title: Locally advanced squamous cell carcinoma of the head and neck: CT texture and histogram analysis allow independent prediction of overall survival in patients treated with induction chemotherapy.
abstract: OBJECTIVE
  To determine if computed tomographic (CT) texture and histogram analysis measurements of the primary mass are independently associated with overall survival in patients with locally advanced squamous cell carcinoma of the head and neck who were previously treated with cisplatin, 5-fluorouracil, and docetaxel (TPF) induction chemotherapy.
  
  
  METHODS
  This institutional review board-approved retrospective study included 72 patients with locally advanced squamous cell carcinoma of the head and neck who were treated with induction TPF chemotherapy in 2004-2010. CT texture and histogram analysis of the primary mass on the pretherapy CT images were performed by using TexRAD software before and after application of spatial filters at different anatomic scales ranging from fine detail to coarse features. Cox proportional hazards models were used to examine the association between overall survival and the baseline CT imaging measurements and clinical variables.
  
  
  RESULTS
  Primary mass entropy and skewness measurements with multiple spatial filters were associated with overall survival. Multivariate Cox regression analysis incorporating clinical and imaging variables indicated that primary mass size (hazard ratio [HR], 1.58 for each 1-cm increase; P = .018), N stage (HR, 8.77 for N3 vs N0 or N1; P = .002; HR, 4.99 for N3 vs N2; P = .001), and primary mass entropy (HR, 2.10 for each 0.5-unit increase; P = .036) and skewness (HR, 3.67 for each 1.0-unit increase; P = .009) measurements with the 1.0 spatial filter were independently associated with overall survival.
  
  
  CONCLUSIONS
  Independent of tumor size, N stage, and other clinical variables, primary mass CT texture and histogram analysis parameters are associated with overall survival in patients with locally advanced squamous cell carcinoma of the head and neck who were treated with induction TPF. Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology (H.Z., C.M.G., M.K., A.D.S.), Center for Biostatistics and Bioinformatics (O.E., M.E.G., X.Z.), Department of Otolaryngology (K.P.), Department of Radiation Oncology (J.J.C.), and Department of Medicine (R.D.H.), University of Mississippi Medical Center 2500 N State St, Jackson, MS 39216; Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Fla (J.J.C.); and Institute of Nuclear Medicine, University College London, London, England (B.G.).
authors.forename: Haowei
authors.initials: H
authors.lastname: Zhang
authors.forename: Caleb M
authors.initials: CM
authors.lastname: Graham
authors.forename: Okan
authors.initials: O
authors.lastname: Elci
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Majid A
authors.initials: MA
authors.lastname: Khan
authors.forename: Karen
authors.initials: K
authors.lastname: Pitman
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Caudell
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hamilton
authors.forename: Balaji
authors.initials: B
authors.lastname: Ganeshan
authors.forename: Andrew Dennis
authors.initials: AD
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D003287:Contrast Media; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012984:Software; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil