Highlights • Computing power and data storage costs are continuously decreasing. • Electronic Health Records can now be used to create comprehensive phenotypic profiles. • Genomics can be correlated ...to these phenotypic profiles to better understand treatment response and toxicity. • Combining EHR and Genomics through Machine Learning could generate high-quality evidence for precision medicine. • These methods could be used to create a “learning health system” to predict the outcome of any treatment.
An increasing number of parameters can be considered when making decisions in oncology. Tumor characteristics can also be extracted from imaging through the use of radiomics and add to this wealth of ...clinical data. Machine learning can encompass these parameters and thus enhance clinical decision as well as radiotherapy workflow.
We performed a description of machine learning applications at each step of treatment by radiotherapy in head and neck cancers. We then performed a systematic review on radiomics and machine learning outcome prediction models in head and neck cancers.
Machine Learning has several promising applications in treatment planning with automatic organ at risk delineation improvements and adaptative radiotherapy workflow automation. It may also provide new approaches for Normal Tissue Complication Probability models. Radiomics may provide additional data on tumors for improved machine learning powered predictive models, not only on survival, but also on risk of distant metastasis, in field recurrence, HPV status and extra nodal spread. However, most studies provide preliminary data requiring further validation.
Promising perspectives arise from machine learning applications and radiomics based models, yet further data are necessary for their implementation in daily care.
Lung cancer represents the first cause of cancer-related death in the world. Radiomics studies arise rapidly in this late decade. The aim of this review is to identify important recent publications ...to be synthesized into a comprehensive review of the current status of radiomics in lung cancer at each step of the patients' care.
A literature review was conducted using PubMed/Medline for search of relevant peer-reviewed publications from January 2012 to June 2020.
We identified several studies at each point of patient's care: detection and classification of lung nodules (n=16), determination of histology and genomic (n=10) and finally treatment outcomes predictions (=23). We reported the methodology of those studies and their results and discuss the limitations and the progress to be made for clinical routine applications.
Promising perspectives arise from machine learning applications and radiomics based models in lung cancers, yet further data are necessary for their implementation in daily care. Multicentric collaboration and attention to quality and reproductivity of radiomics studies should be further consider.
Leveraging Electronic Health Records (EHR) and Oncology Information Systems (OIS) has great potential to generate hypotheses for cancer treatment, since they directly provide medical data on a large ...scale. In order to gather a significant amount of patients with a high level of clinical details, multicenter studies are necessary. A challenge in creating high quality Big Data studies involving several treatment centers is the lack of semantic interoperability between data sources. We present the ontology we developed to address this issue.
Radiation Oncology anatomical and target volumes were categorized in anatomical and treatment planning classes. International delineation guidelines specific to radiation oncology were used for lymph nodes areas and target volumes. Hierarchical classes were created to generate The Radiation Oncology Structures (ROS) Ontology. The ROS was then applied to the data from our institution.
Four hundred and seventeen classes were created with a maximum of 14 children classes (average = 5). The ontology was then converted into a Web Ontology Language (.owl) format and made available online on Bioportal and GitHub under an Apache 2.0 License. We extracted all structures delineated in our department since the opening in 2001. 20,758 structures were exported from our "record-and-verify" system, demonstrating a significant heterogeneity within a single center. All structures were matched to the ROS ontology before integration into our clinical data warehouse (CDW).
