giraffa M, Meldolesi E, Manfredi R, Valentini V, Gambacorta MA. Does restaging MRI radiomics analysis improve pathological complete response prediction in rectal cancer patients? A prognostic model development. Radiol Med 2021; 127:11-20. [PMID: 34725772 DOI: 10.1007/s11547-021-01421-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Our study investigated the contribution that the application of radiomics analysis on post-treatment magnetic resonance imaging can add to the assessments performed by an experienced disease-specific multidisciplinary tumor board (MTB) for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). MATERIALS AND METHODS This analysis included consecutively retrospective LARC patients who obtained a complete or near-complete response after nCRT and/or a pCR after surgery between January 2010 and September 2019. A three-step radiomics features selection was performed and three models were generated: a radiomics model (rRM), a multidisciplinary tumor board model (yMTB) and a combined model (CM). The predictive performance of models was quantified using the receiver operating characteristic (ROC) curve, evaluating the area under curve (AUC). RESULTS The analysis involved 144 LARC patients; a total of 232 radiomics features were extracted from the MR images acquired post-nCRT. The yMTB, rRM and CM predicted pCR with an AUC of 0.82, 0.73 and 0.84, respectively. ROC comparison was not significant (p = 0.6) between yMTB and CM. CONCLUSION Radiomics analysis showed good performance in identifying complete responders, which increased when combined with standard clinical evaluation; this increase was not statistically significant but did improve the prediction of clinical response.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Paola de Franco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy.
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Carano
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Martina Giraffa
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
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14
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Korte JC, Cardenas C, Hardcastle N, Kron T, Wang J, Bahig H, Elgohari B, Ger R, Court L, Fuller CD, Ng SP. Radiomics feature stability of open-source software evaluated on apparent diffusion coefficient maps in head and neck cancer. Sci Rep 2021; 11:17633. [PMID: 34480036 PMCID: PMC8417253 DOI: 10.1038/s41598-021-96600-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Radiomics is a promising technique for discovering image based biomarkers of therapy response in cancer. Reproducibility of radiomics features is a known issue that is addressed by the image biomarker standardisation initiative (IBSI), but it remains challenging to interpret previously published radiomics signatures. This study investigates the reproducibility of radiomics features calculated with two widely used radiomics software packages (IBEX, MaZda) in comparison to an IBSI compliant software package (PyRadiomics). Intensity histogram, shape and textural features were extracted from 334 diffusion weighted magnetic resonance images of 59 head and neck cancer (HNC) patients from the PREDICT-HN observational radiotherapy study. Based on name and linear correlation, PyRadiomics shares 83 features with IBEX and 49 features with MaZda, a sub-set of well correlated features are considered reproducible (IBEX: 15 features, MaZda: 18 features). We explore the impact of including non-reproducible radiomics features in a HNC radiotherapy response model. It is possible to classify equivalent patient groups using radiomic features from either software, but only when restricting the model to reliable features using a correlation threshold method. This is relevant for clinical biomarker validation trials as it provides a framework to assess the reproducibility of reported radiomic signatures from existing trials.
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Affiliation(s)
- James C. Korte
- grid.1055.10000000403978434Department of Physical Science, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Carlos Cardenas
- grid.240145.60000 0001 2291 4776Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nicholas Hardcastle
- grid.1055.10000000403978434Department of Physical Science, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1007.60000 0004 0486 528XCentre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Tomas Kron
- grid.1055.10000000403978434Department of Physical Science, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jihong Wang
- grid.240145.60000 0001 2291 4776Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Baher Elgohari
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA ,grid.10251.370000000103426662Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
| | - Rachel Ger
- grid.470142.40000 0004 0443 9766Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ USA
| | - Laurence Court
- grid.240145.60000 0001 2291 4776Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Clifton D. Fuller
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sweet Ping Ng
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA ,grid.1055.10000000403978434Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.482637.cDepartment of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Australia
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15
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Gul M, Bonjoc KJC, Gorlin D, Wong CW, Salem A, La V, Filippov A, Chaudhry A, Imam MH, Chaudhry AA. Diagnostic Utility of Radiomics in Thyroid and Head and Neck Cancers. Front Oncol 2021; 11:639326. [PMID: 34307123 PMCID: PMC8293690 DOI: 10.3389/fonc.2021.639326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
Radiomics is an emerging field in radiology that utilizes advanced statistical data characterizing algorithms to evaluate medical imaging and objectively quantify characteristics of a given disease. Due to morphologic heterogeneity and genetic variation intrinsic to neoplasms, radiomics have the potential to provide a unique insight into the underlying tumor and tumor microenvironment. Radiomics has been gaining popularity due to potential applications in disease quantification, predictive modeling, treatment planning, and response assessment - paving way for the advancement of personalized medicine. However, producing a reliable radiomic model requires careful evaluation and construction to be translated into clinical practices that have varying software and/or medical equipment. We aim to review the diagnostic utility of radiomics in otorhinolaryngology, including both cancers of the head and neck as well as the thyroid.
