Integrating Tumor and Nodal Imaging Characteristics at Baseline and Mid-Treatment Computed Tomography Scans to Predict Distant Metastasis in Oropharyngeal Cancer Treated With Concurrent Chemoradiotherapy

Jia Wu, Micheal F. Gensheimer, Nasha Zhang, Fei Han, Rachel Liang, Yushen Qian, Carrie Zhang, Nancy Fischbein, Erqi L. Pollom, Beth Beadle, Quynh Thu Le, Ruijiang Li

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Purpose: Prognostic biomarkers of disease relapse are needed for risk-adaptive therapy of oropharyngeal cancer (OPC). This work aims to identify an imaging signature to predict distant metastasis in OPC. Methods and Materials: This single-institution retrospective study included 140 patients treated with definitive concurrent chemoradiotherapy, for whom both pre- and midtreatment contrast-enhanced computed tomography (CT) scans were available. Patients were divided into separate training and testing cohorts. Forty-five quantitative image features were extracted to characterize tumor and involved lymph nodes at both time points. By incorporating both imaging and clinicopathological features, a random survival forest (RSF) model was built to predict distant metastasis–free survival (DMFS). The model was optimized via repeated cross-validation in the training cohort and then independently validated in the testing cohort. Results: The most important features for predicting DMFS were the maximum distance among nodes, maximum distance between tumor and nodes at mid-treatment, and pretreatment tumor sphericity. In the testing cohort, the RSF model achieved good discriminability for DMFS (C-index = 0.73, P = .008), and further divided patients into 2 risk groups with different 2-year DMFS rates: 96.7% versus 67.6%. Similar trends were observed for patients with p16+ tumors and smoking ≤10 pack-years. The RSF model based on pretreatment CT features alone achieved lower performance (concordance index = 0.68, P = .03). Conclusions: Integrating tumor and nodal imaging characteristics at baseline and mid-treatment CT allows prediction of distant metastasis in OPC. The proposed imaging signature requires prospective validation and, if successful, may help identify high-risk human papillomavirus-positive patients who should not be considered for deintensification therapy.

Original languageEnglish (US)
Pages (from-to)942-952
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume104
Issue number4
DOIs
StatePublished - Jul 15 2019
Externally publishedYes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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