In this study we describe a new ontology, specific to radiation oncology, that reports all anatomical and treatment planning structures that can be delineated. This ontology will be used to integrate dosimetric data in the Assistance Publique-Hôpitaux de Paris CDW that stores data from 6.5 million patients (as of February 2017).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Stereotactic radiotherapy (SRT) is gaining increasing importance in metastatic non-small-cell lung cancer (mNSCLC) management. The optimal sequence of tumor irradiation relative to systemic treatment ...remains unclear. If waiting response evaluation to first-line systemic therapy (FLST) before considering local treatment may allow for the exclusion of poorer prognosis progressive tumors that may not benefit from SRT, performing irradiation near immune check point inhibitor (ICI) first administration seems to improve their synergic effect. Herein, we aimed to determine whether delaying SRT after response evaluation to FLST would result in better prognosis. We compared overall survival (OS), progression-free survival (PFS), and time to first subsequent therapy (TFST) for 50 patients locally treated before or within 90 days of initiating FLST (early SRT), with 49 patients treated at least 90 days after initiating FLST (late SRT). Patients treated with conventional chemotherapy alone exhibited significantly poorer median OS, PFS, and TFST in the early SRT arm: (in months) 16.5 8.33-NR vs. 58.3 35.05-NR (p = 0.0015); 4.69 3.57–8.98 vs. 8.20 6.66–12.00 (p = 0.017); and 6.26 4.82–11.8 vs. 10.0 7.44–21.8 (p = 0.0074), respectively. Patient receiving ICI showed no difference in OS (NR 25.2-NR vs. 36.6 35.1-NR, p = 0.79), PFS (7.54 6.23-NR vs. 4.07 2.52-NR, p = 0.19), and TFST (13.7 9.48-NR vs. 10.3 3.54-NR, p = 0.49). These results suggest that delaying SRT treatment in order to filter a rapidly growing tumor may be less necessary when ICI is administered in mNSCLC.
Abstract Background and purpose In 2003, the French Authority for Health (HAS) recommended the use of intensity modulated radiotherapy (IMRT) in prospective trial before its routine use. The Oncology ...and Radiotherapy Group for Head and Neck Cancer (GORTEC) proposed to evaluate prospectively acute and late toxicities, locoregional control and overall survival for patients treated for head and neck cancer (HNC) with IMRT and bilateral neck irradiation. Materials and methods Between 2002 and 2008, 208 patients with HNC were treated with IMRT in 8 centres. There were 38 nasopharynx, 117 oropharynx, 25 pharyngo-larynx, 24 oral cavity and 4 unknown primary (28.5% stage I–II and 71% Stage III–IV). Ninety-three patients (46%) had postoperative IMRT and 78 patients (37.5%) received concurrent chemotherapy. The doses were 70 Gy to the gross tumour, 66 Gy to the high-risk postoperative sites and 50 Gy to the subclinical disease. Toxicities were graded according to the RTOG–EORTC scales. Results The median follow-up was 25.3 months (range: 0.4–72 months). There were 29 local–regional failures: 24 were in-field, three were marginal and one was out-field. The two-year loco-regional control and overall survival were 86% and 86.7%, respectively. At 18 months, grade ⩾2 xerostomia was 16.1%. A mean dose to the spared parotid below 28 Gy led to significantly less grade ⩾2 xerostomia (8.5% vs 24%) with a relative risk of 1.2 95% CI: 1.02–1.41, p = 0.03. Grade ⩾2 xerostomia increased by approximately 3% per Gy of mean parotid dose up to 28, Gy then 7% per Gy above 33 Gy. Conclusions IMRT for HN cancer seems to reduce late toxicities without jeopardising local control and overall survival.
Background
Sarcopenia appears to be a negative prognostic factor for poor survival outcomes and worse treatment tolerance in patients with head‐and‐neck squamous cell carcinoma (HNSCC). We evaluated ...sarcopenia's impact on overall survival (OS), disease‐free survival (DFS) and chemo‐radiation tolerance in patients with head‐and‐neck cancer (HNC) treated with chemoradiotherapy (CRT) from a monocentric observational study.
Methods
We identified patients with HNC treated by CRT between 2009 and 2018 with pretreatment imaging using positron emission tomography–computed tomography scans (PET/CT). Sarcopenia was measured using the pretreatment PET/CT at the L3 vertebral body using previously published methods. Clinical variables were retrospectively retrieved.
Results
Of 216 patients identified, 54 patients (25.47%) met the criteria for sarcopenia. These patients had a lower mean body mass index before treatment (21.92 vs. 25.65 cm/m2, p < 0.001) and were more likely to have a history of smoking (88.89% vs. 71.52%, p = 0.01), alcohol use (55.56% vs. 38.61%, p = 0.03) and positive human papilloma virus status (67.74% vs. 41.75%, p = 0.011). At 3 years of follow‐up, OS and DFS were 75% and 70% versus 82% and 85% for sarcopenic and non‐sarcopenic patients, respectively (p = 0.1 and p = 0.00015). On multivariate analysis, sarcopenia appeared as a pejorative factor on DFS (hazard ratio 2.174, p = 0.0001) in the overall cohort. Sarcopenic patients did not require more chemotherapy and radiation‐treatment interruptions and did not suffer from more chemo‐induced and radiation‐induced grade 3–4 toxicities than their non‐sarcopenic counterparts.
