Comparison of PET and CT radiomics for prediction of local tumor control in head and neck squamous cell carcinoma.

PURPOSE: An association between radiomic features extracted from CT and local tumor control in the head and neck squamous cell carcinoma (HNSCC) has been shown. This study investigated the value of pretreatment functional imaging (18F-FDG PET) radiomics for modeling of local tumor control.

MATERIAL AND METHODS: Data from HNSCC patients (n = 121) treated with definitive radiochemotherapy were used for model training. In total, 569 radiomic features were extracted from both contrast-enhanced CT and 18F-FDG PET images in the primary tumor region. CT, PET and combined PET/CT radiomic models to assess local tumor control were trained separately. Five feature selection and three classification methods were implemented. The performance of the models was quantified using concordance index (CI) in 5-fold cross validation in the training cohort. The best models, per image modality, were compared and verified in the independent validation cohort (n = 51). The difference in CI was investigated using bootstrapping. Additionally, the observed and radiomics-based estimated probabilities of local tumor control were compared between two risk groups.

RESULTS: The feature selection using principal component analysis and the classification based on the multivariabale Cox regression with backward selection of the variables resulted in the best models for all image modalities (CICT  = 0.72, CIPET  = 0.74, CIPET/CT  = 0.77). Tumors more homogenous in CT density (decreased GLSZMsize_zone_entropy ) and with a focused region of high FDG uptake (higher GLSZMSZLGE ) indicated better prognosis. No significant difference in the performance of the models in the validation cohort was observed (CICT  = 0.73, CIPET  = 0.71, CIPET/CT  = 0.73). However, the CT radiomics-based model overestimated the probability of tumor control in the poor prognostic group (predicted  = 68%, observed  = 56%).

CONCLUSIONS: Both CT and PET radiomics showed equally good discriminative power for local tumor control modeling in HNSCC. However, CT-based predictions overestimated the local control rate in the poor prognostic validation cohort, and thus, we recommend to base the local control modeling on the 18F-FDG PET.