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Affiliation(s)
- Maryam Gul
- Amaze Research Foundation, Department of Biomarker Discovery, Anaheim, CA, United States
| | - Kimberley-Jane C. Bonjoc
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - David Gorlin
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Chi Wah Wong
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Amirah Salem
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Vincent La
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Aleksandr Filippov
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Abbas Chaudhry
- Amaze Research Foundation, Department of Biomarker Discovery, Anaheim, CA, United States
| | - Muhammad H. Imam
- Florida Cancer Specialists, Department of Oncology, Orlando, FL, United States
| | - Ammar A. Chaudhry
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, United States
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16
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Wang JH, Wahid KA, van Dijk LV, Farahani K, Thompson RF, Fuller CD. Radiomic biomarkers of tumor immune biology and immunotherapy response. Clin Transl Radiat Oncol 2021; 28:97-115. [PMID: 33937530 PMCID: PMC8076712 DOI: 10.1016/j.ctro.2021.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
Immunotherapies are leading to improved outcomes for many cancers, including those with devastating prognoses. As therapies like immune checkpoint inhibitors (ICI) become a mainstay in treatment regimens, many concurrent challenges have arisen - for instance, delineating clinical responders from non-responders. Predicting response has proven to be difficult given a lack of consistent and accurate biomarkers, heterogeneity of the tumor microenvironment (TME), and a poor understanding of resistance mechanisms. For the most part, imaging data have remained an untapped, yet abundant, resource to address these challenges. In recent years, quantitative image analyses have highlighted the utility of medical imaging in predicting tumor phenotypes, prognosis, and therapeutic response. These studies have been fueled by an explosion of resources in high-throughput mining of image features (i.e. radiomics) and artificial intelligence. In this review, we highlight current progress in radiomics to understand tumor immune biology and predict clinical responses to immunotherapies. We also discuss limitations in these studies and future directions for the field, particularly if high-dimensional imaging data are to play a larger role in precision medicine.
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Affiliation(s)
- Jarey H. Wang
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, United States
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Keyvan Farahani
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD, United States
| | - Reid F. Thompson
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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17
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Gui B, Autorino R, Miccò M, Nardangeli A, Pesce A, Lenkowicz J, Cusumano D, Russo L, Persiani S, Boldrini L, Dinapoli N, Macchia G, Sallustio G, Gambacorta MA, Ferrandina G, Manfredi R, Valentini V, Scambia G. Pretreatment MRI Radiomics Based Response Prediction Model in Locally Advanced Cervical Cancer. Diagnostics (Basel) 2021; 11:diagnostics11040631. [PMID: 33807494 PMCID: PMC8066099 DOI: 10.3390/diagnostics11040631] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to create a radiomics model for Locally Advanced Cervical Cancer (LACC) patients to predict pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) analysing T2-weighted 1.5 T magnetic resonance imaging (MRI) acquired before treatment start. Patients with LACC and an International Federation of Gynecology and Obstetrics stage from IB2 to IVA at diagnosis were retrospectively enrolled for this study. All patients underwent NACRT, followed by radical surgery; pCR―assessed on surgical specimen―was defined as absence of any residual tumour. Finally, 1889 features were extracted from MR images; features showing statistical significance in predicting pCR at the univariate analysis were selected following an iterative method, which was ad-hoc developed for this study. Based on this method, 15 different classifiers were trained considering the most significant features selected. Model selection was carried out using the area under the receiver operating characteristic curve (AUC) as target metrics. One hundred eighty-three patients from two institutions were analysed. The model, showing the highest performance with an AUC of 0.80, was the random forest method initialised with default parameters. Radiomics appeared to be a reliable tool in pCR prediction for LACC patients undergoing NACRT, supporting the identification of patient risk groups, which paves treatment pathways tailored according to the predicted outcome.
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Affiliation(s)
- Benedetta Gui
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Rosa Autorino
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Maura Miccò
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Alessia Nardangeli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Correspondence:
| | - Adele Pesce
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Davide Cusumano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Luca Russo
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Salvatore Persiani
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Luca Boldrini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
| | - Gabriella Macchia
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy; (G.M.); (G.S.)
| | - Giuseppina Sallustio
- Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy; (G.M.); (G.S.)
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
| | - Giovanni Scambia
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Roma, Italy; (B.G.); (R.A.); (M.M.); (J.L.); (D.C.); (L.B.); (N.D.); (M.A.G.); (G.F.); (R.M.); (V.V.); (G.S.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (L.R.); (S.P.)
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18
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De Maria Marchiano R, Di Sante G, Piro G, Carbone C, Tortora G, Boldrini L, Pietragalla A, Daniele G, Tredicine M, Cesario A, Valentini V, Gallo D, Babini G, D’Oria M, Scambia G. Translational Research in the Era of Precision Medicine: Where We Are and Where We Will Go. J Pers Med 2021; 11:216. [PMID: 33803592 PMCID: PMC8002976 DOI: 10.3390/jpm11030216] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
The advent of Precision Medicine has globally revolutionized the approach of translational research suggesting a patient-centric vision with therapeutic choices driven by the identification of specific predictive biomarkers of response to avoid ineffective therapies and reduce adverse effects. The spread of "multi-omics" analysis and the use of sensors, together with the ability to acquire clinical, behavioral, and environmental information on a large scale, will allow the digitization of the state of health or disease of each person, and the creation of a global health management system capable of generating real-time knowledge and new opportunities for prevention and therapy in the individual person (high-definition medicine). Real world data-based translational applications represent a promising alternative to the traditional evidence-based medicine (EBM) approaches that are based on the use of randomized clinical trials to test the selected hypothesis. Multi-modality data integration is necessary for example in precision oncology where an Avatar interface allows several simulations in order to define the best therapeutic scheme for each cancer patient.
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Affiliation(s)
- Ruggero De Maria Marchiano
- Department of Translational Medicine and Surgery, Section of General Pathology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy or (R.D.M.M.); (M.T.)
- Scientific Direction, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.C.); (M.D.); or (G.S.)
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
| | - Gabriele Di Sante
- Department of Translational Medicine and Surgery, Section of General Pathology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy or (R.D.M.M.); (M.T.)
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
| | - Geny Piro
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Carmine Carbone
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, Section of Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Boldrini
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Department of Radiology, Radiation Oncology and Hematology, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonella Pietragalla
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Unità di Medicina Traslazionale per la Salute della Donna e del Bambino, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gennaro Daniele
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Unità di Medicina Traslazionale per la Salute della Donna e del Bambino, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Tredicine
- Department of Translational Medicine and Surgery, Section of General Pathology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy or (R.D.M.M.); (M.T.)
