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Bio-physic Constraint Model Using Spatial Registration of Delta 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Images for Predicting Radiation Pneumonitis in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Chemoradiation

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Bio-physic Constraint Model Using Spatial Registration of Delta 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Images for Predicting Radiation Pneumonitis in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Chemoradiation

Tien-Chi Hou et al. Onco Targets Ther.

Abstract

Purpose: This study integrated clinical outcomes and radiomics of advanced thoracic esophageal squamous cell carcinoma patients receiving neoadjuvant concurrent chemoradiotherapy (NACCRT) to establish a novel constraint model for predicting radiation pneumonitis (RP).

Patients and methods: We conducted a retrospective review for thoracic advanced esophageal cancer patients who received NACCRT. From 2013 to 2018, 89 patients were eligible for review. Staging workup and response evaluation included positron emission tomography/computed tomography (PET/CT) scans and endoscopic ultrasound. Patients received RT with 48 Gy to gross tumor and 43.2 Gy to elective nodal area in simultaneous integrated boost method divided in 24 fractions. Weekly platinum-based chemotherapy was administered concurrently. Side effects were evaluated using CTCAE v4. Images of 2-fluoro-2-deoxyglucose PET/CT before and after NACCRT were registered to planning CT images to create a region of interest for dosimetry parameters that spatially matched RP-related regions, including V10, V20, V50%, V27, and V30. Correlation between bio-physic parameters and toxicity was used to establish a constraint model for avoiding RP.

Results: Among the investigated cohort, clinical downstaging, complete pathological response, and 5-year overall survival rates were 59.6%, 40%, and 34.4%, respectively. Multivariate logistic regression analysis demonstrated that each individual set standardized uptake value ratios (SUVRs), neither pre- nor post-NACCRT, was not predictive. Interestingly, cutoff increments of 6.2% and 8.9% in SUVRs (delta-SUVR) in registered V20 and V27 regions were powerful predictors for acute and chronic RP, respectively.

Conclusion: Spatial registration of metabolic and planning CT images with delta-radiomics analysis using fore-and-aft image sets can establish a unique bio-physic prediction model for avoiding RP in esophageal cancer patients receiving NACCRT.

Keywords: PET/CT; constraint model; esophageal cancer; neoadjuvant concurrent chemoradiation; radiation pneumonitis.

Conflict of interest statement

The authors report no conflicts of interests in this work.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curve of overall survival and progression-free survival. (A) Overall survival (OS) (B) progression-free survival (PFS) of all 89 reviewed patients in presented study at 1,3, 5 years relatively.
Figure 2
Figure 2
Representative image of patient with grade 3 acute radiation pneumonitis predicted by presented bio-physic parameters. Upper panel showed the PET-dose-volume fusion images. Lower panel showed the CT-dose-volume fusion images; blue, yellow, and pink line circled the volume of prescribed dose exceeding 20, 27, and 30 Gy relatively.
Figure 3
Figure 3
Receiver-operating characteristic (ROC) curves for predictors of the presented bio-physic constraints for acute and chronic radiation pneumonitis (A) acute radiation pneumonitis (%ΔSUVR of V20); (B) chronic pulmonary fibrosis (%ΔSUVR of V27). Abbreviations: AUC, area under the ROC curve; %ΔSUVR of Vx, percentage of SUV change between pre- and post-NACCRT at dose volume Vx.

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