Radiomics-based nomogram guides adaptive de-intensification in locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy

• Published in: European radiology 2024-10, Vol.34 (10), p.6831-6842
• Main Authors: Wang, Shun-Xin, Yang, Yi, Xie, Hui, Yang, Xin, Liu, Zhi-Qiao, Li, Hao-Jiang, Huang, Wen-Jie, Luo, Wei-Jie, Lei, Yi-Ming, Sun, Ying, Ma, Jun, Chen, Yan-Feng, Liu, Li-Zhi, Mao, Yan-Ping
• Format: Article
• Language: English
• Subjects: Adult; Aged; Calibration; Cancer; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Decision making; Diagnostic Radiology; Feature extraction; Female; Head and Neck; Humans; Imaging; Induction Chemotherapy; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging - methods; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - diagnostic imaging; Nasopharyngeal Carcinoma - drug therapy; Nasopharyngeal Carcinoma - therapy; Nasopharyngeal Neoplasms - diagnostic imaging; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - therapy; Neuroradiology; Nomograms; Patients; Prognosis; Radiation therapy; Radiology; Radiomics; Radiotherapy, Intensity-Modulated; Retrospective Studies; Risk; Risk groups; Survival; Toxicity; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-024-10678-8

Objectives This study aimed to construct a radiomics-based model for prognosis and benefit prediction of concurrent chemoradiotherapy (CCRT) versus intensity-modulated radiotherapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (LANPC) following induction chemotherapy (IC). Materials and methods A cohort of 718 LANPC patients treated with IC + IMRT or IC + CCRT were retrospectively enrolled and assigned to a training set ( n  = 503) and a validation set ( n  = 215). Radiomic features were extracted from pre-IC and post-IC MRI. After feature selection, a delta-radiomics signature was built with LASSO-Cox regression. A nomogram incorporating independent clinical indicators and the delta-radiomics signature was then developed and evaluated for calibration and discrimination. Risk stratification by the nomogram was evaluated with Kaplan–Meier methods. Results The delta-radiomics signature, which comprised 19 selected features, was independently associated with prognosis. The nomogram, composed of the delta-radiomics signature, age, T category, N category, treatment, and pre-treatment EBV DNA, showed great calibration and discrimination with an area under the receiver operator characteristic curve of 0.80 (95% CI 0.75–0.85) and 0.75 (95% CI 0.64–0.85) in the training and validation sets. Risk stratification by the nomogram, excluding the treatment factor, resulted in two groups with distinct overall survival. Significantly better outcomes were observed in the high-risk patients with IC + CCRT compared to those with IC + IMRT, while comparable outcomes between IC + IMRT and IC + CCRT were shown for low-risk patients. Conclusion The radiomics-based nomogram can predict prognosis and survival benefits from concurrent chemotherapy for LANPC following IC. Low-risk patients determined by the nomogram may be potential candidates for omitting concurrent chemotherapy during IMRT. Clinical relevance statement The radiomics-based nomogram was constructed for risk stratification and patient selection. It can help guide clinical decision-making for patients with locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy, and avoid unnecessary toxicity caused by overtreatment. Key Points • The benefits from concurrent chemotherapy remained controversial for locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy. • Radiomics-based nomogram achieved prognosis and benefits prediction of concurrent chemotherapy. • Low