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Smits HJG, Raaijmakers CPJ, de Ridder M, Gouw ZAR, Doornaert PAH, Pameijer FA, Lodeweges JE, Ruiter LN, Kuijer KM, Schakel T, de Bree R, Dankbaar JW, Terhaard CHJ, Breimer GE, Willems SM, Philippens MEP. Improved delineation with diffusion weighted imaging for laryngeal and hypopharyngeal tumors validated with pathology. Radiother Oncol 2024; 194:110182. [PMID: 38403024 DOI: 10.1016/j.radonc.2024.110182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE This study aims to determine the added value of a geometrically accurate diffusion-weighted (DW-) MRI sequence on the accuracy of gross tumor volume (GTV) delineations, using pathological tumor delineations as a ground truth. METHODS Sixteen patients with laryngeal or hypopharyngeal carcinoma were included. After total laryngectomy, the specimen was cut into slices. Photographs of these slices were stacked to create a 3D digital specimen reconstruction, which was registered to the in vivo imaging. The pathological tumor (tumorHE) was delineated on the specimen reconstruction. Six observers delineated all tumors twice: once with only anatomical MR imaging, and once (a few weeks later) when DW sequences were also provided. The majority voting delineation of session one (GTVMRI) and session two (GTVDW-MRI), as well as the clinical target volumes (CTVs), were compared to the tumorHE. RESULTS The mean tumorHE volume was 11.1 cm3, compared to a mean GTVMRI volume of 18.5 cm3 and a mean GTVDW-MRI volume of 15.7 cm3. The median sensitivity (tumor coverage) was comparable between sessions: 0.93 (range: 0.61-0.99) for the GTVMRI and 0.91 (range: 0.53-1.00) for the GTVDW-MRI. The CTV volume also decreased when DWI was available, with a mean CTVMR of 47.1 cm3 and a mean CTVDW-MRI of 41.4 cm3. Complete tumor coverage was achieved in 15 and 14 tumors, respectively. CONCLUSION GTV delineations based on anatomical MR imaging tend to overestimate the tumor volume. The availability of the geometrically accurate DW sequence reduces the GTV overestimation and thereby CTV volumes, while maintaining acceptable tumor coverage.
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Affiliation(s)
- Hilde J G Smits
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Mischa de Ridder
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Zeno A R Gouw
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Frank A Pameijer
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joyce E Lodeweges
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lilian N Ruiter
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Koen M Kuijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tim Schakel
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerben E Breimer
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
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Gouw ZAR, Jeong J, Rimner A, Lee NY, Jackson A, Fu A, Sonke JJ, Deasy JO. "Primer shot" fractionation with an early treatment break is theoretically superior to consecutive weekday fractionation schemes for early-stage non-small cell lung cancer. Radiother Oncol 2024; 190:110006. [PMID: 37972733 DOI: 10.1016/j.radonc.2023.110006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/14/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Radiotherapy is traditionally given in equally spaced weekday fractions. We hypothesize that heterogeneous interfraction intervals can increase radiosensitivity via reoxygenation. Through modeling, we investigate whether this minimizes local failures and toxicity for early-stage non-small cell lung cancer (NSCLC). METHODS Previously, a tumor dose-response model based on resource competition and cell-cycle-dependent radiosensitivity accurately predicted local failure rates for early-stage NSCLC cohorts. Here, the model mathematically determined non-uniform inter-fraction intervals minimizing local failures at similar normal tissue toxicity risk, i.e., iso-BED3 (iso-NTCP) for fractionation schemes 18Gyx3, 12Gyx4, 10Gyx5, 7.5Gyx8, 5Gyx12, 4Gyx15. Next, we used these optimized schedules to reduce toxicity risk (BED3) while maintaining stable local failures (TCP). RESULTS Optimal schedules consistently favored a "primer shot" fraction followed by a 2-week break, allowing tumor reoxygenation. Increasing or decreasing the assumed baseline hypoxia extended or shortened this optimal break by up to one week. Fraction sizes of 7.5 Gy and up required a single primer shot, while smaller fractions needed one or two extra fractions for full reoxygenation. The optimized schedules, versus consecutive weekday fractionation, predicted absolute LF reductions of 4.6%-7.4%, except for the already optimal LF rate seen for 18Gyx3. Primer shot schedules could also reduce BED3 at iso-TCP with the biggest improvements for the shortest schedules (94.6Gy reduction for 18Gyx3). CONCLUSION A validated simulation model clearly supports non-standard "primer shot" fractionation, reducing the impact of hypoxia-induced radioresistance. A limitation of this study is that primer-shot fractionation is outside prior clinical experience and therefore will require clinical studies for definitive testing.
