Machine Learning Modeling of Cancer Treatment-Related Cardiac Events in Breast Cancer: Utilizing Dosiomics and Radiomics

Abstract

Background: Personalized medicine has transformed disease management by focusing on individual characteristics, driven by advancements in genome mapping and biomarker discoveries. Objectives: This study aims to develop a predictive model for the early detection of treatment-related cardiac side effects in breast cancer patients by integrating clinical data, high-sensitivity Troponin-T (hs-TropT), radiomics, and dosiomics. The ultimate goal is to identify subclinical cardiotoxicity before clinical symptoms manifest, enabling personalized surveillance strategies. It is the first study to utilize heart-segmented dosiomics in breast cancer patients. Methods and Materials: This retrospective study included clinical, dosimetric, radiomic, and dosiomic data from 42 women with localized breast cancer. Heart-specific Troponin T levels were measured 2–3 weeks post-radiotherapy, with 14 ng/L as the cutoff. Patients were grouped on this threshold to identify potential treatment-related cardiac events. Radiomics and dosiomics were extracted using PyRadiomics. Machine learning models were optimized using the Tree-based Pipeline Optimization Tool (TPOT), identifying the gradient-boosted classification as the best-performing algorithm. Feature selection was conducted using gradient-boosted recursive feature elimination. Model performance is assessed by the area under the curve (AUC). Results: A total of 111 dosiomic and 119 radiomic features were extracted per patient. The highest predictive accuracy was achieved using clinical, dosiomic, and radiomic parameters (validation cohort-AUC = 0.96), outperforming the clinical + dosimetric model (validation cohort-AUC = 0.67). Permutation tests confirmed the non-randomness of these two models results (p <0.05). Cross-validation indicated that the clinical + dosiomic + radiomic model had a fair-to-good generalizable performance (mean AUC = 80.33 ± 21%). Discussion: This study may demonstrate that radiomics and dosiomics provide superior predictive capabilities for cardiac events in breast cancer patients compared to traditional parameters. © 2025 Elsevier B.V., All rights reserved.