AI & Radiomics for Stratification of Lung Nodules After Radically Treated Cancer

NCT ID: NCT05375591

Last Updated: 2022-05-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

1000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-10-13

Study Completion Date

2026-11-01

Brief Summary

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This study will assess the utility of radiomics and artificial intelligence approaches to new lung nodules in patients who have undergone radical treatment for a previous cancer.

Detailed Description

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Improvements in cancer detection and diagnosis have led to increasing numbers of patients being diagnosed with early stage cancer and potentially receiving curative therapy with improved survival outcomes. Recent retrospective studies in cancer survivors have demonstrated such patients possess an increased risk of further cancer in their lifetime compared to the general population, in part potentially due to shared lifestyle risk factors (e.g. smoking), genetic cancer pre-disposition or downstream oncogenic side effects of anti-cancer therapies (eg. radiotherapy). Lung cancer remains the leading cause of cancer related deaths worldwide and the lungs also represent a common site for metastatic disease in patients with non-pulmonary malignancy. Furthermore, lung cancer is one of the most common second primary malignancy in patients with a prior history of treated cancer. Therefore, discerning the significance of a pulmonary nodule in the context of a previous cancer remains a clinical challenge given it may possess the potential to represent benign disease, metastatic relapse or new primary malignancy.

This study will assess the utility of radiomics and artificial intelligence approaches to new lung nodules in patients who have undergone radical treatment for a previous cancer. This will entail use of machine learning (ML) approaches and later, exploration of deep-learning/convolutional neural network approaches to nodule interpretation for differentiation of benign, metastatic and new primary lung cancer nodules/lesions. Development of a ML classifier or deep learning based tool may help guide which patients would benefit from earlier investigations including additional imaging, biopsy sampling and lead to earlier cancer diagnosis, leading to better patient outcomes in this unique cohort. This is a retrospective study analysing data already collected routinely as part of patient care. All data will be anonymised prior to any analysis, no patient directed/related interventions will be employed and consent-waiver for study inclusion will be exercised.

Conditions

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Indeterminate Pulmonary Nodules Lung Metastases Second Primary Cancer Lung Cancer

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Benign Nodules

CT scans of patients with a new lung nodule(s) subsequently confirmed to be benign and in the context of a previous history of radically treated cancer, will be identified at participating NHS sites and recruited.

Non-Interventional Study

Intervention Type OTHER

First nodule detection CT scans as per eligibility criteria will be used as input into in-house software to extract multiple radiomic features and used to develop a machine learning based classifier to differentiate nodule aetiology. Scans will also be used as input in to a deep learning/convolutional neural network models to perform automated imaging classification.

Metastatic Nodules

CT scans of patients with a new lung nodule(s) subsequently confirmed to be metastatic in nature and in the context of a previous history of radically treated cancer, will be identified at participating NHS sites and recruited.

Non-Interventional Study

Intervention Type OTHER

First nodule detection CT scans as per eligibility criteria will be used as input into in-house software to extract multiple radiomic features and used to develop a machine learning based classifier to differentiate nodule aetiology. Scans will also be used as input in to a deep learning/convolutional neural network models to perform automated imaging classification.

Second Primary Lung Cancers

CT scans of patients with a new lung nodule(s) subsequently confirmed to be a new second primary lung cancer and in the context of a previous history of radically treated cancer, will be identified at participating NHS sites and recruited.

Non-Interventional Study

Intervention Type OTHER

First nodule detection CT scans as per eligibility criteria will be used as input into in-house software to extract multiple radiomic features and used to develop a machine learning based classifier to differentiate nodule aetiology. Scans will also be used as input in to a deep learning/convolutional neural network models to perform automated imaging classification.

Interventions

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Non-Interventional Study

First nodule detection CT scans as per eligibility criteria will be used as input into in-house software to extract multiple radiomic features and used to develop a machine learning based classifier to differentiate nodule aetiology. Scans will also be used as input in to a deep learning/convolutional neural network models to perform automated imaging classification.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Confirmed history of previous radically or curative-intent treated solid organ cancer within 10 years of new index CT thoracic scan demonstrating a new pulmonary nodule and either of the following:

* Biopsy confirming previous malignancy with MDT consensus and successful cancer resolution/remission following anti-cancer treatment on interval imaging or blood assay analysis
* Where biopsy was not possible/confirmed for previous malignancy, MDT consensus outcome confirming cancer (+/- calculated Herder score \>80% if applicable) and decision to treat as malignancy with subsequent resolution/remission following anti-cancer treatment on interval imaging or blood assay analysis
* Radical treatment for previous cancer defined as either of the following:

* Surgical resection
* Radical radiotherapy or stereotactic beam radiotherapy
* Radical chemotherapy
* Radical chemo-radiotherapy
* Multi-modality treatment with any of the above
* New pulmonary nodule ground truth known

