Dynamic stochastic deep learning approaches for predicting geometric changes in head and neck cancer

Objective. Modern radiotherapy stands to benefit from the ability to efficiently adapt plans during treatment in response to setup and geometric variations such as those caused by internal organ deformation or tumor shrinkage. A promising strategy is to develop a framework, which given an initial state defined by patient-attributes, can predict future states based on pre-learned patterns from a well-defined patient population. Approach. Here, we investigate the feasibility of predicting patient anatomical changes, defined as a joint state of volume and daily setup changes, across a fractionated treatment schedule using two approaches. The first is based on a new joint framework employing quantum mechanics in combination with deep recurrent neural networks, denoted QRNN. The second approach is developed based on a classical framework, which models patient changes as a Markov process, denoted MRNN. We evaluated the performance characteristics of these two approaches on a dataset of 125 head and neck cancer patients, which was supplemented by synthetic data generated using a generative adversarial network. Model performance was evaluated using area under the receiver operating characteristic curve (AUC) scores. Main results. The MRNN framework had slightly better performance than the QRNN framework, with MRNN (QRNN) validation AUC scores of 0.742 +/- 0.021 (0.675 +/- 0.036), 0.709 +/- 0.026 (0.656 +/- 0.021), 0.724 +/- 0.036 (0.652 +/- 0.044), and 0.698 +/- 0.016 (0.605 +/- 0.035) for system state vector sizes of 4, 6, 8, and 10, respectively. Of these, only the results from the two higher order states had statistically significant differences (p < 0.05). A similar trend was also observed when the models were applied to an external testing dataset of 20 patients, yielding MRNN (QRNN) AUC scores of 0.707 (0.623), 0.687 (0.608), 0.723 (0.669), and 0.697 (0.609) for states vectors sizes of 4, 6, 8, and 10, respectively. Significance. These results suggest that both stochastic models have potential value in predicting patient changes during the course of adaptive radiotherapy.