Conclusion
Sarcopenia in HNSCC patients is an independent adverse prognostic factor for DFS after definitive chemoradiotherapy.
Sarcopenia in patients with head‐and‐neck squamous cell carcinoma treated by definitive chemoradiotherapy is an independent negative prognostic factor for disease‐free survival. Sarcopenic patients did not have more grade 3+ toxicities or more treatment interruptions.
There is no evidence to support surgery or radiotherapy as the best treatment for resectable oropharyngeal cancers with a negative HPV status. Predictive algorithms may help to decide which strategy ...to choose, but they will only be accepted by caregivers and European authorities if they are interpretable. As a proof of concept, we developed a predictive and interpretable algorithm to predict locoregional relapse at 18 months for oropharyngeal cancers as a first step towards that goal.
The model was based on clinical and Pyradiomics features extracted from the dosimetric CT scan. Intraclass correlation was used to filter out features dependant on delineation. Correlated redundant features were also removed. An XGBoost model was cross-validated and optimised on the HN1 cohort (79 patients), and performances were assessed on the ART ORL cohort (45 patients). The Shapley Values were used to provide an overall and local explanation of the model.
On the ART ORL cohort, the model trained on HN1 yielded a precision-or predictive positive value-of 0.92, a recall of 0.42, an area under the curve of the receiver operating characteristic of 0.68 and an accuracy of 0.64. The most contributory features were shape Voxel Volume, grey level size zone matrix Small Area Emphasis (glszmSAE), gldm Dependence Non Uniformity Normalized (gldmDNUN), Sex and Age.
We developed an interpretable and generalizable model that could yield a good precision-positive predictive value-for relapse at 18 months on a different test cohort.
Background and purpose: To review the literature on techniques used in high-dose radiotherapy of lung cancer in order to develop recommendations for clinical practice and for use in research ...protocols.
Patients and methods: A literature search was performed for articles and abstracts that were considered both clinically relevant and practical to use. The relevant information was arbitrarily categorized under the following headings: patient positioning, CT scanning, incorporating tumour mobility, definition of target volumes, radiotherapy planning, treatment delivery, and scoring of response and toxicity.
Results: Recommendations were made for each of the above steps from the published literature. Although most of the recommended techniques have yet to be evaluated in multicenter clinical trials, their use in high-dose radiotherapy to the thorax appears to be rational on the basis of current evidence.
Conclusions: Recommendations for the clinical implementation of high-dose conformal radiotherapy for lung tumours were identified in the literature. Procedures that are still considered to be investigational were also highlighted.
Avian trichomonosis is a common and widespread disease, traditionally affecting columbids and raptors, and recently emerging among finch populations mainly in Europe. Across Europe, finch ...trichomonosis is caused by a single clonal strain of Trichomonas gallinae and negatively impacts finch populations. Here, we report an outbreak of finch trichomonosis in the wintering populations of Chloris chloris (European greenfinch) and Carduelis carduelis (European goldfinch) from the Boulonnais, in northern France. The outbreak was detected and monitored by bird ringers during their wintering bird ringing protocols. A total of 105 records from 12 sites were collected during the first quarter of 2017, with 46 and 59 concerning dead and diseased birds, respectively. Fourteen carcasses from two locations were necropsied and screened for multiple pathogens; the only causative agent identified was T. gallinae. Genetic characterization was performed by four markers (small subunit ribosomal RNA, hydrogenosomal iron-hydrogenase, and RNA polymerase II subunit 1 genes, and the internal transcribed spacers (ITS) region) and confirmed the T. gallinae strain to be A1, which affects the finch populations of Europe. This was also confirmed by an ITS-based phylogenetic analysis which further illustrated the diversity of the Trichomonas infecting birds. Preliminary data on the survival and dispersion of infected birds were obtained from ring-returns of diseased individuals. The anthropogenic spread of diseases through bird feeding practices is highlighted and some suggestions to prevent pathogen transmission via backyard supplementary feeders for garden birds are given.
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