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Affiliation(s)
- Z A R Gouw
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY, USA; The Netherlands Cancer Institute, Amsterdam, Department of Radiation Oncology, the Netherlands.
| | - J Jeong
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY, USA
| | - A Rimner
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA
| | - N Y Lee
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA
| | - A Jackson
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY, USA
| | - A Fu
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY, USA
| | - J-J Sonke
- The Netherlands Cancer Institute, Amsterdam, Department of Radiation Oncology, the Netherlands
| | - J O Deasy
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, NY, USA
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Bisgaard ALH, Keesman R, van Lier ALHMW, Coolens C, van Houdt PJ, Tree A, Wetscherek A, Romesser PB, Tyagi N, Lo Russo M, Habrich J, Vesprini D, Lau AZ, Mook S, Chung P, Kerkmeijer LGW, Gouw ZAR, Lorenzen EL, van der Heide UA, Schytte T, Brink C, Mahmood F. Recommendations for improved reproducibility of ADC derivation on behalf of the Elekta MRI-linac consortium image analysis working group. Radiother Oncol 2023; 186:109803. [PMID: 37437609 DOI: 10.1016/j.radonc.2023.109803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND AND PURPOSE The apparent diffusion coefficient (ADC), a potential imaging biomarker for radiotherapy response, needs to be reproducible before translation into clinical use. The aim of this study was to evaluate the multi-centre delineation- and calculation-related ADC variation and give recommendations to minimize it. MATERIALS AND METHODS Nine centres received identical diffusion-weighted and anatomical magnetic resonance images of different cancerous tumours (adrenal gland, pelvic oligo metastasis, pancreas, and prostate). All centres delineated the gross tumour volume (GTV), clinical target volume (CTV), and viable tumour volume (VTV), and calculated ADCs using both their local calculation methods and each of the following calculation conditions: b-values 0-500 vs. 150-500 s/mm2, region-of-interest (ROI)-based vs. voxel-based calculation, and mean vs. median. ADC variation was assessed using the mean coefficient of variation across delineations (CVD) and calculation methods (CVC). Absolute ADC differences between calculation conditions were evaluated using Friedman's test. Recommendations for ADC calculation were formulated based on observations and discussions within the Elekta MRI-linac consortium image analysis working group. RESULTS The median (range) CVD and CVC were 0.06 (0.02-0.32) and 0.17 (0.08-0.26), respectively. The ADC estimates differed 18% between b-value sets and 4% between ROI/voxel-based calculation (p-values < 0.01). No significant difference was observed between mean and median (p = 0.64). Aligning calculation conditions between centres reduced CVC to 0.04 (0.01-0.16). CVD was comparable between ROI types. CONCLUSION Overall, calculation methods had a larger impact on ADC reproducibility compared to delineation. Based on the results, significant sources of variation were identified, which should be considered when initiating new studies, in particular multi-centre investigations.
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Affiliation(s)
- Anne L H Bisgaard
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense Denmark.
| | - Rick Keesman
- Department of Radiation Oncology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Astrid L H M W van Lier
- Department of Radiotherapy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX,Utrecht, The Netherlands.
| | - Catherine Coolens
- Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, M5G 2M9 Toronto, ON, Canada.
| | - Petra J van Houdt
- Department of Radiation Oncology, the Netherlands Cancer Institute, Postbus 90203, 1006 BE Amsterdam, The Netherlands.
| | - Alison Tree
- Department of Urology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT London, UK.
