Harnessing deep learning to optimize induction chemotherapy choices in nasopharyngeal carcinoma

BACKGROUND: Currently, there is no guidance for personalized choice of induction chemotherapy (IC) regimens (TPF, docetaxel + cisplatin + 5-Fu; or GP, gemcitabine + cisplatin) for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). This study aimed to develop deep learning models for IC response prediction in LA-NPC. METHODS: For 1438 LA-NPC patients, pretreatment magnetic resonance imaging (MRI) scans and complete biological response (cBR) information after 3 cycles of IC were collected from two centers. All models were trained in 969 patients (TPF: 548, GP: 421), and internally validated in 243 patients (TPF: 138, GP: 105), then tested on an internal dataset of 226 patients (TPF: 125, GP: 101). MRI models for the TPF and GP cohorts were constructed to predict cBR from MRI using radiomics and graph convolutional network (GCN). The MRI-Clinical models were built based on both MRI and clinical parameters. RESULTS: The MRI models and MRI-Clinical models achieved high discriminative accuracy in both TPF cohorts (MRI model: AUC, 0.835; MRI-Clinical model: AUC, 0.838) and GP cohorts (MRI model: AUC, 0.764; MRI-Clinical model: AUC, 0.777). The MRI-Clinical models also showed good performance in the risk stratification. The survival curve revealed that the 3-year disease-free survival of the high-sensitivity group was better than that of the low-sensitivity group in both the TPF and GP cohorts. An online tool guiding personalized choice of IC regimen was developed based on MRI-Clinical models. CONCLUSIONS: Our radiomics and GCN-based IC response prediction tool has robust predictive performance and may provide guidance for personalized treatment.