scholarly journals MRI-Based Random Survival Forest Model Improves the Prediction of Progression-Free Survival to Induction Chemotherapy plus Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

2022 ◽  
Author(s):  
Wei Pei ◽  
Chen Wang ◽  
Hai Liao ◽  
Xiaobo Chen ◽  
Yunyun Wei ◽  
...  
Keyword(s):  
Concurrent Chemoradiotherapy ◽  
Risk Group ◽  
Cox Model ◽  
Progression Free Survival ◽  
Resonance Imaging ◽  
Cox Models ◽  
Free Survival ◽  
Training Cohort ◽  
Magnetic Resonance Imaging Mri ◽  
Random Survival Forest

Abstract BackgroundThe present study aimed to explore the application value of random survival forest (RSF) model and Cox model in predicting the progression-free survival (PFS) among patients with locoregionally advanced nasopharyngeal carcinoma (LANPC) after induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT).MethodsEligible LANPC patients underwent magnetic resonance imaging (MRI) scan before treatment were subjected to radiomics feature extraction. Radiomics and clinical features of patients in the training cohort were subjected to RSF analysis to predict PFS and were tested in the testing cohort. The performance of an RSF model with clinical and radiologic predictors was assessed with the area under the receiver operating characteristic (ROC) curve (AUC) and Delong test and compared with Cox models based on clinical and radiologic parameters. Further, the Kaplan-Meier method was used for risk stratification of patients.ResultsA total of 294 LANPC patients (206 in the training cohort; 88 in the testing cohort) were enrolled and underwent magnetic resonance imaging (MRI) scans before treatment. The AUC value of the clinical Cox model, radiomics Cox model, clinical + radiomics Cox model, and clinical + radiomics RSF model in predicting 3- and 5-year PFS for LANPC patients was [0.545 vs 0.648 vs 0.648 vs 0.899 (training cohort), and 0.566 vs 0.736 vs 0.73 vs 0.861 (testing cohort); 0.556 vs 0.604 vs 0.611 vs 0.897 (training cohort), and 0.591 vs 0.661 vs 0.676 vs 0.847 (testing cohort), respectively]. Delong test showed that the RSF model and the other three Cox models were statistically significant, and the RSF model markedly improved prediction performance (P<0.001). Additionally, the PFS of the high-risk group was lower than that of the low-risk group in the RSF model (P<0.001), while comparable in the Cox model (P>0.05).ConclusionThe RSF model may be a potential tool for prognostic prediction and risk stratification of LANPC patients.

scholarly journals Temporal muscle thickness is an independent prognostic marker in patients with progressive glioblastoma: translational imaging analysis of the EORTC 26101 trial

2019 ◽  
Vol 21 (12) ◽  
pp. 1587-1594 ◽  
Author(s):  
Julia Furtner ◽  
Els Genbrugge ◽  
Thierry Gorlia ◽  
Martin Bendszus ◽  
Martha Nowosielski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Model ◽  
Surrogate Marker ◽  
Muscle Thickness ◽  
Progression Free Survival ◽  
Therapeutic Interventions ◽  
Phase Iii ◽  
Cox Models ◽  
Temporal Muscle ◽  
Training Cohort

Abstract Background Temporal muscle thickness (TMT) was described as a surrogate marker of skeletal muscle mass. This study aimed to evaluate the prognostic relevance of TMT in patients with progressive glioblastoma. Methods TMT was analyzed on cranial MR images of 596 patients with progression of glioblastoma after radiochemotherapy enrolled in the European Organisation for Research and Treatment of Cancer 26101 trial. An optimal TMT cutoff for overall survival (OS) and progression-free survival (PFS) was defined in the training cohort (n = 260, phase II). Patients were grouped as “below” or “above” the TMT cutoff and associations with OS and PFS were tested using the Cox model adjusted for important risk factors. Findings were validated in a test cohort (n = 308, phase III). Results An optimal baseline TMT cutoff of 7.2 mm was obtained in the training cohort for both OS and PFS (area under the curve = 0.64). Univariate analyses estimated a hazard ratio (HR) of 0.54 (95% CI: 0.42, 0.70; P &lt; 0.0001) for OS and an HR of 0.49 (95% CI: 0.38, 0.64; P &lt; 0.0001) for PFS for the comparison of training cohort patients above versus below the TMT cutoff. Similar results were obtained in Cox models adjusted for important risk factors with relevance in the trial for OS (HR, 0.54; 95% CI: 0.41, 0.70; P &lt; 0.0001) and PFS (HR, 0.47; 95% CI: 0.36, 0.61; P &lt; 0.0001). Results were confirmed in the validation cohort. Conclusion Reduced TMT is an independent negative prognostic parameter in patients with progressive glioblastoma and may help to facilitate patient management by supporting patient stratification for therapeutic interventions or clinical trials.

