Radiomic Analysis of Treatment Effect for Patients with Radiation Necrosis Treated with Pentoxifylline and Vitamin E.

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Tomography Pub Date : 2024-09-09 DOI:10.3390/tomography10090110

Jimmy S Patel, Elahheh Salari, Xuxin Chen, Jeffrey Switchenko, Bree R Eaton, Jim Zhong, Xiaofeng Yang, Hui-Kuo G Shu, Lisa J Sudmeier

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引用次数: 0

Abstract

Background: The combination of oral pentoxifylline (Ptx) and vitamin E (VitE) has been used to treat radiation-induced fibrosis and soft tissue injury. Here, we review outcomes and perform a radiomic analysis of treatment effects in patients prescribed Ptx + VitE at our institution for the treatment of radiation necrosis (RN).

Methods: A total of 48 patients treated with stereotactic radiosurgery (SRS) had evidence of RN and had MRI before and after starting Ptx + VitE. The radiation oncologist's impression of the imaging in the electronic medical record was used to score response to treatment. Support Vector Machine (SVM) was used to train a model of radiomics features derived from radiation necrosis on pre- and 1st post-treatment T1 post-contrast MRIs that can classify the ultimate response to treatment with Ptx + VitE.

Results: A total of 43.8% of patients showed evidence of improvement, 18.8% showed no change, and 25% showed worsening RN upon imaging after starting Ptx + VitE. The median time-to-response assessment was 3.17 months. Nine patients progressed significantly and required Bevacizumab, hyperbaric oxygen therapy, or surgery. Patients who had multiple lesions treated with SRS were less likely to show improvement (p = 0.037). A total of 34 patients were also prescribed dexamethasone, either before (7), with (16), or after starting (11) treatment. The use of dexamethasone was not associated with an improved response to Ptx + VitE (p = 0.471). Three patients stopped treatment due to side effects. Finally, we were able to develop a machine learning (SVM) model of radiomic features derived from pre- and 1st post-treatment MRIs that was able to predict the ultimate treatment response to Ptx + VitE with receiver operating characteristic (ROC) area under curve (AUC) of 0.69.

Conclusions: Ptx + VitE appears safe for the treatment of RN, but randomized data are needed to assess efficacy and validate radiomic models, which may assist with prognostication.

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使用五氧化锡和维生素 E 治疗放射性坏死患者的放射线组学疗效分析

背景：口服喷托维林（Ptx）和维生素 E（VitE）已被用于治疗辐射引起的纤维化和软组织损伤。在此，我们回顾了本院为治疗放射性坏死（RN）而处方 Ptx + VitE 的患者的治疗结果，并对治疗效果进行了放射学分析：共有 48 名接受立体定向放射手术（SRS）治疗的患者有 RN 证据，并在开始使用 Ptx + VitE 之前和之后进行了 MRI 检查。放射肿瘤学家根据电子病历中的影像印象对治疗反应进行评分。支持向量机（SVM）用于训练治疗前和治疗后第一次 T1 后对比 MRI 上辐射坏死得出的放射组学特征模型，该模型可对 Ptx + VitE 治疗的最终反应进行分类：结果：43.8%的患者在开始Ptx + VitE治疗后的影像学检查中显示病情有所改善，18.8%的患者病情无变化，25%的患者RN病情恶化。中位反应评估时间为 3.17 个月。有九名患者病情明显恶化，需要使用贝伐单抗、高压氧治疗或手术治疗。多个病灶接受 SRS 治疗的患者病情改善的可能性较小（p = 0.037）。共有 34 名患者在治疗前（7 人）、治疗中（16 人）或治疗后（11 人）使用了地塞米松。地塞米松的使用与 Ptx + VitE 反应的改善无关（p = 0.471）。三名患者因副作用停止了治疗。最后，我们开发出了一个机器学习（SVM）模型，该模型由治疗前和治疗后第一次核磁共振成像得出的放射学特征组成，能够预测 Ptx + VitE 的最终治疗反应，其接收器操作特征曲线下面积（AUC）为 0.69：Ptx+VitE治疗RN似乎是安全的，但需要随机数据来评估疗效和验证放射学模型，这可能有助于预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Tomography Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

2.70

自引率

10.50%

发文量

222

期刊介绍： TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.