T2-based MRI Delta-Radiomics Improve Response Prediction in Soft-Tissue Sarcomas Treated by Neoadjuvant Chemotherapy

International audienceBackground: Standard of care for patients with high-grade soft-tissue sarcoma (STS) are being redefined since neoadjuvant chemotherapy (NAC) has demonstrated a positive effect on patients’ outcome. Yet, response evaluation in clinical trials still remains on RECIST criteria. Purpose: To investigate the added value of a Delta-radiomics approach for early response prediction in patients with STS undergoing NAC Study type: Retrospective Population: 65 adult patients with newly-diagnosed, locally-advanced, histologically proven high-grade STS of trunk and extremities. All were treated by anthracycline-based NAC followed by surgery and had available MRI at baseline and after 2 cycles.Field strength/Sequence: Pre- and post-contrast enhanced T1-weighted imaging (T1-WI), turbo spin echo T2-WI at 1.5T.Assessment: A threshold of <10% viable cells on surgical specimen defined good response (Good-HR). Two senior radiologists performed a semantic analysis of the MRI. After 3D manual segmentation of tumors at baseline and early evaluation, and standardization of voxelsizes and intensities, absolute changes in 33 texture and shape features were calculated. Statistical tests: Classification models based on logistic regression, support vector machine, k-nearest neighbors and random forests were elaborated using cross-validation (training and validation) on 50 patients (‘training cohort’) and was validated on 15 other patients (‘test cohort’).Results: 16 patients were good-HR. Neither RECIST status, nor semantic radiological variables were associated with response except an edema decrease (p=0.003) although 14 shape and texture features were (range of p-values: 0.002-0.037). On the training cohort, the highest diagnostic performances were obtained with random forests built on 3 features: Δ_Histogram_Entropy, Δ_Elongation, Δ_Surrounding_Edema, which provided: AUROC=0.86, accuracy=88.1%, sensitivity=94.1%, specificity=66.3%. On the test cohort, this model provided an accuracy of 74.6% but 3/5 good-HR were systematically ill-classified. Data conclusions: A T2-based Delta-Radiomics approach can improve early response prediction in STS patients with a limited number of features

What scans we will read: imaging instrumentation trends in clinical oncology

Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non- invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/ CT), advanced MRI, optical or ultrasound imaging. This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now. Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by progress in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as “data”, and – through the wider adoption of advanced analysis, including machine learning approaches and a “big data” concept – move to the next stage of non-invasive tumor phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi- dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging

The wife of a physically challenged husband: A study of her perceptions and adjustments

This descriptive study is about the perceptions and adjustments of wives of physically challenged husbands. The researchers used in-depth interview in obtaining the data essential for the study. There were nine respondents that were chosen through the use of snowball or chain referral technique. Six (6) respondents came from the low income family while three (3) from the middle income family. From the results that were gathered and analyzed, the researchers found out that financial difficulty was the main problem that each respondents faced when their husbands became physically disabled. Other problems also arose such as having more responsibilities as the consequences brought about by the said disability. Factors that contributed to the wife\u27s adjustments after her husband\u27s disability were also revealed. Psychological, emotional and physical effects of the husband\u27s disability on the wife were also looked into

Adjuvant or Salvage Radiation Therapy for Prostate Cancer after Prostatectomy: Current Status, Controversies and Perspectives

Nearly one-third of the patients who undergo prostatectomy for prostate cancer have a biochemical recurrence (BCR) during follow-up. While several randomized trials have shown that adjuvant radiation therapy (aRT) improves biochemical control, this strategy has not been widely used because of the risk of toxicity and the fear of overtreating patients who would not have relapsed. In addition, the possibility of close PSA monitoring in the era of ultrasensitive assays enables to anticipate early salvage strategies (sRT). Three recent randomized trials and their meta-analysis have confirmed that aRT does not improve event-free survival compared to sRT, imposing the latter as the new standard of treatment. The addition of androgen deprivation therapy (ADT) to RT has been shown to improve biochemical control and metastasis-free survival, but the precise definition of to whom it should be proposed is still a matter of debate. The development of genomic tests or the use of artificial intelligence will allow more individualized treatment in the future. Therapeutic intensification with the combination of new-generation hormone therapy and RT is under study. Finally, the growing importance of metabolic imaging (PET/CT) due to its performance especially for low PSA levels will help in further personalizing management strategies

Rethinking the role of clinical imaging

Radiomics has the potential to improve the management of cancer patients, but further research is required before it can be adopted into routine clinical practice