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
| | - Alfredo Cesario
- Scientific Direction, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.C.); (M.D.); or (G.S.)
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
| | - Vincenzo Valentini
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Department of Radiology, Radiation Oncology and Hematology, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Institute of di Radiology, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Daniela Gallo
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Unità di Medicina Traslazionale per la Salute della Donna e del Bambino, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Babini
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Unità di Medicina Traslazionale per la Salute della Donna e del Bambino, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marika D’Oria
- Scientific Direction, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.C.); (M.D.); or (G.S.)
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
| | - Giovanni Scambia
- Scientific Direction, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.C.); (M.D.); or (G.S.)
- Comprehensive Cancer Center—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (C.C.); or (G.T.); (L.B.); (A.P.); (G.D.); or (V.V.); or (D.G.); (G.B.)
- Unità di Medicina Traslazionale per la Salute della Donna e del Bambino, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Cusumano D, Meijer G, Lenkowicz J, Chiloiro G, Boldrini L, Masciocchi C, Dinapoli N, Gatta R, Casà C, Damiani A, Barbaro B, Gambacorta MA, Azario L, De Spirito M, Intven M, Valentini V. A field strength independent MR radiomics model to predict pathological complete response in locally advanced rectal cancer. LA RADIOLOGIA MEDICA 2021; 126:421-429. [PMID: 32833198 PMCID: PMC7937600 DOI: 10.1007/s11547-020-01266-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Aim of this study was to develop a generalised radiomics model for predicting pathological complete response after neoadjuvant chemo-radiotherapy in locally advanced rectal cancer patients using pre-CRT T2-weighted images acquired at a 1.5 T and a 3 T scanner. METHODS In two institutions, 195 patients were scanned: 136 patients were scanned on a 1.5 T MR scanner, 59 patients on a 3 T MR scanner. Gross tumour volumes were delineated on the MR images and 496 radiomic features were extracted, applying the intensity-based (IB) filter. Features were standardised with Z-score normalisation and an initial feature selection was carried out using Wilcoxon-Mann-Whitney test: The most significant features at 1.5 T and 3 T were selected as main features. Several logistic regression models combining the main features with a third one selected by those resulting significant were elaborated and evaluated in terms of area under curve (AUC). A tenfold cross-validation was repeated 300 times to evaluate the model robustness. RESULTS Three features were selected: maximum fractal dimension with IB = 0-50, energy and grey-level non-uniformity calculated on the run-length matrix with IB = 0-50. The AUC of the model applied to the whole dataset after cross-validation was 0.72, while values of 0.70 and 0.83 were obtained when 1.5 T and 3 T patients were considered, respectively. CONCLUSIONS The model elaborated showed good performance, even when data from patients scanned on 1.5 T and 3 T were merged. This shows that magnetic field intensity variability can be overcome by means of selecting appropriate image features.
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Affiliation(s)
- Davide Cusumano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Gert Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacopo Lenkowicz
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Carlotta Masciocchi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Roberto Gatta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Calogero Casà
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Damiani
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | | | - Luigi Azario
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Marco De Spirito
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Martijn Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
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20
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Predicting Radiotherapy Impact on Late Bladder Toxicity in Prostate Cancer Patients: An Observational Study. Cancers (Basel) 2021; 13:cancers13020175. [PMID: 33419144 PMCID: PMC7825573 DOI: 10.3390/cancers13020175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of our study was to elaborate a suitable model on bladder late toxicity in prostate cancer (PC) patients treated by radiotherapy with volumetric technique. MATERIALS AND METHODS PC patients treated between September 2010 and April 2017 were included in the analysis. An observational study was performed collecting late toxicity data of any grade, according to RTOG and CTCAE 4.03 scales, cumulative dose volumes histograms were exported for each patient. Vdose, the value of dose to a specific volume of organ at risk (OAR), impact was analyzed through the Mann-Whitney rank-sum test. Logistic regression was used as the final model. The model performance was estimated by taking 1000 samples with replacement from the original dataset and calculating the AUC average. In addition, the calibration plot (Hosmer-Lemeshow goodness-of-fit test) was used to evaluate the performance of internal validation. RStudio Software version 3.3.1 and an in house developed software package "Moddicom" were used. RESULTS Data from 175 patients were collected. The median follow-up was 39 months (min-max 3.00-113.00). We performed Mann-Whitney rank-sum test with continuity correction in the subset of patients with late bladder toxicity grade ≥ 2: a statistically significant p-value with a Vdose of 51.43 Gy by applying a logistic regression model (coefficient 4.3, p value 0.025) for the prediction of the development of late G ≥ 2 GU toxicity was observed. The performance for the model's internal validation was evaluated, with an AUC equal to 0.626. Accuracy was estimated through the elaboration of a calibration plot. CONCLUSIONS Our preliminary results could help to optimize treatment planning procedures and customize treatments.
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21
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Cusumano D, Boldrini L, Yadav P, Casà C, Lee SL, Romano A, Piras A, Chiloiro G, Placidi L, Catucci F, Votta C, Mattiucci GC, Indovina L, Gambacorta MA, Bassetti M, Valentini V. Delta Radiomics Analysis for Local Control Prediction in Pancreatic Cancer Patients Treated Using Magnetic Resonance Guided Radiotherapy. Diagnostics (Basel) 2021; 11:diagnostics11010072. [PMID: 33466307 PMCID: PMC7824764 DOI: 10.3390/diagnostics11010072] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of this study is to investigate the role of Delta Radiomics analysis in the prediction of one-year local control (1yLC) in patients affected by locally advanced pancreatic cancer (LAPC) and treated using Magnetic Resonance guided Radiotherapy (MRgRT). A total of 35 patients from two institutions were enrolled: A 0.35 Tesla T2*/T1 MR image was acquired for each case during simulation and on each treatment fraction. Physical dose was converted in biologically effective dose (BED) to compensate for different radiotherapy schemes. Delta Radiomics analysis was performed considering the gross tumour volume (GTV) delineated on MR images acquired at BED of 20, 40, and 60 Gy. The performance of the delta features in predicting 1yLC was investigated in terms of Wilcoxon Mann-Whitney test and area under receiver operating characteristic (ROC) curve (AUC). The most significant feature in predicting 1yLC was the variation of cluster shade calculated at BED = 40 Gy, with a p-value of 0.005 and an AUC of 0.78 (0.61-0.94). Delta Radiomics analysis on low-field MR images might play a promising role in 1yLC prediction for LAPC patients: further studies including an external validation dataset and a larger cohort of patients are recommended to confirm the validity of this preliminary experience.