Construction and Validation of a Nomogram for Predicting Progression-Free Survival in Patients with Early-Stage Testicular Germ Cell Tumor

2021 ◽  
Vol 16 ◽  
Author(s):  
Jin-Guo Chen ◽  
Jing-Quan Wang ◽  
Tian-Wen Peng ◽  
Zhe-Sheng Chen ◽  
Shan-Chao Zhao
Keyword(s):  
Prognostic Factors ◽  
Validation Cohort ◽  
Early Stage ◽  
Predictive Ability ◽  
Testicular Germ Cell Tumor ◽  
Progression Free Survival ◽  
Cell Tumor ◽  
Testicular Germ Cell ◽  
Free Survival ◽  
Training Cohort

Background: Testicular Germ Cell Tumor (TGCT) is the most common malignant tumor in young men, but there is a lack of prediction model to evaluate prognosis of patients with TGCT. Objective: To explore the prognostic factors for Progression-Free Survival (PFS) and construct a nomogram model for patients with early-stage TGCT after radical orchiectomy. Methods: Patients with TGCT from The Cancer Genome Atlas (TCGA) database were used as the training cohort; univariate and multivariate cox analysis were performed. A nomogram was constructed based on the independent prognostic factors. Patients from the Nanfang Hospital affiliated with Southern Medical University were used as the cohort to validate the predictive ability using the nomogram model. Harrell's concordance index (C-index) and calibration plots were used to evaluate the nomogram. Results: A total of 110 and 62 patients with TGCT were included in training cohort and validation cohort, respectively. Lymphatic Vascular Invasion (LVI), American Joint Committee on Cancer (AJCC) stage and adjuvant therapy were independent prognostic factors in multivariate regression analyses and were included to establish a nomogram. The C-index in the training cohort for 1-, 3-, and 5-year PFS were 0.768, 0.74 and 0.689, respectively. While the C-index for 1-, 3-, and 5-year PFS in the external validation cohort were 0.853, 0.663 and 0.609, respectively. The calibration plots for 1-, 3-, and 5-year PFS in the training and validation cohort showed satisfactory consistency between predicted and actual outcomes. The nomogram revealed a better predictive ability for PFS than AJCC staging system. Conclusion: The nomogram as a simple and visual tool to predict individual PFS in patients with TGCT could guide clinicians and clinical pharmacists in therapeutic strategy.

scholarly journals Early intra-treatment diffusion weighted magnetic resonance imaging in patients with recurrent nasopharyngeal carcinoma treated with nivolumab

2020 ◽  
Vol 6 (3) ◽  
pp. 568
Author(s):  
Tiffany Y. So ◽  
Qi-Yong Ai ◽  
Brigette B.Y. Ma ◽  
Ann D. King
Keyword(s):  
Magnetic Resonance Imaging ◽  
Overall Survival ◽  
Magnetic Resonance ◽  
Nasopharyngeal Carcinoma ◽  
Progression Free Survival ◽  
Tumour Volume ◽  
Resonance Imaging ◽  
Free Survival ◽  
Diffusion Weighted ◽  
Weighted Magnetic Resonance Imaging