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, SM2 5NG London, UK.
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 22, NY 10065, New York, USA.
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 545 E. 73rd street, NY 10021, New York, USA.
| | - Monica Lo Russo
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Jonas Habrich
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, M4N 3M5 Toronto, ON, Canada.
| | - Angus Z Lau
- Physical Sciences Platform, Sunnybrook Research Institute. Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, M4N 3M5 Toronto, ON, Canada.
| | - Stella Mook
- Department of Radiotherapy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX,Utrecht, The Netherlands.
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network. Department of Radiation Oncology, University of Toronto, 610 University Avenue, M5G 2M9 Toronto, ON, Canada.
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Zeno A R Gouw
- Department of Radiation Oncology, the Netherlands Cancer Institute, Postbus 90203, 1006 BE Amsterdam, The Netherlands.
| | - Ebbe L Lorenzen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, 5000 Odense, Denmark.
| | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Postbus 90203, 1006 BE Amsterdam, The Netherlands.
| | - Tine Schytte
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense Denmark; Department of Oncology, Odense University Hospital, Kløvervænget 19, 5000 Odense, Denmark.
| | - Carsten Brink
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense Denmark.
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense Denmark.
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Bos P, van den Brekel MWM, Taghavi M, Gouw ZAR, Al-Mamgani A, Waktola S, J W L Aerts H, Beets-Tan RGH, Castelijns JA, Jasperse B. Largest diameter delineations can substitute 3D tumor volume delineations for radiomics prediction of human papillomavirus status on MRI's of oropharyngeal cancer. Phys Med 2022; 101:36-43. [PMID: 35882094 DOI: 10.1016/j.ejmp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Laborious and time-consuming tumor segmentations are one of the factors that impede adoption of radiomics in the clinical routine. This study investigates model performance using alternative tumor delineation strategies in models predictive of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC). METHODS Of 153 OPSCC patients, HPV status was determined using p16/p53 immunohistochemistry. MR-based radiomic features were extracted within 3D delineations by an inexperienced observer, experienced radiologist or radiation oncologist, and within a 2D delineation of the largest axial tumor diameter and 3D spheres within the tumor. First, logistic regression prediction models were constructed and tested separately for each of these six delineation strategies. Secondly, the model trained on experienced delineations was tested using these delineation strategies. The latter methodology was repeated with the omission of shape features. Model performance was evaluated using area under the curve (AUC), sensitivity and specificity. RESULTS Models constructed and tested using single-slice delineations (AUC/Sensitivity/Specificity: 0.84/0.75/0.84) perform better compared to 3D experienced observer delineations (AUC/Sensitivity/Specificity: 0.76/0.76/0.71), where models based on 4 mm sphere delineations (AUC/Sensitivity/Specificity: 0.77/0.59/0.71) show similar performance. Similar performance was found when experienced and largest diameter delineations (AUC/Sens/Spec: 0.76/0.75/0.65 vs 0.76/0.69/0.69) was used to test the model constructed using experienced delineations without shape features. CONCLUSION Alternative delineations can substitute labor and time intensive full tumor delineations in a model that predicts HPV status in OPSCC. These faster delineations may improve adoption of radiomics in the clinical setting. Future research should evaluate whether these alternative delineations are valid in other radiomics models.
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Affiliation(s)
- Paula Bos
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands.
