Can AI-based body composition assessment outperform body surface area in predicting dose-limiting toxicities for colonic cancer patients on chemotherapy?

Abstract

Purpose Gold standard chemotherapy dosage is based on body surface area (BSA); however many patients experience dose-limiting toxicities (DLT). We aimed to evaluate the effectiveness of BSA, two-dimensional (2D) and three-dimensional (3D) body composition (BC) measurements derived from Lumbar 3 vertebra (L3) computed tomography (CT) slices, in predicting DLT in colon cancer patients. Methods 203 patients (60.87 ± 12.42 years; 97 males, 47.8%) receiving adjuvant chemotherapy (Oxaliplatin and/or 5-Fluorouracil) were retrospectively evaluated. An artificial intelligence segmentation model was used to extract 2D and 3D body composition measurements from each patients' single mid-L3 CT slice as well as multiple-L3 CT scans to produce a 3D BC report. DLT was defined as any incidence of dose reduction or discontinuation due to chemotherapy toxicities. A receiver operating characteristic (ROC) analysis was performed on BSA and individual body composition measurements to demonstrate their predictive performance. Results A total of 120 (59.1%) patients experienced DLT. Age and BSA did not vary significantly between DLT and non-DLT group. Females were significantly more likely to experience DLT (p = 4.9 × 10–3). In all patients, the predictive effectiveness of 2D body composition measurements (females: AUC = 0.50–0.54; males: AUC = 0.50–0.61) was equivalent to that of BSA (females: AUC = 0.49; males: AUC = 0.58). The L3 3D skeletal muscle volume was the most predictive indicator of DLT (AUC of 0.66 in females and 0.64 in males). Conclusion Compared to BSA and 2D body composition measurements, 3D L3 body composition measurements had greater potential to predict DLT in CRC patients receiving chemotherapy and this was sex dependent.

Identification of Differences in Body Composition Measures Using 3D-Derived Artificial Intelligence from Multiple CT Scans across the L3 Vertebra Compared to a Single Mid-Point L3 CT Scan

“…Body composition measurements, in particular SM surface area, have been associated with rectal cancer response to neoadjuvant therapy and corresponding survival outcomes [ 23 , 24 ]. Furthermore, body composition has been suggested as a superior method of dosing chemotherapy for CRC, to decrease rates of dose-limiting toxicity [ 8 , 25 ]. Currently, 2D body composition is still commonly measured as there is limited clinically validated software available for researchers and clinicians to use.…”

“…Te measurement of body composition relies on the assessment of quantity and distribution of body fat and lean muscle mass [1] and varies between sexes [2]. In colorectal cancer (CRC) patients, body composition has been associated with survival-related clinical outcomes [3][4][5][6][7][8]. Te most common technique for evaluating body composition has arisen through the use of computed tomography (CT) [9].…”