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Affiliation(s)
- Davide Cusumano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Luca Boldrini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Poonam Yadav
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA; (P.Y.); (M.B.)
| | - Calogero Casà
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
- Correspondence: ; Tel.: +39-06-3015-5226
| | - Sangjune Laurence Lee
- Department of Oncology, University of Calgary, 1331 29 Street NW, Calgary, AB T2N 1N4, Canada;
| | - Angela Romano
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Antonio Piras
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Francesco Catucci
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Claudio Votta
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Gian Carlo Mattiucci
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Luca Indovina
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
| | - Michael Bassetti
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA; (P.Y.); (M.B.)
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (D.C.); (L.B.); (A.R.); (A.P.); (G.C.); (L.P.); (F.C.); (C.V.); (G.C.M.); (L.I.); (M.A.G.); (V.V.)
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22
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Chiloiro G, Rodriguez-Carnero P, Lenkowicz J, Casà C, Masciocchi C, Boldrini L, Cusumano D, Dinapoli N, Meldolesi E, Carano D, Damiani A, Barbaro B, Manfredi R, Valentini V, Gambacorta MA. Delta Radiomics Can Predict Distant Metastasis in Locally Advanced Rectal Cancer: The Challenge to Personalize the Cure. Front Oncol 2020; 10:595012. [PMID: 33344243 PMCID: PMC7744725 DOI: 10.3389/fonc.2020.595012] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Distant metastases are currently the main cause of treatment failure in locally advanced rectal cancer (LARC) patients. The aim of this research is to investigate a correlation between the variation of radiomics features using pre- and post-neoadjuvant chemoradiation (nCRT) magnetic resonance imaging (MRI) with 2 years distant metastasis (2yDM) rate in LARC patients. METHODS AND MATERIALS Diagnostic pre- and post- nCRT MRI of LARC patients, treated in a single institution from May 2008 to June 2015 with an adequate follow-up time, were retrospectively collected. Gross tumor volumes (GTV) were contoured by an abdominal radiologist and blindly reviewed by a radiation oncologist expert in rectal cancer. The dataset was firstly randomly split into 90% training data, for features selection, and 10% testing data, for the validation. The final set of features after the selection was used to train 15 different classifiers using accuracy as target metric. The models' performance was then assessed on the testing data and the best performing classifier was then selected, maximising the confusion matrix balanced accuracy (BA). RESULTS Data regarding 213 LARC patients (36% female, 64% male) were collected. Overall 2yDM was 17%. A total of 2,606 features extracted from the pre- and post- nCRT GTV were tested and 4 features were selected after features selection process. Among the 15 tested classifiers, logistic regression proved to be the best performing one with a testing set BA, sensitivity and specificity of 78.5%, 71.4% and 85.7%, respectively. CONCLUSIONS This study supports a possible role of delta radiomics in predicting following occurrence of distant metastasis. Further studies including a consistent external validation are needed to confirm these results and allows to translate radiomics model in clinical practice. Future integration with clinical and molecular data will be mandatory to fully personalized treatment and follow-up approaches.
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Affiliation(s)
- Giuditta Chiloiro
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Jacopo Lenkowicz
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Calogero Casà
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlotta Masciocchi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Cusumano
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Meldolesi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Carano
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Damiani
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Brunella Barbaro
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Fornacon-Wood I, Mistry H, Ackermann CJ, Blackhall F, McPartlin A, Faivre-Finn C, Price GJ, O'Connor JPB. Reliability and prognostic value of radiomic features are highly dependent on choice of feature extraction platform. Eur Radiol 2020; 30:6241-6250. [PMID: 32483644 PMCID: PMC7553896 DOI: 10.1007/s00330-020-06957-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/28/2020] [Accepted: 05/14/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To investigate the effects of Image Biomarker Standardisation Initiative (IBSI) compliance, harmonisation of calculation settings and platform version on the statistical reliability of radiomic features and their corresponding ability to predict clinical outcome. METHODS The statistical reliability of radiomic features was assessed retrospectively in three clinical datasets (patient numbers: 108 head and neck cancer, 37 small-cell lung cancer, 47 non-small-cell lung cancer). Features were calculated using four platforms (PyRadiomics, LIFEx, CERR and IBEX). PyRadiomics, LIFEx and CERR are IBSI-compliant, whereas IBEX is not. The effects of IBSI compliance, user-defined calculation settings and platform version were assessed by calculating intraclass correlation coefficients and confidence intervals. The influence of platform choice on the relationship between radiomic biomarkers and survival was evaluated using univariable cox regression in the largest dataset. RESULTS The reliability of radiomic features calculated by the different software platforms was only excellent (ICC > 0.9) for 4/17 radiomic features when comparing all four platforms. Reliability improved to ICC > 0.9 for 15/17 radiomic features when analysis was restricted to the three IBSI-compliant platforms. Failure to harmonise calculation settings resulted in poor reliability, even across the IBSI-compliant platforms. Software platform version also had a marked effect on feature reliability in CERR and LIFEx. Features identified as having significant relationship to survival varied between platforms, as did the direction of hazard ratios. CONCLUSION IBSI compliance, user-defined calculation settings and choice of platform version all influence the statistical reliability and corresponding performance of prognostic models in radiomics. KEY POINTS • Reliability of radiomic features varies between feature calculation platforms and with choice of software version. • Image Biomarker Standardisation Initiative (IBSI) compliance improves reliability of radiomic features across platforms, but only when calculation settings are harmonised. • IBSI compliance, user-defined calculation settings and choice of platform version collectively affect the prognostic value of features.