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Marjaneh Taghavi
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Zeno A R Gouw
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Selam Waktola
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hugo J W L Aerts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States; Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Jonas A Castelijns
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Bas Jasperse
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiology, Amsterdam University Medical Center, Amsterdam the Netherlands
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Bos P, van den Brekel MWM, Gouw ZAR, Al-Mamgani A, Taghavi M, Waktola S, Aerts HJWL, Castelijns JA, Beets-Tan RGH, Jasperse B. Improved outcome prediction of oropharyngeal cancer by combining clinical and MRI features in machine learning models. Eur J Radiol 2021; 139:109701. [PMID: 33865064 DOI: 10.1016/j.ejrad.2021.109701] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/14/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES New markers are required to predict chemoradiation response in oropharyngeal squamous cell carcinoma (OPSCC) patients. This study evaluated the ability of magnetic resonance (MR) radiomics to predict locoregional control (LRC) and overall survival (OS) after chemoradiation and aimed to determine whether this has added value to traditional clinical outcome predictors. METHODS 177 OPSCC patients were eligible for this study. Radiomic features were extracted from the primary tumor region in T1-weighted postcontrast MRI acquired before chemoradiation. Logistic regression models were created using either clinical variables (clinical model), radiomic features (radiomic model) or clinical and radiomic features combined (combined model) to predict LRC and OS 2-years posttreatment. Model performance was evaluated using area under the curve (AUC), 95 % confidence intervals were calculated using 500 iterations of bootstrap. All analyses were performed for the total population and the Human papillomavirus (HPV) negative tumor subgroup. RESULTS A combined model predicted treatment outcome with a higher AUC (LRC: 0.745 [0.734-0.757], OS: 0.744 [0.735-0.753]) than the clinical model (LRC: 0.607 [0.594-0.620], OS: 0.708 [0.697-0.719]). Performance of the radiomic model was comparable to the combined model for LRC (AUC: 0.740 [0.729-0.750]), but not for OS prediction (AUC: 0.654 [0.646-0.662]). In HPV negative patients, the performance of all models was not sufficient with AUCs ranging from 0.587 to 0.660 for LRC and 0.559 to 0.600 for OS prediction. CONCLUSION Predictive models that include clinical variables and radiomic tumor features derived from MR images of OPSCC better predict LRC after chemoradiation than models based on only clinical variables. Predictive models that include clinical variables perform better than models based on only radiomic features for the prediction of OS.
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Affiliation(s)
- Paula Bos
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands.
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Zeno A R Gouw
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marjaneh Taghavi
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Selam Waktola
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hugo J W L Aerts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Artificial Intelligence in Medicine (AIM) Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonas A Castelijns
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Bas Jasperse
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Bos P, van den Brekel MWM, Gouw ZAR, Al‐Mamgani A, Waktola S, Aerts HJWL, Beets‐Tan RGH, Castelijns JA, Jasperse B. Clinical variables and magnetic resonance imaging-based radiomics predict human papillomavirus status of oropharyngeal cancer. Head Neck 2021; 43:485-495. [PMID: 33029923 PMCID: PMC7821378 DOI: 10.1002/hed.26505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) have better prognosis and treatment response compared to HPV-negative OPSCC. This study aims to noninvasively predict HPV status of OPSCC using clinical and/or radiological variables. METHODS Seventy-seven magnetic resonance radiomic features were extracted from T1-weighted postcontrast images of the primary tumor of 153 patients. Logistic regression models were created to predict HPV status, determined with immunohistochemistry, based on clinical variables, radiomic features, and its combination. Model performance was evaluated using area under the curve (AUC). RESULTS Model performance showed AUCs of 0.794, 0.764, and 0.871 for the clinical, radiomic, and combined models, respectively. Smoking, higher T-classification (T3 and T4), larger, less round, and heterogeneous tumors were associated with HPV-negative tumors. CONCLUSION Models based on clinical variables and/or radiomic tumor features can predict HPV status in OPSCC patients with good performance and can be considered when HPV testing is not available.
