Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 4:24:95-101.
doi: 10.1016/j.phro.2022.10.004. eCollection 2022 Oct.

Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features

Thomas Berger  1 , David J Noble  2   3 , Leila E A Shelley  1 , Thomas McMullan  1 , Amy Bates  2 , Simon Thomas  4 , Linda J Carruthers  1 , George Beckett  5 , Aileen Duffton  6 , Claire Paterson  6 , Raj Jena  2 , Duncan B McLaren  3 , Neil G Burnet  7 , William H Nailon  1   8
Affiliations

Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features

Thomas Berger et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: The images acquired during radiotherapy for image-guidance purposes could be used to monitor patient-specific response to irradiation and improve treatment personalisation. We investigated whether the kinetics of radiomics features from daily mega-voltage CT image-guidance scans (MVCT) improve prediction of moderate-to-severe xerostomia compared to dose/volume parameters in radiotherapy of head-and-neck cancer (HNC).

Materials and methods: All included HNC patients (N = 117) received 30 or more fractions of radiotherapy with daily MVCTs. Radiomics features were calculated on the contra-lateral parotid glands of daily MVCTs. Their variations over time after each complete week of treatment were used to predict moderate-to-severe xerostomia (CTCAEv4.03 grade ≥ 2) at 6, 12 and 24 months post-radiotherapy. After dimensionality reduction, backward/forward selection was used to generate combinations of predictors.Three types of logistic regression model were generated for each follow-up time: 1) a pre-treatment reference model using dose/volume parameters, 2) a combination of dose/volume and radiomics-based predictors, and 3) radiomics-based predictors. The models were internally validated by cross-validation and bootstrapping and their performance evaluated using Area Under the Curve (AUC) on separate training and testing sets.

Results: Moderate-to-severe xerostomia was reported by 46 %, 33 % and 26 % of the patients at 6, 12 and 24 months respectively. The selected models using radiomics-based features extracted at or before mid-treatment outperformed the dose-based models with an AUCtrain/AUCtest of 0.70/0.69, 0.76/0.74, 0.86/0.86 at 6, 12 and 24 months, respectively.

Conclusion: Our results suggest that radiomics features calculated on MVCTs from the first half of the radiotherapy course improve prediction of moderate-to-severe xerostomia in HNC patients compared to a dose-based pre-treatment model.

Keywords: Head and neck cancer; Mega-voltage CT; Parotid gland; Radiomics; Xerostomia.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NB, LJC, RJ, AB, WHN, DJN, GB, LEAS, TB, DM, TM report grants from Chief Scientist Office (CSO) Scotland grant (TCS/17/26 - CSO Award), during the conduct of the study. The authors alone are responsible for the content and writing of the paper. LJC reports personal fees from BrainLAB - Novalis Certified, outside the submitted work; RJ reports personal fees from Microsoft, outside the submitted work; DJN reports grants from Cancer Research UK Clinical Research Fellowship (Ref: C20/A20917), grants from Cancer Research UK Programme Grant (Ref: C8857/A13405), during the conduct of the study; LEAS reports grants from University of Cambridge WD Armstrong Trust, outside the submitted work; AD, CP, and ST have nothing to disclose.

Figures

Fig. 1
Fig. 1
Diagram illustrating the main methodological steps from radiomics features extraction to development and evaluation of predictive models.
Fig. 2
Fig. 2
Plot showing training and testing AUC, sensitivity, specificity and accuracy, for the selected models of both types studied. Magenta rounds show the performance of models composed of dose/volume parameters. cPG = contra-lateral parotid gland; mDose = mean dose. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

References

    1. McDowell L.J., Rock K., Xu W., Chan B., Waldron J., Lu L., et al. Long-term late toxicity, quality of life, and emotional distress in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2018;102:340–352. doi: 10.1016/j.ijrobp.2018.05.060. - DOI - PubMed
    1. Vergeer M.R., Doornaert P.A.H., Rietveld D.H.F., Leemans C.R., Slotman B.J., Langendijk J.A. Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: results of a nonrandomized prospective study using a standardized follow-up program. Int J Radiat Oncol Biol Phys. 2009;74:1–8. doi: 10.1016/j.ijrobp.2008.07.059. - DOI - PubMed
    1. Wijers O.B., Levendag P.C., Braaksma M.M.J., Boonzaaijer M., Visch L.L., Schmitz P.I.M. Patients with head and neck cancer cured by radiation therapy: A survey of the dry mouth syndrome in long-term survivors. Head Neck. 2002;24:737–747. doi: 10.1002/hed.10129. - DOI - PubMed
    1. Sim C.P.C., Soong Y.L., Pang E.P.P., Lim C., Walker G.D., Manton D.J., et al. Xerostomia, salivary characteristics and gland volumes following intensity-modulated radiotherapy for nasopharyngeal carcinoma: a two-year follow-up. Aust Dent J. 2018;63:217–223. doi: 10.1111/adj.12608. - DOI - PubMed
    1. Vainshtein J.M., Moon D.H., Feng F.Y., Chepeha D.B., Eisbruch A., Stenmark M.H. Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2015;91:925–933. doi: 10.1016/j.ijrobp.2014.12.045. - DOI - PMC - PubMed

LinkOut - more resources