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Affiliation(s)
| | - Hitesh Mistry
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | - Fiona Blackhall
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Andrew McPartlin
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Gareth J Price
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - James P B O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Diagnostic Radiology, The Christie Hospital NHS Foundation Trust, Manchester, UK
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Artificial intelligence (AI) and interventional radiotherapy (brachytherapy): state of art and future perspectives. J Contemp Brachytherapy 2020; 12:497-500. [PMID: 33299440 PMCID: PMC7701925 DOI: 10.5114/jcb.2020.100384] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Artificial intelligence (AI) plays a central role in building decision supporting systems (DSS), and its application in healthcare is rapidly increasing. The aim of this study was to define the role of AI in healthcare, with main focus on radiation oncology (RO) and interventional radiotherapy (IRT, brachytherapy). Artificial intelligence in interventional radiation therapy AI in RO has a large impact in providing clinical decision support, data mining and advanced imaging analysis, automating repetitive tasks, optimizing time, and modelling patients and physicians' behaviors in heterogeneous contexts. Implementing AI and automation in RO and IRT can successfully facilitate all the steps of treatment workflow, such as patient consultation, target volume delineation, treatment planning, and treatment delivery. Conclusions AI may contribute to improve clinical outcomes through the application of predictive models and DSS optimization. This approach could lead to reducing time-consuming repetitive tasks, healthcare costs, and improving treatment quality assurance and patient's assistance in IRT.
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25
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Nero C, Ciccarone F, Boldrini L, Lenkowicz J, Paris I, Capoluongo ED, Testa AC, Fagotti A, Valentini V, Scambia G. Germline BRCA 1-2 status prediction through ovarian ultrasound images radiogenomics: a hypothesis generating study (PROBE study). Sci Rep 2020; 10:16511. [PMID: 33020566 PMCID: PMC7536234 DOI: 10.1038/s41598-020-73505-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
Radiogenomics is a specific application of radiomics where imaging features are linked to genomic profiles. We aim to develop a radiogenomics model based on ovarian US images for predicting germline BRCA1/2 gene status in women with healthy ovaries. From January 2013 to December 2017 a total of 255 patients addressed to germline BRCA1/2 testing and pelvic US documenting normal ovaries, were retrospectively included. Feature selection for univariate analysis was carried out via correlation analysis. Multivariable analysis for classification of germline BRCA1/2 status was then carried out via logistic regression, support vector machine, ensemble of decision trees and automated machine learning pipelines. Data were split into a training (75%) and a testing (25%) set. The four strategies obtained a similar performance in terms of accuracy on the testing set (from 0.54 of logistic regression to 0.64 of the auto-machine learning pipeline). Data coming from one of the tested US machine showed generally higher performances, particularly with the auto-machine learning pipeline (testing set specificity 0.87, negative predictive value 0.73, accuracy value 0.72 and 0.79 on training set). The study shows that a radiogenomics model on machine learning techniques is feasible and potentially useful for predicting gBRCA1/2 status in women with healthy ovaries.
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Affiliation(s)
- Camilla Nero
- Dipartimento per le Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology, Rome, Italy.
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Francesca Ciccarone
- Dipartimento per le Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- Dipartimento di Diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ida Paris
- Dipartimento per le Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology, Rome, Italy
| | - Ettore Domenico Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Federico II University-CEINGE, Advanced Biotechnology, Naples, Italy
| | - Antonia Carla Testa
- Dipartimento per le Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology, Rome, Italy
| | - Anna Fagotti
- Dipartimento per le Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Dipartimento per le Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology, Rome, Italy
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Abstract
Machine learning (ML) and artificial intelligence (AI) are aiding in improving sensitivity and specificity of diagnostic imaging. The rapid adoption of these advanced ML algorithms is transforming imaging analysis; taking us from noninvasive detection of pathology to noninvasive precise diagnosis of the pathology by identifying whether detected abnormality is a secondary to infection, inflammation and/or neoplasm. This is led to the emergence of “Radiobiogenomics”; referring to the concept of identifying biologic (genomic, proteomic) alterations in the detected lesion. Radiobiogenomic involves image segmentation, feature extraction, and ML model to predict underlying tumor genotype and clinical outcomes. Lung cancer is the most common cause of cancer related death worldwide. There are several histologic subtypes of lung cancer, e.g., small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC) (adenocarcinoma, squamous cell carcinoma). These variable histologic subtypes not only appear different at microscopic level, but these also differ at genetic and transcription level. This intrinsic heterogeneity reveals itself as different morphologic appearances on diagnostic imaging, such as CT, PET/CT and MRI. Traditional evaluation of imaging findings of lung cancer is limited to morphologic characteristics, such as lesion size, margins, density. Radiomics takes image analysis a step further by looking at imaging phenotype with higher order statistics in efforts to quantify intralesional heterogeneity. This heterogeneity, in turn, can be potentially used to extract intralesional genomic and proteomic data. This review aims to highlight novel concepts in ML and AI and their potential applications in identifying radiobiogenomics of lung cancer.
