Assessment Of Treatment Effect For Esophageal Carcinoma Based On The Changes Of Texture Features Of Daily Diagnostic-quality Computed Tomography During Radiation Therapy

Objectives1.To analyze the changes of texture features in esophageal squamous cell carcinoma(ESC),normal esophageal mucosa tissue(NEC)and organ at risk(cord)during radiotherapy.2.To analyze the relationship between the changes of texture features and radiosensitivity in esophageal squamous cell carcinoma during radiotherapy.3.To analyze the relationship between the changes of texture features and survival in esophageal squamous cell carcinoma during radiotherapy.4.To analyze the changes of texture features comprehensively in order to find out the imaging indexes that affected the radiotherapy sensitivity and survival rate of esophageal squamous cell carcinoma.Methods1.Patients with esophageal squamous cell carcinoma who received radical radiotherapy in our hospital from August 2013 to September 2015 were screened.61 patients eligible for IGRT radiotherapy were included in the analysis.2.61 patients were followed up by telephone,and the images(CT,MRI,digestive tract angiography,endoscopic ultrasonography,etc.)were obtained from HIS system.The early radiotherapy response was evaluated according to the WHO treatment response evaluation standard of solid tumor.3.During radiotherapy,CT images(4 to 6 times)were transmitted to MIM system every week.The tissue contours of esophageal squamous cell carcinoma were outlined by endoscopic ultrasonography,MRI,CT and digestive tract angiography.The normal esophageal mucosa of 5cm and the spinal cord of the corresponding area were selected from the tumor tissue for contour delineation.4.CUBETAB developed by MATLAB(ver 2017)was used to conduct the radiomics texture analysis,including average CT value(MCTN),volume,standard deviation(SD),skewness,kurtosis,entropy,coarseness,busyness,complexity and strength.5.The relationship between texture features and radiotherapy sensitivity and survival was analyzed.6.A t-test was used to analyze whether there was a significant difference between the data,and Pearson correlation analysis was used to analyze the correlation between features and survival.Results1.Texture features of esophageal squamous cell carcinoma changed significantly during radiotherapy.MCTN decreased by 2.06 ± 6.68HU(P = 0.02),coarseness increased by 0.00072 ± 0.00197)(P < 0.0001),SD increased by 1.99 ±6.35HU(P = 0.0184),and entropy increased by 0.14 ± 0.40(P = 0.0064).The average increase of strength was 2.34 ± 3.56(P < 0.0001),the average increase of skewness was 0.17 ± 0.55HU(P = 0.0216),the average decrease of volume was 8.88 ± 15.71cc(P < 0.0001),and the average decrease of busyness was 0.07 ± 0.11(P < 0.0001).2.The changes of coarseness,strength,SD and entropy of esophageal squamous cell carcinoma in patients with radiotherapy sensitivity(CR+PR)changed significantly at the 3rd and 4th week of radiotherapy,with an average of 0.00064,2.10,0.15 HU and 2.11,Statistical analysis showed significant difference(P = 0.0061,0.0086,0.018 and 0.0002).3.Statistical analysis showed that the survival of the patients was significantly correlated with coarseness and strength(r = 0.9572,P = 0.0027 and r = 0.9917,P = 0.0001).4.Statistical analysis showed that the survival rate of patients with smaller changes of MCTN was higher than that of patients with larger changes(P = 0.0208).ConclusionThe texture features of CT images of esophageal squamous cell carcinoma changed during radiotherapy,among which coarseness,strength,SD,entropy and volume changed significantly.It was found that they were related to radiotherapy sensitivity and survival.Coarseness and strength may be imaging indexes to predict the curative effect of esophageal squamous cell carcinoma.