* Scan data showing 2-year stability (based on diameter or volumetry) or resolution in cases of benign disease
* Scan data showing progressive nodule enlargement or increase in nodule number on interval imaging with MDT consensus (+/- PET with Herder score \>80% if applicable) determining metastatic disease or new primary malignancy
* Biopsy sampling confirming benign disease or malignancy and in cases of malignancy, metastasis or new primary lung cancer
* CT scan slice thickness ≤ 2.5mm
* Nodule size ≥ 5mm

Exclusion Criteria

* CT Imaging \> 10 years old
* Non-solid haematological malignancies including leukaemia
* Cases of radically treated primary cancer disease with early oligometastatic recurrence treated radically
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institute of Cancer Research, United Kingdom

OTHER

Sponsor Role collaborator

National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

Royal Brompton & Harefield NHS Foundation Trust

OTHER

Sponsor Role collaborator

Royal Marsden Partners Cancer Alliance

UNKNOWN

Sponsor Role collaborator

Imperial College London

OTHER

Sponsor Role collaborator

Oxford University Hospitals NHS Trust

OTHER

Sponsor Role collaborator

National Heart and Lung Institute

OTHER

Sponsor Role collaborator

Royal Marsden NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard Lee

Role: PRINCIPAL_INVESTIGATOR

The Royal Marsden Hospitals NHS Trust

Locations

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The Royal Marsden NHS Foundation Trust (Chelsea Site)

London, , United Kingdom

Site Status RECRUITING

Royal Brompton Hospital

London, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Sejal Jain

Role: CONTACT

020 7808 2603

Laura Boddy

Role: CONTACT

020 7808 2603

Facility Contacts

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Sejal Jain

Role: primary

02078082603

Laura Boddy

Role: backup

07414643915

Hardeep Kalsi

Role: primary

02078082603

References

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Tabuchi T, Ito Y, Ioka A, Miyashiro I, Tsukuma H. Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data. Cancer Sci. 2012 Jun;103(6):1111-20. doi: 10.1111/j.1349-7006.2012.02254.x. Epub 2012 Apr 11.

Reference Type BACKGROUND
PMID: 22364479 (View on PubMed)

Youlden DR, Baade PD. The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study. BMC Cancer. 2011 Feb 23;11:83. doi: 10.1186/1471-2407-11-83.

Reference Type BACKGROUND
PMID: 21342533 (View on PubMed)

Stella GM, Kolling S, Benvenuti S, Bortolotto C. Lung-Seeking Metastases. Cancers (Basel). 2019 Jul 19;11(7):1010. doi: 10.3390/cancers11071010.

Reference Type BACKGROUND
PMID: 31330946 (View on PubMed)

Deng L, Harethardottir H, Song H, Xiao Z, Jiang C, Wang Q, Valdimarsdottir U, Cheng H, Loo BW, Lu D. Mortality of lung cancer as a second primary malignancy: A population-based cohort study. Cancer Med. 2019 Jun;8(6):3269-3277. doi: 10.1002/cam4.2172. Epub 2019 Apr 16.

Reference Type BACKGROUND
PMID: 30993899 (View on PubMed)

Mery CM, Pappas AN, Bueno R, Mentzer SJ, Lukanich JM, Sugarbaker DJ, Jaklitsch MT. Relationship between a history of antecedent cancer and the probability of malignancy for a solitary pulmonary nodule. Chest. 2004 Jun;125(6):2175-81. doi: 10.1378/chest.125.6.2175.

Reference Type BACKGROUND
PMID: 15189939 (View on PubMed)

Johnson BE. Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst. 1998 Sep 16;90(18):1335-45. doi: 10.1093/jnci/90.18.1335.

Reference Type BACKGROUND
PMID: 9747865 (View on PubMed)

Travis LB. The epidemiology of second primary cancers. Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2020-6. doi: 10.1158/1055-9965.EPI-06-0414. Epub 2006 Oct 20.

Reference Type BACKGROUND
PMID: 17057028 (View on PubMed)

Wilson R, Devaraj A. Radiomics of pulmonary nodules and lung cancer. Transl Lung Cancer Res. 2017 Feb;6(1):86-91. doi: 10.21037/tlcr.2017.01.04.

Reference Type BACKGROUND
PMID: 28331828 (View on PubMed)

Baldwin DR, Gustafson J, Pickup L, Arteta C, Novotny P, Declerck J, Kadir T, Figueiras C, Sterba A, Exell A, Potesil V, Holland P, Spence H, Clubley A, O'Dowd E, Clark M, Ashford-Turner V, Callister ME, Gleeson FV. External validation of a convolutional neural network artificial intelligence tool to predict malignancy in pulmonary nodules. Thorax. 2020 Apr;75(4):306-312. doi: 10.1136/thoraxjnl-2019-214104. Epub 2020 Mar 5.

Reference Type BACKGROUND
PMID: 32139611 (View on PubMed)

Other Identifiers

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CCR5502

Identifier Type: -

Identifier Source: org_study_id

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