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Affiliation(s)
- Chi Wah Wong
- Department of Applied AI and Data Science, City of Hope National Medical Center, Duarte, CA, USA.,Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Applied AI and Data Science, City of Hope National Medical Center, Duarte, CA, USA
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27
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Farchione A, Larici AR, Masciocchi C, Cicchetti G, Congedo MT, Franchi P, Gatta R, Lo Cicero S, Valentini V, Bonomo L, Manfredi R. Exploring technical issues in personalized medicine: NSCLC survival prediction by quantitative image analysis-usefulness of density correction of volumetric CT data. Radiol Med 2020; 125:625-635. [PMID: 32125637 DOI: 10.1007/s11547-020-01157-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study was to apply density correction method to the quantitative image analysis of non-small cell lung cancer (NSCLC) computed tomography (CT) images, determining its influence on overall survival (OS) prediction of surgically treated patients. Clinicopathological (CP) data and preoperative CT scans, pre- and post-contrast medium (CM) administration, of 57 surgically treated NSCLC patients, were retrospectively collected. After CT volumetric density measurement of primary gross tumour volume (GTV), aorta and tracheal air, density correction was conducted on GTV (reference values: aortic blood and tracheal air). For each resulting data set (combining CM administration and normalization), first-order statistical and textural features were extracted. CP and imaging data were correlated with patients 1-, 3- and 5-year OS, alone and combined (uni-/multivariate logistic regression and Akaike information criterion). Predictive performance was evaluated using the ROC curves and AUC values and compared among non-normalized/normalized data sets (DeLong test). The best predictive values were obtained when combining CP and imaging parameters (AUC values: 1 year 0.72; 3 years 0.82; 5 years 0.78). After normalization resulted an improvement in predicting 1-year OS for some of the grey level size zonebased features (large zone low grey level emphasis) and for the combined CP-imaging model, a worse performance for grey level co-occurrence matrix (cluster prominence and shade) and first-order statistical (range) parameters for 1- and 5-year OS, respectively. The negative performance of cluster prominence in predicting 1-year OS was the only statistically significant result (p value 0.05). Density corrections of volumetric CT data showed an opposite influence on the performance of imaging quantitative features in predicting OS of surgically treated NSCLC patients, even if no statistically significant for almost all predictors.
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Affiliation(s)
- Alessandra Farchione
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Anna Rita Larici
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Carlotta Masciocchi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giuseppe Cicchetti
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Maria Teresa Congedo
- Dipartimento Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Paola Franchi
- UOC Radiologia, Ospedale G. Mazzini, ASL Teramo, Piazza Italia, 64100, Teramo, Italy
| | - Roberto Gatta
- Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, C/o Piazzale spedali civili 1, 25123, Brescia, Italy
| | - Stefano Lo Cicero
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Lorenzo Bonomo
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Largo Francesco Vito 1, 00168, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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28
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Liang ZG, Tan HQ, Zhang F, Rui Tan LK, Lin L, Lenkowicz J, Wang H, Wen Ong EH, Kusumawidjaja G, Phua JH, Gan SA, Sin SY, Ng YY, Tan TW, Soong YL, Fong KW, Park SY, Soo KC, Wee JT, Zhu XD, Valentini V, Boldrini L, Sun Y, Chua ML. Comparison of radiomics tools for image analyses and clinical prediction in nasopharyngeal carcinoma. Br J Radiol 2019; 92:20190271. [PMID: 31453720 PMCID: PMC6774600 DOI: 10.1259/bjr.20190271] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: Radiomics pipelines have been developed to extract novel information from radiological images, which may help in phenotypic profiling of tumours that would correlate to prognosis. Here, we compared two publicly available pipelines for radiomics analyses on head and neck CT and MRI in nasopharynx cancer (NPC). Methods and materials: 100 biopsy-proven NPC cases stratified by T- and N-categories were enrolled in this study. Two radiomics pipeline, Moddicom (v. 0.51) and Pyradiomics (v. 2.1.2) were used to extract radiomics features of CT and MRI. Segmentation of primary gross tumour volume was performed using Velocity v. 4.0 by consensus agreement between three radiation oncologists. Intraclass correlation between common features of the two pipelines was analysed by Spearman’s rank correlation. Unsupervised hierarchical clustering was used to determine association between radiomics features and clinical parameters. Results: We observed a high proportion of correlated features in the CT data set, but not for MRI; 76.1% (51 of 67 common between Moddicom and Pyradiomics) of CT features and 28.6% (20 of 70 common) of MRI features were significantly correlated. Of these, 100% were shape-related for both CT and MRI, 100 and 23.5% were first-order-related, 61.9 and 19.0% were texture-related, respectively. This interpipeline heterogeneity affected the downstream clustering with known prognostic clinical parameters of cTN-status and GTVp. Nonetheless, shape features were the most reproducible predictors of clinical parameters among the different radiomics modules. Conclusion: Here, we highlighted significant heterogeneity between two publicly available radiomics pipelines that could affect the downstream association with prognostic clinical factors in NPC Advances in knowledge: The present study emphasized the broader importance of selecting stable radiomics features for disease phenotyping, and it is necessary prior to any investigation of multicentre imaging datasets to validate the stability of CT-related radiomics features for clinical prognostication.
