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Identifying the optimal time point for adaptive re-planning in prostate cancer radiotherapy to minimise rectal toxicity using normal tissue imaging biomarkers
Yang, Z. Noble, D. J. Elliot, S. Shelley, L. Berger, T. Jena, R. McLaren, D. B. Burnet, N. G. Nailon, W. H.
Yang, Z.
Noble, D. J.
Elliot, S.
Shelley, L.
Berger, T.
Jena, R.
McLaren, D. B.
Burnet, N. G.
Nailon, W. H.
Abstract
BACKGROUND AND PURPOSE: Adaptive radiotherapy (ART) in prostate cancer (PCa), although not yet standard practice, is typically triggered by inter-fractional anatomical changes that emerge progressively during treatment. This study investigates whether radiomics extracted before and during treatment can identify the optimal time point for re-planning, with the goal of reducing late rectal bleeding. MATERIALS AND METHODS: This study included 187 PCa patients from the single-centre, prospectively collected VoxTox dataset (UK-CRN-ID-13716), treated with image-guided radiotherapy using TomoTherapy and daily MVCT. Patients received either 74 Gy in 37 fractions (N = 110) or 60 Gy in 20 fractions (N = 77). Radiomic features were extracted from pre-treatment planning CTs and daily MVCTs. Grade ≥ 1 rectal bleeding was assessed at 2 years post-treatment using CTCAE v4.03. Two analysis strategies were employed: a separate analysis, where weekly features were evaluated independently; and a cumulative analysis, which progressively incorporated features from previous weeks. Logistic regression models with elastic net penalty were trained and evaluated using AUC. RESULTS: In both groups, week 1 provided the highest standalone predictive performance (test AUC = 0.766 for 74 Gy; 0.734 for 60 Gy). In the cumulative analysis, week 3 was optimal for the 74 Gy group (test AUC = 0.767), balancing performance and timing. For the 60 Gy group, week 1 remained optimal but suffered from reduced generalisability (test AUC = 0.643). CONCLUSIONS: Radiomic analysis of daily imaging can support early, proactive ART in PCa, offering a personalised strategy to reduce late rectal bleeding beyond conventional anatomy-based approaches.
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Date
2025
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Article
Citation
Yang Z, Noble DJ, Elliot S, Shelley L, Berger T, Jena R, et al. Identifying the optimal time point for adaptive re-planning in prostate cancer radiotherapy to minimise rectal toxicity using normal tissue imaging biomarkers. Physics and imaging in radiation oncology. 2025 Oct;36:100850. PubMed PMID: 41141224. Pubmed Central PMCID: PMC12547930. Epub 2025/10/27. eng.