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Affiliation(s)
- Paula Bos
- Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Oral and Maxillofacial SurgeryAmsterdam University Medical Center (AUMC)Amsterdamthe Netherlands
| | - Zeno A. R. Gouw
- Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Abrahim Al‐Mamgani
- Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Selam Waktola
- Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Hugo J. W. L. Aerts
- Department of Radiation OncologyDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Regina G. H. Beets‐Tan
- Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- GROW School for Oncology and Developmental BiologyUniversity of MaastrichtMaastrichtThe Netherlands
- Department of Regional Health ResearchUniversity of Southern DenmarkDenmark
| | - Jonas A. Castelijns
- Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Bas Jasperse
- Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of RadiologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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Heukelom J, Navran A, Gouw ZAR, Tesselaar ME, Zuur CL, van Werkhoven E, Sonke JJ, Rasch CRN, Al-Mamgani A. Organ Function Preservation Failure after (Chemo)Radiotherapy in Head and Neck Cancer: A Retrospective Cohort Analysis. Otolaryngol Head Neck Surg 2019; 161:288-296. [DOI: 10.1177/0194599819846073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the current study was to determine the incidence of organ function preservation failure (OFPF) in patients with head and neck squamous cell carcinoma (HNSCC) treated by (chemo)radiotherapy and to identify its risk factors. Study Design Retrospective cohort analysis. Setting Tertiary cancer care center. Subjects and Methods A single-center retrospective cohort analysis was done (n = 703) in which OFPF after (chemo)radiotherapy was assessed. OFPF was defined as local failure or pure functional failure in the absence of local failure because of major surgical intervention (total laryngectomy, commando resection, permanent tracheostomy) or feeding tube dependence >2 years. Results OFPF occurred in 153 patients (21.8%). Reasons for OFPF were local failure in 103 patients (14.6%) and functional failure in 50 patients (7.2%). Evidence of functional failure included need for total laryngectomy (n = 9, 1.3%), commando resection (n = 2, 0.3%), permanent tracheostomy (n = 16, 2.3%), and/or long-term feeding tube for functional reasons (n = 23, 3.3%). In a Cox proportional hazards model, OFPF was worse for patients with T4 tumors (hazard ratio [HR] <0.5 and P < .001 for all other stages), for laryngeal vs oropharyngeal cancer (HR, 1.83; 95% confidence interval [CI], 1.20-2.79, P = .005, hypopharyngeal not significant), and for smokers (HR, 1.68; 95% CI, 1.10-2.56, P = .015). Exploratory multivariate analysis by tumor site showed that T4 tumor and pretreatment tracheostomy were the strongest predictive factors for OFPF in laryngeal and hypopharyngeal carcinoma while T4 tumor and smoking were predictive for poor OFPF in oropharyngeal carcinoma. Conclusion This work shows a detrimental effect of smoking on functional outcomes after (chemo-)radiotherapy for HNSCC. Moreover, T4 tumor, laryngeal subsite, and pretreatment tracheostomy are strong predictors of OFPF.
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Affiliation(s)
- Jolien Heukelom
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Zeno A. R. Gouw
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margot E. Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L. Zuur
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Gouw ZAR, La Fontaine MD, van Kranen S, van de Kamer JB, Vogel WV, van Werkhoven E, Sonke JJ, Al-Mamgani A. The Prognostic Value of Baseline 18F-FDG PET/CT in Human Papillomavirus–Positive Versus Human Papillomavirus–Negative Patients With Oropharyngeal Cancer. Clin Nucl Med 2019; 44:e323-e328. [DOI: 10.1097/rlu.0000000000002531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Ridder M, Gouw ZAR, Navran A, Hamming-Vrieze O, Jasperse B, van den Brekel MWM, Vogel WV, Al-Mamgani A. FDG-PET/CT improves detection of residual disease and reduces the need for examination under anaesthesia in oropharyngeal cancer patients treated with (chemo-)radiation. Eur Arch Otorhinolaryngol 2019; 276:1447-1455. [PMID: 30758660 DOI: 10.1007/s00405-019-05340-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Early detection of residual disease (RD) after (chemo)radiation for oropharyngeal (OPC) is crucial. Surveillance of neck nodes with FDG-PET/CT has been studied extensively, whereas its value for local RD remains less clear. We aim to evaluate the diagnostic