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Affiliation(s)
- Zhong-Guo Liang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Fan Zhang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Lloyd Kuan Rui Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Li Lin
- Division of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | | | - Haitao Wang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Enya Hui Wen Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | | | - Jun Hao Phua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Soon Ann Gan
- Division of Cancer Informatics, National Cancer Centre Singapore, Singapore
| | - Sze Yarn Sin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yan Yee Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Terence Wee Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Khee-Chee Soo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Joseph Tien Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Xiao-Dong Zhu
- Division of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, P.R. China
| | | | | | - Ying Sun
- Division of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Melvin Lee Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Boldrini L, Cusumano D, Chiloiro G, Casà C, Masciocchi C, Lenkowicz J, Cellini F, Dinapoli N, Azario L, Teodoli S, Gambacorta MA, De Spirito M, Valentini V. Delta radiomics for rectal cancer response prediction with hybrid 0.35 T magnetic resonance-guided radiotherapy (MRgRT): a hypothesis-generating study for an innovative personalized medicine approach. LA RADIOLOGIA MEDICA 2019; 124:145-153. [PMID: 30374650 PMCID: PMC6373341 DOI: 10.1007/s11547-018-0951-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/15/2018] [Indexed: 02/07/2023]
Abstract
The aim of this study was to evaluate the variation of radiomics features, defined as "delta radiomics", in patients undergoing neoadjuvant radiochemotherapy (RCT) for rectal cancer treated with hybrid magnetic resonance (MR)-guided radiotherapy (MRgRT). The delta radiomics features were then correlated with clinical complete response (cCR) outcome, to investigate their predictive power. A total of 16 patients were enrolled, and 5 patients (31%) showed cCR at restaging examinations. T2*/T1 MR images acquired with a hybrid 0.35 T MRgRT unit were considered for this analysis. An imaging acquisition protocol of 6 MR scans per patient was performed: the first MR was acquired at first simulation (t0) and the remaining ones at fractions 5, 10, 15, 20 and 25. Radiomics features were extracted from the gross tumour volume (GTV), and each feature was correlated with the corresponding delivered dose. The variations of each feature during treatment were quantified, and the ratio between the values calculated at different dose levels and the one extracted at t0 was calculated too. The Wilcoxon-Mann-Whitney test was performed to identify the features whose variation can be predictive of cCR, assessed with a MR acquired 6 weeks after RCT and digital examination. The most predictive feature ratios in cCR prediction were the L_least and glnu ones, calculated at the second week of treatment (22 Gy) with a p value = 0.001. Delta radiomics approach showed promising results and the quantitative analysis of images throughout MRgRT treatment can successfully predict cCR offering an innovative personalized medicine approach to rectal cancer treatment.
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Affiliation(s)
- Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Calogero Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlotta Masciocchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Jacopo Lenkowicz
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Dinapoli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Azario
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Fisica, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefania Teodoli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Marco De Spirito
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Fisica, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
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30
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Filograna L, Lenkowicz J, Cellini F, Dinapoli N, Manfrida S, Magarelli N, Leone A, Colosimo C, Valentini V. Identification of the most significant magnetic resonance imaging (MRI) radiomic features in oncological patients with vertebral bone marrow metastatic disease: a feasibility study. Radiol Med 2018; 124:50-57. [PMID: 30191445 DOI: 10.1007/s11547-018-0935-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Recently, radiomic analysis has gained attention as a valuable instrument for the management of oncological patients. The aim of the study is to isolate which features of magnetic resonance imaging (MRI)-based radiomic analysis have to be considered the most significant predictors of metastasis in oncological patients with spinal bone marrow metastatic disease. MATERIALS AND METHODS Eight oncological patients (3 lung cancer; 1 prostatic cancer; 1 esophageal cancer; 1 nasopharyngeal cancer; 1 hepatocarcinoma; 1 breast cancer) with pre-radiotherapy MR imaging for a total of 58 dorsal vertebral bodies, 29 metastatic and 29 non-metastatic were included. Each vertebral body was contoured in T1 and T2 weighted images at a radiotherapy delineation console. The obtained data were transferred to an automated data extraction system for morphological, statistical and textural analysis. Eighty-nine features for each lesion in both T1 and T2 images were computed as the median of by-slice values. A Wilcoxon test was applied to the 89 features and the most statistically significant of them underwent to a stepwise feature selection, to find the best performing predictors of metastasis in a logistic regression model. An internal cross-validation via bootstrap was conducted for estimating the model performance in terms of the area under the curve (AUC) of the receiver operating characteristic. RESULTS Of the 89 textural features tested, 16 were found to differ with statistical significance in the metastatic vs non-metastatic group. The best performing model was constituted by two predictors for T1 and T2 images, namely one morphological feature (center of mass shift) (p value < 0.01) for both datasets and one histogram feature minimum grey level (p value < 0.01) for T1 images and one textural feature (grey-level co-occurrence matrix joint variance (p value < 0.01) for T2 images. The internal cross-validation showed an AUC of 0.8141 (95% CI 0.6854-0.9427) in T1 images and 0.9116 (95% CI 0.8294-0.9937) in T2 images. CONCLUSIONS The results suggest that MRI-based radiomic analysis on oncological patients with bone marrow metastatic disease is able to differentiate between metastatic and non-metastatic vertebral bodies. The most significant predictors of metastasis were found to be based on T2 sequence and were one morphological and one textural feature.
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Affiliation(s)
- Laura Filograna
- Department of Radiation Oncology - Gemelli-ART, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy. .,Department of Radiological Sciences, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy. .,Department of Radiological Sciences, PhD Training Program in Oncological Sciences, Catholic University of Rome, School of Medicine, University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy. .,Department of Diagnostic and Interventional Radiology, Molecular Imaging and Radiotherapy, PTV Foundation, "Tor Vergata" University of Rome, Viale Oxford 81, 00133, Rome, Italy.