<p class="abstract">Immune check point inhibitors have demonstrated promising efficacy in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) in phase I and phase II trials. Early identification of treatment response is important in these patients. This report aimed to document the early intratreatment diffusion weighted magnetic resonance imaging (DW-MRI) findings in NPC patients following treatment with the programmed cell death-1 inhibitor, nivolumab. Two consecutive patients with histologically confirmed recurrent undifferentiated NPC treated with nivolumab were prospectively recruited. Nivolumab was administered at a dosage of 3 mg/kg intravenously every 2 weeks. Patients underwent magnetic resonance imaging examinations at baseline, and at 3 and 5 weeks after commencement of treatment. Intratreatment changes in tumour volume and apparent diffusion coefficient (ADC<sub>mean</sub>)were calculated. The endpoints were objective response by response evaluation criteria in solid tumors and survival. In patient 1, an intratreatment ADC increase at 5 weeks corresponded with anatomical tumour volume reduction and a better long-term survival outcome (progression free survival 1.3 years, overall survival 2.9 years). In patient 2, an intratreatment ADC decrease at 5 weeks corresponded to progressive disease and worse outcome (progression free survival 0.0 years, overall survival 0.9 years). Intratreatment ADC changes at 3 weeks were not associated with response outcome. These cases suggest that intratreatment changes in ADC at 5 weeks may potentially predict tumour response in patients treated with nivolumab. Dedicated studies are needed to clarify these findings and fully characterise patterns of treatment related ADC change.</p>

Delta-volume radiomics of induction chemotherapy to predict outcome of subsequent chemoradiotherapy for locally advanced hypopharyngeal cancer

2021 ◽  
pp. 030089162110390
Author(s):  
Che-Wei Su ◽  
Jehn-Chuan Lee ◽  
Yi-Fang Chang ◽  
Nai-Wen Su ◽  
Pei-Hsuan Lee ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Hypopharyngeal Cancer ◽  
Imaging Biomarker ◽  
Free Survival ◽  
Before And After ◽  
Selection Operator

Introduction: Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) is recommended for larynx-preserving treatment of locally advanced hypopharyngeal cancer (LAHC). However, the conventional evaluation of response is not robust enough to predict the outcome of subsequent treatments. This study aimed to develop an imaging biomarker using changes in radiomic features in invasive tumor front (ITF) by IC to predict treatment outcome of subsequent CCRT in LAHC. Methods: From 2006 to 2018, 59 computed tomography (CT) scan images before and after IC in patients with LAHC were used to contour the gross tumor volumes (GTVs). A total of 48 delta-volume radiomics features were acquired from the absolute spatial difference of GTVs (delta-GTV) before and after IC, conceptually representing a consistent portion of ITF. Least absolute shrinkage and selection operator regression (LASSO) was used to select features for establishing the model generating radiomic score (R score). Results: A model including 5 radiomic features from delta-GTV to predict better progression-free survival (PFS) of patients receiving subsequent CCRT was established. The R score was validated with all datasets (area under the curve 0.77). Low R score (<–0.16) was associated with improved PFS ( p < 0.05). Conclusions: The established radiomic model for ITF from radiomic features of delta-GTV after IC might be a potential imaging biomarker for predicting clinical outcome of subsequent CCRT in LAHC.

scholarly journals Induction Chemotherapy Followed by Cetuximab Radiotherapy Is Not Superior to Concurrent Chemoradiotherapy for Head and Neck Carcinomas: Results of the GORTEC 2007-02 Phase III Randomized Trial

2018 ◽  
Vol 36 (31) ◽  
pp. 3077-3083 ◽  
Author(s):  
Lionnel Geoffrois ◽  
Laurent Martin ◽  
Dominique De Raucourt ◽  
Xu Shan Sun ◽  
Yungan Tao ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Squamous Cell ◽  
Concurrent Chemoradiotherapy ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Phase Iii ◽  
Free Survival

