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Kasai A, Miyoshi J, Sato Y, Okamoto K, Miyamoto H, Kawanaka T, Tonoiso C, Harada M, Goto M, Yoshida T, Haga A, Takayama T. A novel CT-based radiomics model for predicting response and prognosis of chemoradiotherapy in esophageal squamous cell carcinoma. Sci Rep 2024; 14:2039. [PMID: 38263395 PMCID: PMC10806175 DOI: 10.1038/s41598-024-52418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
No clinically relevant biomarker has been identified for predicting the response of esophageal squamous cell carcinoma (ESCC) to chemoradiotherapy (CRT). Herein, we established a CT-based radiomics model with artificial intelligence (AI) to predict the response and prognosis of CRT in ESCC. A total of 44 ESCC patients (stage I-IV) were enrolled in this study; training (n = 27) and validation (n = 17) cohorts. First, we extracted a total of 476 radiomics features from three-dimensional CT images of cancer lesions in training cohort, selected 110 features associated with the CRT response by ROC analysis (AUC ≥ 0.7) and identified 12 independent features, excluding correlated features by Pearson's correlation analysis (r ≥ 0.7). Based on the 12 features, we constructed 5 prediction models of different machine learning algorithms (Random Forest (RF), Ridge Regression, Naive Bayes, Support Vector Machine, and Artificial Neural Network models). Among those, the RF model showed the highest AUC in the training cohort (0.99 [95%CI 0.86-1.00]) as well as in the validation cohort (0.92 [95%CI 0.71-0.99]) to predict the CRT response. Additionally, Kaplan-Meyer analysis of the validation cohort and all the patient data showed significantly longer progression-free and overall survival in the high-prediction score group compared with the low-prediction score group in the RF model. Univariate and multivariate analyses revealed that the radiomics prediction score and lymph node metastasis were independent prognostic biomarkers for CRT of ESCC. In conclusion, we have developed a CT-based radiomics model using AI, which may have the potential to predict the CRT response as well as the prognosis for ESCC patients with non-invasiveness and cost-effectiveness.
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Affiliation(s)
- Akinari Kasai
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Jinsei Miyoshi
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
- Department of Gastroenterology, Kawashima Hospital, 6-1 Kitasakoichiban-cho, Tokushima, 770-0011, Japan
| | - Yasushi Sato
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Koichi Okamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takashi Kawanaka
- Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Chisato Tonoiso
- Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masakazu Goto
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takahiro Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
- Yoshida Clinic, 1-18 shinuchimachi, Tokushima, 770-0845, Japan
| | - Akihiro Haga
- Department of Medical Image Informatics, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
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Matsumoto T, Noma K, Maeda N, Kato T, Moriwake K, Kawasaki K, Hashimoto M, Tanabe S, Shirakawa Y, Fujiwara T. Safe and curative modified two-stage operation for T4 esophageal cancer after definitive chemoradiotherapy: a case report. Surg Case Rep 2023; 9:119. [PMID: 37358692 DOI: 10.1186/s40792-023-01692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND The prognosis of esophageal cancer (EC) with organ invasion is extremely poor. In these cases, definitive chemoradiotherapy (CRT) followed by salvage surgery can be planned; however, the issue of high morbidity and mortality rates persists. Herein, we report the long-term survival of a patient with EC and T4 invasion who underwent a modified two-stage operation after definitive CRT. CASE PRESENTATION A 60-year-old male presented with type 2 upper thoracic EC with tracheal invasion. First, definitive CRT was performed, which resulted in tumor shrinkage and improvement in the tracheal invasion. However, an esophagotracheal fistula subsequently developed, and the patient was treated with fasting and antibiotics. Although the fistula recovered, severe esophageal stenoses made oral intake impossible. To improve quality of life and cure the EC, a modified two-stage operation was planned. In the first surgery, an esophageal bypass was performed using a gastric tube with cervical and abdominal lymph node dissections. After confirming improved nutritional status and absence of distant metastasis, the second surgery was performed with subtotal esophagectomy, mediastinal lymph node dissection, and tracheobronchial coverage of the fistula. The patient discharged without major complications after radical resection and has been recurrence-free for 5 years since the start of treatment. CONCLUSION A standard curative strategy could be difficult for EC with T4 invasion due to differences in the invaded organs, presence of complications, and patient condition. Therefore, patient-tailored treatment plans are needed, including a modified two-stage operation.
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Affiliation(s)
- Tasuku Matsumoto
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Kazuhiro Noma
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Naoaki Maeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Takuya Kato
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Kazuya Moriwake
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Kento Kawasaki
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Masashi Hashimoto
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Shunsuke Tanabe
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Yasuhiro Shirakawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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Bostel T, Akbaba S, Wollschläger D, Mayer A, Nikolaidou E, Murnik M, Kirste S, Rühle A, Grosu AL, Debus J, Fottner C, Moehler M, Grimminger P, Schmidberger H, Nicolay NH. Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly. Front Oncol 2023; 13:1063670. [PMID: 36937445 PMCID: PMC10022427 DOI: 10.3389/fonc.2023.1063670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
Background and purpose To evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC). Materials and methods This multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed. Results The delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001). Conclusions Chemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort.
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Affiliation(s)
- Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
- *Correspondence: Tilman Bostel,
| | - Sati Akbaba
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Daniel Wollschläger
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Arnulf Mayer
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Eirini Nikolaidou
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Markus Murnik
- Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Simon Kirste
- Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Heidelberg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Christian Fottner
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Markus Moehler
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Peter Grimminger
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany
- German Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
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Li YT, Lee WL, Wang PH. Is it possible to increase detection rate of esophageal precancer or cancer lesions in the high-risk population? J Chin Med Assoc 2021; 84:1075-1077. [PMID: 34654018 DOI: 10.1097/jcma.0000000000000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan, ROC
| | - Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
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Chou FW, Chang WH, Wang PH. Was capsule penetration of locally advanced renal cell carcinoma associated with recurrence in patients undergoing curative surgery? J Chin Med Assoc 2021; 84:664. [PMID: 33901123 DOI: 10.1097/jcma.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Fang-Wei Chou
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
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