value of post-treatment FDG-PET/CT in detecting local RD and the outcome of patients with local RD. METHODS A cohort (n = 352) of consecutively treated OPC patients at our institute between 2010 and 2017 was evaluated. Patients that underwent FDG-PET/CT at 3 months post-treatment (n = 94) were classified as having complete (CMR) or partial metabolic response (PMR). PMR was defined as visually detectable metabolic activity above the background of surrounding normal tissues. Primary endpoint was diagnostic accuracy in detecting local RD. RESULTS Local RD was seen in 19/352 patients (5%), all of them were HPV negative. The FDG-PET/CT had a sensitivity of 100% (8/8), specificity 85% (73/86), PPV 38% (8/21), NPV 100% (73/73), and accuracy 86%. Patients with local RD had significantly worse OS at 2 years, compared to those without (10 versus 88%, P < 0.001). In multivariable analysis, local RD remained a significant predictive factor for death with a hazard ratio of 11.9 (95% CI 5.8-24.3). The number of patients that underwent PET/CT increased over time (P < 0.001), whereas the number of patients that underwent EUA declined (P = 0.072). CONCLUSION FDG-PET/CT has excellent performance for the detection of RD, with the sensitivity and negative predictive value approaching 100%. Due to these excellent results is examination under anaesthesia today in the vast majority of the PET-negative cases not necessary anymore.
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Affiliation(s)
- Mischa de Ridder
- Department of Radiation Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiation Oncology, Verbeeten Instituut, Tilburg, The Netherlands
| | - Zeno A R Gouw
- Department of Radiation Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Bas Jasperse
- Department of Radiology, Antoni van Leeuwenhoek/Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Maxillo-facial Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Radiation Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Nuclear Medicine, Antoni van Leeuwenhoek/Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - A Al-Mamgani
- Department of Radiation Oncology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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de Ridder M, Gouw ZAR, Sonke JJ, Navran A, Jasperse B, Heukelom J, Tesselaar MET, Klop WMC, van den Brekel MWM, Al-Mamgani A. Recurrent oropharyngeal cancer after organ preserving treatment: pattern of failure and survival. Eur Arch Otorhinolaryngol 2016; 274:1691-1700. [PMID: 27942891 DOI: 10.1007/s00405-016-4413-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/29/2016] [Indexed: 01/05/2023]
Abstract
The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the site of failure to the planned radiation dose. Between January 2010 and April 2014, 57 patients with recurrent OPC after (chemo)radiotherapy were analyzed. Endpoints were pattern of failure and overall survival (OS). Local (LF) and regional failure (RF) were classified as in-field [>50% within gross tumor volume (GTV)], marginal [<50% within GTV but >50% within clinical target volume (CTV)], or out-of-field (>50% outside CTV) recurrences. In the whole group, 70 recurrences were reported. Of the 31 LF, 29 (93.5%) were in-field and 2 (6.5%) were marginal. No out-field LF was reported. Of the 21 RF, 13 RF (62%) were in-field, 6 (28.5%) marginal, and 2 (9.5%) out-of-field recurrences. Forty-three percent of RF was developed in an electively treated neck level, and 2 of them were contralateral. OS at 2 years in recurrent HPV positive, compared to HPV-negative OPC, were 66 and 18%, respectively (p = 0.011). OS was also significantly better in patients that were salvage treatment which was possible (70 vs. 6%, p < 0.001). Median survival after distant failure was 3.6 months. The great majority of LFs were located within the GTV and 43% of RFs developed in an electively treated neck level. The currently used margins and dose recipe and the indication for bilateral nodal irradiation need to be reevaluated. OS was significantly better in recurrent HPV-positive OPC and in patients, where salvage treatment was possible.
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Affiliation(s)
- M de Ridder
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Z A R Gouw
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J J Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B Jasperse
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Heukelom
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M E T Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W M C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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