Texture analysis can predict response to Etoposide-Doxorubicin-Cisplatin in patients with adrenocortical carcinoma

Background: The adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy originating from the adrenal cortex. These patients usually undergo chemotherapy with etoposide, doxorubicin, cisplatin and mitotane (EDP-M) in case of locally advanced or metastatic ACC. CT radiomics showed to be useful in adrenal pathologies. The study aimed to analyze the association between response to EDP-M treatment and CT textural features at diagnosis in patients with locally advanced or metastatic ACCs.
Methods: We enrolled 17 patients with advanced ACC who underwent CT before and after EDP-M therapy. The response to treatment was evaluated according to RECIST 1.1, Choi, and volumetric criteria. Based on the aforementioned criteria, the patients were classified as responder and not responder. With LifeX software textural features were extracted form the biggest lesion in contrast enhanced images of staging CT. ROC curves were drawn for the variables that were significantly different (p<0.05) between the two groups.
Results: Long-run high grey level emphasis (LRHGLE_GLRLM) and histogram kurtosis were significantly different between responder and not responder groups (p=0.04) and the multivariate ROC curve combining the two features showed a very good AUC (0.900; 95%IC: 0.724-1.000) in discriminating responders from not responded. More heterogeneous tissue texture of staging CT in locally advanced or metastatic ACC could predict the positive response to EDP-M.
Conclusions: Adrenal texture is able to predict the response to EDP-M therapy in patients with advanced ACC.