Radiomics to predict tumor response to combination chemoradiotherapy in squamous cell carcinoma of the anal canal: a preliminary investigation

BackgroundUpfront combination chemoradiotherapy (CRT) represents the standard of care for patients affected by stage III squamous cell carcinoma (SCC) of the anal canal, achieving satisfactory results both in terms of overall survival and local disease control. However, a non-negligible fraction of patients obtain incomplete responses, highlighting the need for innovative prognostic tools. We report the preliminary results of a customized radiomic algorithm designed to predict tumor response to CRT in patients affected by SCC of the anal canal.MethodsWe manually annotated pretreatment T2-weighted turbo spin-echo images of 26 consecutive patients with stage III SCC of the anal canal treated with CRT at our institution from 2012 to 2022. Each patient was classified as complete response (CR, 17 patients), or non-complete response (non-CR, 9 patients) based on the absence or presence of residual disease at imaging and endoscopy after treatment. A total of 132 three-dimensional radiomic features were extracted for each patient and fed to a dedicated machine-learning classifier.ResultsModels trained with gray-level co-occurrence matrix features achieved the best performances (accuracy 0.846 +/- 0.064, sensitivity 0.900 +/- 0.122, specificity 0.833 +/- 0.175, area under receiver operating characteristics curve 0.867 +/- 0.055), highlighting a more homogeneous distribution of voxel intensities and lower spatial complexity in non-CR patients.ConclusionOur radiomic tool accurately predicted tumor response to CRT in patients with stage III SCC of the anal canal, highlighting a more homogeneous tissue composition in poor responders.Relevance statementThe more homogeneous radiomic texture observed in non-CR patients may be imputable to a dominant neoplastic clone with a relatively low mitotic index (therefore, limited tissue necrosis), intrinsically more resistant to CRT than faster-proliferating tumors.Key PointA non-negligible fraction of patients with anal SCC respond unsatisfactorily to CRT.Our radiomic model predicted response to CRT based on pretreatment MRI.We observed a more homogeneous tissue composition in poor responders.The slow proliferation of a dominant clone may explain non-CR to CRT.