New Imaging Score May Predict Chemo Benefit in Early OPSCC

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • A newly developed, seven-feature radiomic signature can identify patients with stage I and II HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) who will benefit from chemotherapy.

Why This Matters

  • Chemoradiation is a standard treatment option for HPV-associated OPSCC.

  • However, not all patients benefit from chemotherapy, especially patients with early-stage disease.

  • The investigators developed a predictive radiomic image signature to distinguish patients with stage I and II disease who will benefit from chemotherapy from those who will not.

  • If prospectively validated, the signature could serve as an inexpensive, non-invasive companion diagnostic to identify patients who can likely safely forgo chemotherapy.

Study Design

  • The team analyzed head and neck CT scans from 60 patients with nonmetastatic stage I and II disease treated with radiation alone to identify radiographic features predictive of survival.

  • Seven radiomic textural features were identified and incorporated into the predictive radiomic image signature.

  • One feature captures textural heterogeneity from within the primary tumor and the remaining six features capture heterogeneity around the tumor.

  • The prognostic performance was evaluated in 431 patients with nonmetastatic stage I and II disease in two validation cohorts — those treated with radiation alone or radiation plus chemotherapy.

  • The median signature value in the development cohort of -1.04 was used to divide patients into low and high score groups.

Key Results

  • Chemotherapy was associated with improved overall survival among patients with high scores in both validation cohorts — radiation alone (hazard ratio [HR], 4.47, P = .002) and radiation plus chemotherapy (HR, 2.99; P = .04).

  • Chemotherapy did not significantly affect overall survival among patients with low scores in the radiation alone cohort (HR, 2.56; P = .136) or the radiation plus chemotherapy cohort (HR, 0.28; P = .135).

  • The investigators concluded that patients with a low predictive radiomic image signature could be considered for treatment with radiation alone.


  • It was a retrospective study.

  • Observer agreement on radiomic features was not assessed.

  • The reasons why some patients were treated with radiation and others with chemoradiation may have differed across the cohorts.


  • The study was funded by the National Cancer Institute and others.

  • Two senior investigators, Anant Madabhushi, PhD, and Shlomo Koyfman, MD, reported ties to many companies, including Elucid Bioimaging, Inspirata, Merck, BMS, and others.

This is a summary of a preprint research study, “CT Radiomic Signature Predicts Survival and Chemotherapy Benefit in Stage I and II HPV-associated Oropharyngeal Carcinoma,” led by Bolin Song of Emory University, Atlanta, Georgia, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected].

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