Anatomical changes during intensity-modulated proton therapy (IMPT) for head-and-neck cancer (HNC) can shift Bragg peaks, risking tumor underdosing and organ-at-risk overdosing. Treatment replanning is often required to maintain clinically acceptable treatment quality. However, current manual replanning processes are resource-intensive and time-consuming. We propose a patient-specific deep reinforcement learning (DRL) framework for automated IMPT replanning, with a reward-shaping mechanism based on a $150$-point plan quality score addressing competing clinical objectives. We formulate the planning process as a reinforcement learning problem where agents learn control policies to adjust optimization priorities, maximizing plan quality. Unlike population-based approaches, our framework trains agents for each patient using their planning Computed Tomography (CT) and augmented anatomies simulating anatomical changes (tumor progression and regression). This patient-specific approach leverages anatomical similarities along the treatment course, enabling effective plan adaptation. We implemented two DRL algorithms, Deep Q-Network and Proximal Policy Optimization, using dose-volume histograms (DVHs) as state representations and a $22$-dimensional action space of priority adjustments. Evaluation on eight HNC patients using actual replanning CT data showed that both agents improved initial plan scores from $120.78 \pm 17.18$ to $139.59 \pm 5.50$ (DQN) and $141.50 \pm 4.69$ (PPO), surpassing the replans manually generated by a human planner ($136.32 \pm 4.79$). Clinical validation confirms that improvements translate to better tumor coverage and OAR sparing across diverse anatomical changes. This work highlights DRL's potential in addressing geometric and dosimetric complexities of adaptive proton therapy, offering efficient offline adaptation solutions and advancing online adaptive proton therapy.

Causal machine learning (CML) enables individualized estimation of treatment effects, offering critical advantages over traditional correlation-based methods. However, existing approaches for medical survival data with censoring such as causal survival forests estimate effects at fixed time points, limiting their ability to capture dynamic changes over time. We introduce Causal Analysis for Survival Trajectories (CAST), a novel framework that models treatment effects as continuous functions of time following treatment. By combining parametric and non-parametric methods, CAST overcomes the limitations of discrete time-point analysis to estimate continuous effect trajectories. Using the RADCURE dataset [1] of 2,651 patients with head and neck squamous cell carcinoma (HNSCC) as a clinically relevant example, CAST models how chemotherapy and radiotherapy effects evolve over time at the population and individual levels. By capturing the temporal dynamics of treatment response, CAST reveals how treatment effects rise, peak, and decline over the follow-up period, helping clinicians determine when and for whom treatment benefits are maximized. This framework advances the application of CML to personalized care in HNSCC and other life-threatening medical conditions. Source code/data available at: https://github.com/CAST-FW/HNSCC

Radiation therapy (RT) is a vital part of treatment for head and neck cancer, where accurate segmentation of gross tumor volume (GTV) is essential for effective treatment planning. This study investigates the use of pre-RT tumor regions and local gradient maps to enhance mid-RT tumor segmentation for head and neck cancer in MRI-guided adaptive radiotherapy. By leveraging pre-RT images and their segmentations as prior knowledge, we address the challenge of tumor localization in mid-RT segmentation. A gradient map of the tumor region from the pre-RT image is computed and applied to mid-RT images to improve tumor boundary delineation. Our approach demonstrated improved segmentation accuracy for both primary GTV (GTVp) and nodal GTV (GTVn), though performance was limited by data constraints. The final DSCagg scores from the challenge's test set evaluation were 0.534 for GTVp, 0.867 for GTVn, and a mean score of 0.70. This method shows potential for enhancing segmentation and treatment planning in adaptive radiotherapy. Team: DCPT-Stine's group.

Cancer is one of the leading causes of death globally, and early diagnosis is crucial for patient survival. Deep learning algorithms have great potential for automatic cancer analysis. Artificial intelligence has achieved high performance in recognizing and segmenting single lesions. However, diagnosing multiple lesions remains a challenge. This study examines and compares various neural network architectures and training strategies for automatically segmentation of cancer lesions using PET/CT images from the head, neck, and whole body. The authors analyzed datasets from the AutoPET and HECKTOR challenges, exploring popular single-step segmentation architectures and presenting a two-step approach. The results indicate that the V-Net and nnU-Net models were the most effective for their respective datasets. The results for the HECKTOR dataset ranged from 0.75 to 0.76 for the aggregated Dice coefficient. Eliminating cancer-free cases from the AutoPET dataset was found to improve the performance of most models. In the case of AutoPET data, the average segmentation efficiency after training only on images containing cancer lesions increased from 0.55 to 0.66 for the classic Dice coefficient and from 0.65 to 0.73 for the aggregated Dice coefficient. The research demonstrates the potential of artificial intelligence in precise oncological diagnostics and may contribute to the development of more targeted and effective cancer assessment techniques.

