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However, SABR causes benign radiation-induced lung injury (RILI) which appears as lesion growth on follow-up CT scans. This triggers the standard definition of progressive disease, yet cancer recurrence is not usually present, and distinguishing RILI from recurrence when a lesion appears to grow in size is critical but challenging. In this study, we developed a tool to do this using scans with apparent lesion growth after SABR from 68 patients. We performed bootstrapped experiments using radiomics and explored the use of multiple regions of interest (ROIs). The best model had an area under the receiver operating characteristic curve of 0.66 and used a sphere with a diameter equal to the lesion\u2019s longest axial measurement as the ROI. We also investigated the effect of using inter-feature and volume correlation filters and found that the former was detrimental to performance and that the latter had no effect. We also found that the radiomics features ranked as highly important by the model were significantly correlated with outcomes. These findings represent a key step in developing a tool that can help determine who would benefit from follow-up invasive interventions when a SABR-treated lesion increases in size, which could help provide better treatment for patients.<\/jats:p>","DOI":"10.1038\/s41598-024-52828-4","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T15:03:46Z","timestamp":1707923026000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Distinguishing recurrence from radiation-induced lung injury at the time of RECIST progressive disease on post-SABR CT scans using radiomics"],"prefix":"10.1038","volume":"14","author":[{"given":"Salma","family":"Dammak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Gulstene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Palma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Mattonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Senan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron D.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"52828_CR1","unstructured":"Ettinger, D. 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Oncol."},{"key":"52828_CR4","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1097\/JTO.0b013e318219aac5","volume":"6","author":"M Dahele","year":"2011","unstructured":"Dahele, M., Palma, D., Lagerwaard, F., Slotman, B. & Senan, S. Radiological changes after stereotactic radiotherapy for stage I lung cancer. J. Thorac. Oncol. 6, 1221\u20131228 (2011).","journal-title":"J. Thorac. Oncol."},{"key":"52828_CR5","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/S0167-8140(22)04282-7","volume":"174","author":"S Gulstene","year":"2022","unstructured":"Gulstene, S. et al. Assessing treatment response after lung SABR: An evaluation of the predictive value of RECIST criteria. Radiother. Oncol. 174, S4\u2013S5 (2022).","journal-title":"Radiother. Oncol."},{"key":"52828_CR6","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.ijrobp.2015.12.369","volume":"94","author":"SA Mattonen","year":"2016","unstructured":"Mattonen, S. A. et al. Detection of local cancer recurrence after stereotactic ablative radiation therapy for lung cancer: Physician performance versus radiomic assessment. Int. J. Radiat. Oncol. Biol. Phys. 94, 1121\u20131128 (2016).","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"52828_CR7","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.diii.2016.06.016","volume":"97","author":"C De Margerie-Mellon","year":"2016","unstructured":"De Margerie-Mellon, C., De Bazelaire, C. & De Kerviler, E. Image-guided biopsy in primary lung cancer: Why, when and how. Diagn. Interv. Imaging 97, 965\u2013972 (2016).","journal-title":"Diagn. Interv. Imaging"},{"key":"52828_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12957-022-02647-6","volume":"20","author":"H Hui","year":"2022","unstructured":"Hui, H. et al. Computed tomography-guided cutting needle biopsy for lung nodules: When the biopsy-based benign results are real benign. World J. Surg. 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S.S. reports speakers fees from ViewRay Inc and AstraZeneca, and the Department of Radiation Oncology at the Amsterdam University Medical Centers has funded research agreements with ViewRay Inc. and Varian Medical Systems, all unrelated to the current work.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3758"}}