Helping Cancer Patients Avoid Excessive Radiation

A team of scientists led by Case Western Reserve University has used artificial intelligence (AI) to determine which head and neck cancer patients could benefit from reducing the intensity of treatments such as radiation and chemotherapy
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The researchers used artificial intelligence tools similar to those they have developed over the past decade at the Case Western Reserve Center for Computational Imaging and Personal Diagnostics (CCIPD)
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In this case, they asked computers to analyze digitized images of tissue samples taken from 439 patients in six hospital systems with a type of head and neck cancer known as human papillomavirus (HPV)-associated of oropharyngeal squamous cell carcinoma (OPCSCC)
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A computer program has successfully identified a group of patients who may benefit from significantly reduced radiation therapy doses
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While this analysis is retrospective—that is, computers analyze data from patients where the end result is known—the researchers say their next step may be to test them in clinical trials.
accuracy
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Their research was recently published in the Journal of the National Cancer Institute
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The work was led by CCIPD Director Anant Madabhushi, Donnell Institute Professor of Biomedical Engineering in the Case School of Engineering, and Germán Corredor Prada, a research associate in the CCIPD lab
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While most patients with HPV-driven cancers will still benefit from aggressive treatment -- and those whose cancers are not virus-related -- the researchers say their study reveals that a significant group is receiving more treatment than they need to More aggressive treatment for good results
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Clinicians cannot simply differentiate from a mere tissue scan, the researchers said
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As a result, nearly all of these cancer patients—whether caused by HPV or not—received a full course of chemotherapy and radiation therapy

"We overdose chemotherapy and radiation on many patients who didn't need it because we had no way of finding out which patients would benefit from de-escalation," Madabhushi said
.
"What we're saying now is, we're doing it now.
— One day, doctors could adjust the way we care for patients, not just giving everyone the standard high doses of radiation that come in

For these patients, reducing radiation could also help reduce the "toxicity of radiation therapy," which means they can experience fewer side effects such as dry mouth, swallowing dysfunction and changes in taste, Madabhushi said

"There are already ongoing national clinical trials investigating how to reduce the intensity of radiation therapy and chemotherapy in patients with HPV-positive oropharyngeal cancer," said Shlomo Koyfman, director of radiation therapy for head, neck and skin cancers at the Cleveland Clinic and a collaborator on the study
.
, correctly selecting the ideal patients for this treatment reduction has always been a challenge

10 colleges and universities cooperate

Other researchers are already testing whether lowering the intensity of treatment could benefit some patients, Corredor said

"Maybe we can reduce the intensity of treatment for some people and give them a better quality of life, because chemotherapy and radiation often have very strong side effects," Corredor said
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More than 20 other scientists were involved in the study, including six from the Case Western Reserve
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"For a long time, we have been able to observe a patient's tumor with a microscope, but now, with this technology, we can extract meaningful information from the morphology that can be helpful in prognosis and prediction
.
" Vanderbilt said study collaborator James Lewis Jr.

There are also scientists and physicians from Veterans Affairs (VA) Medical Centers in Cleveland and San Francisco; Baylor College of Medicine; Permanent Medical Group of Southern California; University of Texas Southwestern Medical Center; University of California, San Diego; and Washington University in St.
Louis
.

HPV

According to the World Health Organization, head and neck cancer accounts for more than 500,000 cases and 300,000 deaths each year, making it the sixth leading cancer worldwide
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HPV is the most common sexually transmitted infection (STI), infecting about 43 million people in 2018, and according to the Centers for Disease Control , HPV accounts for about 75 percent of oropharyngeal cancer cases in the United States
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Imaging biomarkers isolated from routine digitized pathology slides by a team led by Case Western Reserve will reveal HPV-related cancer patients who can avoid harsher treatments and receive low doses of radiation or no treatment at all radiation
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The system was able to accurately define "the spatial arrangement or structure of lymphocytes surrounding cancer cells," Corredor said
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Lymphocytes, a type of white blood cell, are part of the immune system that attack invading bacteria, viruses, and toxins

The new work also builds on previous CCIPD research that developed novel imaging biomarkers for risk stratification and prognosis prediction in head and neck cancer, with a paper published earlier this year in the Journal of Clinical Investigation Another in the journal Oncology .

article title

An Imaging Biomarker of Tumor-Infiltrating Lymphocytes to Risk-Stratify Patients With HPV-Associated Oropharyngeal Cancer