Comparing 3D deformations between longitudinal daily CBCT acquisitions using CNN for head and neck radiotherapy toxicity prediction

Adaptive radiotherapy is a growing field of study in cancer treatment due to it's objective in sparing healthy tissue. The standard of care in several institutions includes longitudinal cone-beam computed tomography (CBCT) acquisitions to monitor changes, but have yet to be used to improve tumor control while managing side-effects. The aim of this study is to demonstrate the clinical value of pre-treatment CBCT acquired daily during radiation therapy treatment for head and neck cancers for the downstream task of predicting severe toxicity occurrence: reactive feeding tube (NG), hospitalization and radionecrosis. For this, we propose a deformable 3D classification pipeline that includes a component analyzing the Jacobian matrix of the deformation between planning CT and longitudinal CBCT, as well as clinical data. The model is based on a multi-branch 3D residual convolutional neural network, while the CT to CBCT registration is based on a pair of VoxelMorph architectures. Accuracies of 85.8% and 75.3% was found for radionecrosis and hospitalization, respectively, with similar performance as early as after the first week of treatment. For NG tube risk, performance improves with increasing the timing of the CBCT fraction, reaching 83.1% after the $5_{th}$ week of treatment.

Radiomics strategies for risk assessment of tumour failure in head-and-neck cancer

Quantitative extraction of high-dimensional mineable data from medical images is a process known as radiomics. Radiomics is foreseen as an essential prognostic tool for cancer risk assessment and the quantification of intratumoural heterogeneity. In this work, 1615 radiomic features (quantifying tumour image intensity, shape, texture) extracted from pre-treatment FDG-PET and CT images of 300 patients from four different cohorts were analyzed for the risk assessment of locoregional recurrences (LR) and distant metastases (DM) in head-and-neck cancer. Prediction models combining radiomic and clinical variables were constructed via random forests and imbalance-adjustment strategies using two of the four cohorts. Independent validation of the prediction and prognostic performance of the models was carried out on the other two cohorts (LR: AUC = 0.69 and CI = 0.67; DM: AUC = 0.86 and CI = 0.88). Furthermore, the results obtained via Kaplan-Meier analysis demonstrated the potential of radiomics for assessing the risk of specific tumour outcomes using multiple stratification groups. This could have important clinical impact, notably by allowing for a better personalization of chemo-radiation treatments for head-and-neck cancer patients from different risk groups.