TransAnaNet: Transformer-based Anatomy Change Prediction Network for Head and Neck Cancer Patient Radiotherapy

Early identification of head and neck cancer (HNC) patients who would experience significant anatomical change during radiotherapy (RT) is important to optimize patient clinical benefit and treatment resources. This study aims to assess the feasibility of using a vision-transformer (ViT) based neural network to predict RT-induced anatomic change in HNC patients. We retrospectively included 121 HNC patients treated with definitive RT/CRT. We collected the planning CT (pCT), planned dose, CBCTs acquired at the initial treatment (CBCT01) and fraction 21 (CBCT21), and primary tumor volume (GTVp) and involved nodal volume (GTVn) delineated on both pCT and CBCTs for model construction and evaluation. A UNet-style ViT network was designed to learn spatial correspondence and contextual information from embedded CT, dose, CBCT01, GTVp, and GTVn image patches. The model estimated the deformation vector field between CBCT01 and CBCT21 as the prediction of anatomic change, and deformed CBCT01 was used as the prediction of CBCT21. We also generated binary masks of GTVp, GTVn, and patient body for volumetric change evaluation. The predicted image from the proposed method yielded the best similarity to the real image (CBCT21) over pCT, CBCT01, and predicted CBCTs from other comparison models. The average MSE and SSIM between the normalized predicted CBCT to CBCT21 are 0.009 and 0.933, while the average dice coefficient between body mask, GTVp mask, and GTVn mask are 0.972, 0.792, and 0.821 respectively. The proposed method showed promising performance for predicting radiotherapy-induced anatomic change, which has the potential to assist in the decision-making of HNC Adaptive RT.