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Fractal-based radiomic approach to predict complete pathological response after chemo-radiotherapy in rectal cancer

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Abstract

The aim of this study was to propose a methodology to investigate the tumour heterogeneity and evaluate its ability to predict pathologically complete response (pCR) after chemo-radiotherapy (CRT) in locally advanced rectal cancer (LARC). This approach consisted in normalising the pixel intensities of the tumour and identifying the different sub-regions using an intensity-based thresholding. The spatial organisation of these subpopulations was quantified using the fractal dimension (FD). This approach was implemented in a radiomic workflow and applied to 198 T2-weighted pre-treatment magnetic resonance (MR) images of LARC patients. Three types of features were extracted from the gross tumour volume (GTV): morphological, statistical and fractal features. Feature selection was performed using the Wilcoxon test and a logistic regression model was calculated to predict the pCR probability after CRT. The model was elaborated considering the patients treated in two institutions: Fondazione Policlinico Universitario “Agostino Gemelli” of Rome (173 cases, training set) and University Medical Centre of Maastricht (25 cases, validation set). The results obtained showed that the fractal parameters of the subpopulations have the highest performance in predicting pCR. The predictive model elaborated had an area under the curve (AUC) equal to 0.77 ± 0.07. The model reliability was confirmed by the validation set (AUC = 0.79 ± 0.09). This study suggests that the fractal analysis can play an important role in radiomics, providing valuable information not only about the GTV structure, but also about its inner subpopulations.

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Funding

This study was not funded by any company.

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Authors and Affiliations

  1. Polo scienze delle immagini, di laboratorio e infettivologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy

    Davide Cusumano

  2. Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy

    Davide Cusumano, Luca Boldrini, Giuditta Chiloiro, Carlotta Masciocchi, Jacopo Lenkowicz & Vincenzo Valentini

  3. Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy

    Nicola Dinapoli, Roberto Gatta, Calogero Casà & Andrea Damiani

  4. Polo scienze delle immagini, di laboratorio e infettivologiche, Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy

    Luigi Azario & Marco De Spirito

  5. Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Johan Van Soest, Andre Dekker & Philippe Lambin

Authors
  1. Davide Cusumano
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  2. Nicola Dinapoli
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  3. Luca Boldrini
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  4. Giuditta Chiloiro
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  5. Roberto Gatta
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  6. Carlotta Masciocchi
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  7. Jacopo Lenkowicz
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  8. Calogero Casà
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  9. Andrea Damiani
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  10. Luigi Azario
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  11. Johan Van Soest
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  12. Andre Dekker
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  13. Philippe Lambin
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  14. Marco De Spirito
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  15. Vincenzo Valentini
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Corresponding author

Correspondence to Giuditta Chiloiro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all the individual participants.

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Cusumano, D., Dinapoli, N., Boldrini, L. et al. Fractal-based radiomic approach to predict complete pathological response after chemo-radiotherapy in rectal cancer. Radiol med 123, 286–295 (2018). https://doi.org/10.1007/s11547-017-0838-3

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  • DOI: https://doi.org/10.1007/s11547-017-0838-3

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