Purpose Both concurrent chemoradiotherapy (CT-RT) and cetuximab radiotherapy (cetux-RT) have been established as the standard of care for the treatment of locally advanced squamous cell carcinoma of the head and neck. It was not known whether the addition of induction chemotherapy before cetux-RT could improve outcomes compared with standard of care CT-RT. Patients and Methods The current trial was restricted to patients with nonmetastatic N2b, N2c, or N3 squamous cell carcinoma of the head and neck and fit for taxotere, cisplatin, fluorouracil (TPF). Patients were randomly assigned to receive three cycles of TPF followed by cetux-RT versus concurrent carboplatin fluorouracil and RT as recommended in National Comprehensive Cancer Network guidelines. The trial was powered to detect a hazard ratio (HR) of 0.66 in favor of TPF plus cetux-RT for progression-free survival at 2 years. The inclusion of 180 patients per arm was needed to achieve 80% power at a two-sided significance level of .05. Results Between 2009 and 2013, 370 patients were included. All patients and tumors characteristics were well balanced between arms. There were more cases of grade 3 and 4 neutropenia in the induction arm, and the induction TPF was associated with 6.6% treatment-related deaths. With a median follow-up of 2.8 years, 2-year progression-free survival was not different between both arms (CT-RT, 0.38 v TPF + cetux-RT, 0.36; HR, 0.93 [95% CI, 0.73 to 1.20]; P = .58). HR was 0.98 (95% CI, 0.74 to 1.3; P = .90) for locoregional control and 1.12 (95% CI, 0.86 to 1.46; P = .39) for overall survival. These effects were observed regardless of p16 status. The rate of distant metastases was lower in the TPF arm (HR, 0.54 [95% CI, 0.30 to 0.99]; P = .05). Conclusion Induction TPF followed by cetux-RT did not improve outcomes compared with CT-RT in a population of patients with advanced cervical lymphadenopathy.

Anemia before and during concurrent chemoradiotherapy in patients with cervical carcinoma: Effect on progression-free survival

2003 ◽  
Vol 13 (5) ◽  
pp. 633-639 ◽  
Author(s):  
A. Obermair ◽  
R. Cheuk ◽  
K. Horwood ◽  
M. Neudorfer ◽  
M. Janda ◽  
...  
Keyword(s):  
Cervical Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Progression Free Survival ◽  
Figo Stage ◽  
Tumor Stage ◽  
Free Survival ◽  
Parametrial Involvement ◽  
The Impact ◽  
Relevant Factors

To determine the impact of anemia before and during chemoradiation in patients with cervical cancer, we collected data on hemoglobin (Hb) levels before and during treatment from 60 unselected patients with cervical carcinoma. All patients had FIGO stage IB to IVA disease and were treated with concurrent chemoradiation for the aim of cure. Patients with an Hb value below or equal to the lower 25th quartile were considered anemic. Progression-free survival (PFS) was evaluated by univariate and multivariate analyses. After a median follow-up of 26.3 months, 20 patients developed disease progression. The lowest Hb during chemoradiation (nadir Hb), the stage of disease, and parametrial involvement were correlated significantly with PFS. On multivariate analysis, the nadir Hb (relative risk [RR] 0.29) and tumor stage (RR 3.4) remained the only prognostically relevant factors predicting PFS. At 60 months the PFS was 39.1% for anemic patients and 48.0% for nonanemic patients (P < 0.0002). In patients undergoing chemoradiation for cervical carcinoma, a low nadir Hb is highly predictive of shortened PFS, whereas the Hb before treatment is prognostically not significant.

scholarly journals Low-grade Glioma Surgery in Intraoperative Magnetic Resonance Imaging

Neurosurgery ◽  
2015 ◽  
Vol 78 (6) ◽  
pp. 775-786 ◽  
Author(s):  
Jan Coburger ◽  
Andreas Merkel ◽  
Moritz Scherer ◽  
Felix Schwartz ◽  
Florian Gessler ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Field Strength ◽  
Odds Ratio ◽  
Progression Free Survival ◽  
Neurological Deficits ◽  
Low Grade ◽  
Resonance Imaging ◽  
Free Survival ◽  
Intraoperative Magnetic Resonance Imaging

