Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2025
Improving risk assessment of local failure in brain metastases patients using vision transformers - A multicentric development and validation study.
СтатьяМногоцентровое исследованиеВалидационное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Erdur Ayhan Can, Scholz Daniel, Nguyen Q Mai, Buchner Josef A, Mayinger Michael, Christ Sebastian M, Brunner Thomas B, Wittig Andrea, Zimmer Claus, Meyer Bernhard, Guckenberger Matthias, Andratschke Nicolaus, El Shafie Rami A, Debus J Urgen, Rogers Susanne, Riesterer Oliver, Schulze Katrin, Feldmann Horst J, Blanck Oliver, Zamboglou Constantinos, Bilger-Z Angelika, Grosu Anca L, Wolff Robert, Eitz Kerstin A, Combs Stephanie E, Bernhardt Denise, Wiestler Benedikt, Rueckert Daniel, Peeken Jan C
Аннотация
BACKGROUND AND PURPOSE: This study investigates the use of Vision Transformers (ViTs) to predict Freedom from Local Failure (FFLF) in patients with brain metastases using pre-operative MRI scans. The goal is to develop a model that enhances risk stratification and informs personalized treatment strategies.
MATERIALS AND METHODS: Within the AURORA retrospective trial, patients (n = 352) who received surgical resection followed by post-operative stereotactic radiotherapy (SRT) were collected from seven hospitals. We trained our ViT for the direct image-to-risk task on T1-CE and FLAIR sequences and combined clinical features along the way. We employed segmentation-guided image modifications, model adaptations, and specialized patient sampling strategies during training. The model was evaluated with five-fold cross-validation and ensemble learning across all validation runs. An external, international test cohort (n = 99) within the dataset was used to assess the generalization capabilities of the model, and saliency maps were generated for explainability analysis.
RESULTS: We achieved a competent C-Index score of 0.7982 on the test cohort, surpassing all clinical, CNN-based, and hybrid baselines. Kaplan-Meier analysis showed significant FFLF risk stratification. Saliency maps focusing on the BM core confirmed that model explanations aligned with expert observations.
CONCLUSION: Our ViT-based model offers a potential for personalized treatment strategies and follow-up regimens in patients with brain metastases. It provides an alternative to radiomics as a robust, automated tool for clinical workflows, capable of improving patient outcomes through effective risk assessment and stratification.
MATERIALS AND METHODS: Within the AURORA retrospective trial, patients (n = 352) who received surgical resection followed by post-operative stereotactic radiotherapy (SRT) were collected from seven hospitals. We trained our ViT for the direct image-to-risk task on T1-CE and FLAIR sequences and combined clinical features along the way. We employed segmentation-guided image modifications, model adaptations, and specialized patient sampling strategies during training. The model was evaluated with five-fold cross-validation and ensemble learning across all validation runs. An external, international test cohort (n = 99) within the dataset was used to assess the generalization capabilities of the model, and saliency maps were generated for explainability analysis.
RESULTS: We achieved a competent C-Index score of 0.7982 on the test cohort, surpassing all clinical, CNN-based, and hybrid baselines. Kaplan-Meier analysis showed significant FFLF risk stratification. Saliency maps focusing on the BM core confirmed that model explanations aligned with expert observations.
CONCLUSION: Our ViT-based model offers a potential for personalized treatment strategies and follow-up regimens in patients with brain metastases. It provides an alternative to radiomics as a robust, automated tool for clinical workflows, capable of improving patient outcomes through effective risk assessment and stratification.