Survival prediction is crucial for cancer patients as it provides early prognostic information for treatment planning. Recently, deep survival models based on deep learning and medical images have shown promising performance for survival prediction. However, existing deep survival models are not well developed in utilizing multi-modality images (e.g., PET-CT) and in extracting region-specific information (e.g., the prognostic information in Primary Tumor (PT) and Metastatic Lymph Node (MLN) regions). In view of this, we propose a merging-diverging learning framework for survival prediction from multi-modality images. This framework has a merging encoder to fuse multi-modality information and a diverging decoder to extract region-specific information. In the merging encoder, we propose a Hybrid Parallel Cross-Attention (HPCA) block to effectively fuse multi-modality features via parallel convolutional layers and cross-attention transformers. In the diverging decoder, we propose a Region-specific Attention Gate (RAG) block to screen out the features related to lesion regions. Our framework is demonstrated on survival prediction from PET-CT images in Head and Neck (H&N) cancer, by designing an X-shape merging-diverging hybrid transformer network (named XSurv). Our XSurv combines the complementary information in PET and CT images and extracts the region-specific prognostic information in PT and MLN regions. Extensive experiments on the public dataset of HEad and neCK TumOR segmentation and outcome prediction challenge (HECKTOR 2022) demonstrate that our XSurv outperforms state-of-the-art survival prediction methods.

Automatic segmentation of head and neck cancer (HNC) tumors and lymph nodes plays a crucial role in the optimization treatment strategy and prognosis analysis. This study aims to employ nnU-Net for automatic segmentation and radiomics for recurrence-free survival (RFS) prediction using pretreatment PET/CT images in multi-center HNC cohort. A multi-center HNC dataset with 883 patients (524 patients for training, 359 for testing) was provided in HECKTOR 2022. A bounding box of the extended oropharyngeal region was retrieved for each patient with fixed size of 224 x 224 x 224 $mm^{3}$. Then 3D nnU-Net architecture was adopted to automatic segmentation of primary tumor and lymph nodes synchronously.Based on predicted segmentation, ten conventional features and 346 standardized radiomics features were extracted for each patient. Three prognostic models were constructed containing conventional and radiomics features alone, and their combinations by multivariate CoxPH modelling. The statistical harmonization method, ComBat, was explored towards reducing multicenter variations. Dice score and C-index were used as evaluation metrics for segmentation and prognosis task, respectively. For segmentation task, we achieved mean dice score around 0.701 for primary tumor and lymph nodes by 3D nnU-Net. For prognostic task, conventional and radiomics models obtained the C-index of 0.658 and 0.645 in the test set, respectively, while the combined model did not improve the prognostic performance with the C-index of 0.648.

Research presented at the 2022 World Cancer Congress shows that deep learning algorithm outperformed radiologists in detecting head and neck cancer spread. The algorithm was able to detect small areas of cancer spread that were not detected by the radiologists. This is a potentially important finding, as early detection of cancer spread can lead to better outcomes for patients. Head and neck cancers kill about 400,000 people a year worldwide. Radiation with or without chemotherapy or surgery followed by chemotherapy is the most common treatment strategy.

A Case Western Reserve University-led team of scientists has used artificial intelligence (AI) to identify which patients with certain head and neck cancers would benefit from reducing the intensity of treatments such as radiation therapy and chemotherapy. The researchers used AI tools similar to those they developed over the last decade at the Center for Computational Imaging and Personal Diagnostics (CCIPD) at Case Western Reserve. In this case, they asked the computer to analyze digitized images of tissue samples that had been taken from 439 patients from six hospital systems with a type of head and neck cancer known as human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPCSCC). The computer program successfully identified a subset of patients who might have benefited from a significantly reduced dose of radiation therapy. While that analysis was retrospective--meaning the computer analyzed data from patients in which the eventual outcome was already known--the researchers said their next step could be to test its accuracy in clinical trials.

In a bid to fight cancer, Google has collaborated with Mayo Clinic on research to develop an Artificial Intelligence (AI)-based system that can support physicians, help reduce treatment planning time and improve the efficiency of radiotherapy. In this research partnership, Mayo Clinic and Google Health will work to develop an algorithm to assist clinicians in contouring healthy tissue and organs from tumours, and conduct research to better understand how this technology could be deployed effectively in clinical practice. Mayo Clinic is an international centre of excellence for cancer treatment with world-renowned radiation oncologists. "Google researchers have studied how AI can potentially be used to augment other areas of healthcare -- from mammographies to the early deployment of an AI system that detects diabetic retinopathy using eye scans," said Dr Cian Hughes, Informatics Lead, Google Health. More than 18 million new cancer cases are diagnosed globally each year, and radiotherapy is one of the most common cancer treatments.

More than 18 million new cancer cases are diagnosed globally each year, and radiotherapy is one of the most common cancer treatments--used to treat over half of cancers in the United States. But planning for a course of radiotherapy treatment is often a time-consuming and manual process for clinicians. The most labor-intensive step in planning is a technique called "contouring" which involves segmenting both the areas of cancer and nearby healthy tissues that are susceptible to radiation damage during treatment. Clinicians have to painstakingly draw lines around sensitive organs on scans--a time-intensive process that can take up to seven hours for a single patient. Technology has the potential to augment the work of doctors and other care providers, like the specialists who plan radiotherapy treatment.