Abstract 2582: Intra- and peri-tumoral radiomic features are predictive of pathologic response to multiple neoadjuvant therapy regimen in rectal cancers via pre-treatment MRI
Authors: Bao Leo , DeSilvio Thomas , Parker Benjamin N. , Hariri Mohsen , Chirra Prathyush , Labbad Murad , Tang Stephen , O'Connor Gregory M. , Steinhagen Emily , Miller-Ocuin Jennifer L. , Gupta Amit , Marderstein Eric L. , Carroll Aaron , Crittenden Marka , Gough Michael J. , Krishnamurthi Smitha , Young Kristina H. , Viswanath Satish E. 
Published: March 2024

Abstract
Introduction: Rectal cancers undergo neoadjuvant chemoradiation prior to resection, with increasing evidence that neoadjuvant chemotherapy or immunotherapy can boost clinical or pathologic response rates. However, baseline clinical tumor staging and carcinoembryonic antigen levels are limited for identifying which patients will most benefit from a multimodal neoadjuvant regimen, and which will not. We evaluated whether radiomics (computational features from radiographic images) from pretreatment MRI could identify which rectal cancer patients will achieve clinical or pathologic response to different neoadjuvant treatment regimens.
Methods: MRI scans were retrospectively obtained from 3 different institutions for rectal cancer patients who had either undergone neoadjuvant chemoradiation or an experimental immunotherapy + chemoradiation. After pre-processing all MRI scans, tumor was manually delineated with an automated annotation of a 10 mm peritumor region. 916 radiomic features were extracted from two planes of acquisition (axial, coronal) and two ROIs (tumor, peritumor). 5 top-ranked radiomic features were identified from each region and plane via multi-stage mutual information feature selection to train a linear discriminant machine classifier to assign a predicted likelihood of achieving complete response to each patient. Model performance was validated via ROC analysis against response groups defined via (i) tumor regression grade indicating no tumor present on surgical pathology, and (ii) 1-year clinical complete response for patients who underwent non-operative management. Clinical variables (CEA, clinical stage) were statistically compared between response groups.
Results: Training cohort comprised 64 patients who underwent chemoradiation alone (2 institutions, median age 61 yrs, M:F:MtF = 36:27:1). Validation cohort included 37 patients who underwent experimental TGFß inhibitor therapy prior to chemotherapy + chemoradiation (1 institution, median age 51 yrs, M:F = 25:12). Area under the ROC curve for multi-plane tumor+peritumor radiomic features (0.765 ± 0.054) was significantly higher for distinguishing complete response vs non/partial response compared to tumor (AUC = 0.635 ± 0.057, p &lt; 0.0001) or peritumor (AUC = 0.612 ± 0.064, p &lt; 0.0001). In holdout validation, performance was maintained with AUCs of 0.742 (tumor) 0.596 (peritumor), and 0.700 (all), respectively. Baseline CEA levels (p=0.3385) and cT stage (p=0.3386) were found to lack statistical significance as a predictor of response.
Conclusion: Radiomic features from tumor and peritumor regions on pre-treatment MRI scans in rectal cancer patients may enable robust and accurate identification of pathologic or near-complete response after multiple neoadjuvant treatment regimen, while outperforming baseline clinical variables.
Citation Format: Leo Bao, Thomas DeSilvio, Benjamin N. Parker, Mohsen Hariri, Prathyush Chirra, Murad Labbad, Stephen Tang, Gregory M. O'Connor, Emily Steinhagen, Jennifer L. Miller-Ocuin, Amit Gupta, Eric L. Marderstein, Aaron Carroll, Marka Crittenden, Michael J. Gough, Smitha Krishnamurthi, Kristina H. Young, Satish E. Viswanath. Intra- and peri-tumoral radiomic features are predictive of pathologic response to multiple neoadjuvant therapy regimen in rectal cancers via pre-treatment MRI [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2582.