Abstract BACKGROUND: The ideal treatment strategy for low-grade gliomas (LGGs) is a controversial topic. Additionally, only smaller single-center series dealing with the concept of intraoperative magnetic resonance imaging (iMRI) have been published. OBJECTIVE: To investigate determinants for patient outcome and progression-free-survival (PFS) after iMRI-guided surgery for LGGs in a multicenter retrospective study initiated by the German Study Group for Intraoperative Magnetic Resonance Imaging. METHODS: A retrospective consecutive assessment of patients treated for LGGs (World Health Organization grade II) with iMRI-guided resection at 6 neurosurgical centers was performed. Eloquent location, extent of resection, first-line adjuvant treatment, neurophysiological monitoring, awake brain surgery, intraoperative ultrasound, and field-strength of iMRI were analyzed, as well as progression-free survival (PFS), new permanent neurological deficits, and complications. Multivariate binary logistic and Cox regression models were calculated to evaluate determinants of PFS, gross total resection (GTR), and adjuvant treatment. RESULTS: A total of 288 patients met the inclusion criteria. On multivariate analysis, GTR significantly increased PFS (hazard ratio, 0.44; P &lt; .01), whereas “failed” GTR did not differ significantly from intended subtotal-resection. Combined radiochemotherapy as adjuvant therapy was a negative prognostic factor (hazard ratio: 2.84, P &lt; .01). Field strength of iMRI was not associated with PFS. In the binary logistic regression model, use of high-field iMRI (odds ratio: 0.51, P &lt; .01) was positively and eloquent location (odds ratio: 1.99, P &lt; .01) was negatively associated with GTR. GTR was not associated with increased rates of new permanent neurological deficits. CONCLUSION: GTR was an independent positive prognostic factor for PFS in LGG surgery. Patients with accidentally left tumor remnants showed a similar prognosis compared with patients harboring only partially resectable tumors. Use of high-field iMRI was significantly associated with GTR. However, the field strength of iMRI did not affect PFS.

scholarly journals Induction chemotherapy followed by radiotherapy versus concurrent chemoradiotherapy in the treatment of different risk locoregionally advanced nasopharyngeal carcinoma

2020 ◽  
Vol 12 ◽  
pp. 175883592092821
Author(s):  
Li-Ting Liu ◽  
Yu-Jing Liang ◽  
Shan-Shan Guo ◽  
Hao-Yuan Mo ◽  
Ling Guo ◽  
...  
Keyword(s):  
High Risk ◽  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Risk Group ◽  
Risk Groups ◽  
Rank Test ◽  
Intermediate Risk ◽  
Free Survival ◽  
Alternative Treatment Strategy

Background: This study aimed to investigate the efficiency and toxicities of concurrent chemoradiotherapy (CCRT) and induction chemotherapy (IC) followed by radiotherapy (RT) in different risk locoregionally advanced nasopharyngeal carcinoma (NPC). Methods: A total of 1814 eligible patients with stage II–IVB disease treated with CCRT or IC plus RT were included. The overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan–Meier method, and the differences were compared using the log-rank test. Results: Nomograms were developed to predict OS, PFS and DMFS (C-index: 0.71, 0.70 and 0.71, respectively). Patients were then divided into three different risk groups based on the scores calculated by the nomogram for OS. In the low and intermediate-risk group, no significant survival differences were observed between patients treated with IC plus RT alone and CCRT (5-year OS, 97.3% versus 95.6%, p = 0.642 and 87.6% versus 89.7%, p = 0.381, respectively; PFS, 95.9% versus 95.6%, p = 0.325 and 87.6% versus 89.0%, p = 0.160, respectively; DMFS, 97.2% versus 94.8%, p = 0.339 and 87.2% versus 89.3%, p = 0.628, respectively). However, in the high-risk group, IC plus RT displayed an unfavorable 5-year OS (71.0% versus 77.2%, p = 0.022) and PFS (69.4.0% versus 75.4%, p = 0.019) compared with CCRT. A significantly higher incidence of grade 3 and 4 adverse events was documented in patients treated with CCRT than in those treated with IC plus RT in all risk groups ( p = 0.040). Conclusion: IC followed by RT represents an alternative treatment strategy to CCRT for patients with low and intermediate-risk NPC, but it is not recommended for patients with high-risk NPC.

Sign in / Sign up

Export Citation Format

Share Document