Radiomics for the prediction of treatment outcome and survival in patients with colorectal cancer: a systematic review

Abstract Background Prediction of outcome in patients with colorectal cancer (CRC) is challenging, due to lack of a robust biomarker and heterogeneity between and within tumours. The aim of this review was to assess the current possibilities and limitations of radiomics (on CT, MRI and PET) for the prediction of treatment outcome and long-term outcome in CRC. Methods MEDLINE/PubMed was searched up to August 2020 for studies that used radiomics for the prediction of response to treatment and survival in patients with CRC (based on pre-treatment imaging). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and Radiomics Quality Score (RQS) were used for quality assessment. Results A total of 76 studies met the inclusion criteria and were included for further analysis. Radiomics analyses were performed on MRI in 41 studies, on CT in 30 studies and on 18F-FDG-PET-CT in 10 studies. Heterogeneous results were reported regarding radiomics methods and included features. High quality studies (n=13), consisting mainly of MRI-based radiomics to predict response in rectal cancer, were able to predict response with a good performance. Conclusion Radiomics literature in CRC is highly heterogeneous, nonetheless it holds promise for the prediction of outcome. The most evidence is available for MRI-based radiomics in rectal cancer. Future radiomics research in CRC should focus on independent validation of existing models rather than developing new models.