| | - Jacopo Lenkowicz
- Department of Radiation Oncology - Gemelli-ART, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesco Cellini
- Department of Radiation Oncology - Gemelli-ART, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Nicola Dinapoli
- Department of Radiation Oncology - Gemelli-ART, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Stefania Manfrida
- Department of Radiation Oncology - Gemelli-ART, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Nicola Magarelli
- Department of Radiological Sciences, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Antonio Leone
- Department of Radiological Sciences, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Cesare Colosimo
- Department of Radiological Sciences, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Valentini
- Department of Radiation Oncology - Gemelli-ART, Catholic University of Rome, School of Medicine, Foundation University Hospital "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
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31
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Cusumano D, Dinapoli N, Boldrini L, Chiloiro G, Gatta R, Masciocchi C, Lenkowicz J, Casà C, Damiani A, Azario L, Van Soest J, Dekker A, Lambin P, De Spirito M, Valentini V. Fractal-based radiomic approach to predict complete pathological response after chemo-radiotherapy in rectal cancer. LA RADIOLOGIA MEDICA 2018; 123:286-295. [PMID: 29230678 DOI: 10.1007/s11547-017-0838-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
The aim of this study was to propose a methodology to investigate the tumour heterogeneity and evaluate its ability to predict pathologically complete response (pCR) after chemo-radiotherapy (CRT) in locally advanced rectal cancer (LARC). This approach consisted in normalising the pixel intensities of the tumour and identifying the different sub-regions using an intensity-based thresholding. The spatial organisation of these subpopulations was quantified using the fractal dimension (FD). This approach was implemented in a radiomic workflow and applied to 198 T2-weighted pre-treatment magnetic resonance (MR) images of LARC patients. Three types of features were extracted from the gross tumour volume (GTV): morphological, statistical and fractal features. Feature selection was performed using the Wilcoxon test and a logistic regression model was calculated to predict the pCR probability after CRT. The model was elaborated considering the patients treated in two institutions: Fondazione Policlinico Universitario "Agostino Gemelli" of Rome (173 cases, training set) and University Medical Centre of Maastricht (25 cases, validation set). The results obtained showed that the fractal parameters of the subpopulations have the highest performance in predicting pCR. The predictive model elaborated had an area under the curve (AUC) equal to 0.77 ± 0.07. The model reliability was confirmed by the validation set (AUC = 0.79 ± 0.09). This study suggests that the fractal analysis can play an important role in radiomics, providing valuable information not only about the GTV structure, but also about its inner subpopulations.
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Affiliation(s)
- Davide Cusumano
- Polo scienze delle immagini, di laboratorio e infettivologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Nicola Dinapoli
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Luca Boldrini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giuditta Chiloiro
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Roberto Gatta
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Carlotta Masciocchi
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Jacopo Lenkowicz
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Calogero Casà
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Andrea Damiani
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Luigi Azario
- Polo scienze delle immagini, di laboratorio e infettivologiche, Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Johan Van Soest
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marco De Spirito
- Polo scienze delle immagini, di laboratorio e infettivologiche, Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Vincenzo Valentini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
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Boldrini L, Placidi E, Dinapoli N, Azario L, Cellini F, Massaccesi M, Chiesa S, Gambacorta MA, Mattiucci GC, Piccari D, Teodoli S, De Spirito M, Valentini V. Hybrid Tri-Co-60 MRI radiotherapy for locally advanced rectal cancer: An in silico evaluation. Tech Innov Patient Support Radiat Oncol 2018; 6:5-10. [PMID: 32095572 PMCID: PMC7033778 DOI: 10.1016/j.tipsro.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/25/2022] Open
Abstract
Tri-Co-60 MRI radiotherapy (RT) is feasible in locally advanced rectal cancer. Larger volumes of normal tissue receive low-moderate doses in Tri-Co-60 MRI RT. Further studies on functional imaging applications and LinacMRI approach are needed. Tri-Co-60 MRI might represent a safe irradiation technique for pelvic tumors.
Introduction Aim of this paper is to investigate the plan quality of a tri-Co-60 MRI-Hybrid system for intensity-modulated radiation therapy (IMRT) in patients affected by locally advanced rectal cancer (LARC) undergoing neo-adjuvant radiotherapy. Materials and methods Ten consecutive LARC patients were selected. Tri-Co-60 step and shoot IMRT plans were generated simulating the presence of the magnetic field (Bon) or not (Boff) with the dedicated treatment planning system (TPS). The total planned dose was 45 Gy in 25 fractions to the mesorectum and the pelvic nodes (planning target volume 2, PTV2) and 55 Gy to the tumor and correspondent mesorectum (PTV1) through simultaneous integrated boost (SIB). Tri-Co-60 IMRT plans were compared with Volumetric Modulated Arc Therapy (VMAT) and IMRT plans for Linear Accelerator (Linac). Results Bon and Boff tri-Co-60 IMRT plans showed no relevant differences. Mean values of PTV1 and PTV2 receiving at least 95% of the Dp (V95%) were higher than 95% in all treatment plans. All plans met the V105% constraint for the PTV1. Mean values of V105% for the PTV2 were 14.8, 5.0, and 7.3% respectively for tri-Co-60, VMAT and IMRT. Mean Wu’s HI values were similar in all plans (7.4–7.8%). All plans met the V45Gy constraint for small bowel, but mean V45Gy value was higher with tri-Co-60. Bladder irradiation was comparable and always lower than the chosen D max 65 Gy constraint. Mean values of V5Gy and V20Gy to the body and median skin doses were higher with tri-Co-60 plans. Discussion Treatment plans with Tri-Co-60 step and shoot IMRT met the dose-volume objectives in patients with LARC. Nevertheless, a larger volume of normal tissue received low-moderate doses when compared with Linac based VMAT and IMRT.
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Affiliation(s)
- Luca Boldrini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Elisa Placidi
- Polo Scienze delle immagini, di laboratorio e infettivologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Nicola Dinapoli
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Luigi Azario
- Polo Scienze delle immagini, di laboratorio e infettivologiche, Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Francesco Cellini
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Mariangela Massaccesi
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Silvia Chiesa
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Maria Antonietta Gambacorta
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Gian Carlo Mattiucci
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Danila Piccari
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Stefania Teodoli
- Polo Scienze delle immagini, di laboratorio e infettivologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Marco De Spirito
- Polo Scienze delle immagini, di laboratorio e infettivologiche, Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
| | - Vincenzo Valentini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito, 1 - 00168 Roma, Italy
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