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Diagnostics
Volume 15
Issue 21
10.3390/diagnostics15212698
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Optical Coherence Tomography Angiography (OCTA) Captures Early Micro-Vascular Remodeling in Non-Melanoma Skin Cancer During Superficial Radiotherapy: A Proof-of-Concept Study

by
Gerd Heilemann
1,*,
Giulia Rotunno
2,*,
Lisa Krainz
3,
Francesco Gili
2,
Christoph Müller
4,
Kristen M. Meiburger
2,
Dietmar Georg
1,
Joachim Widder
1,
Wolfgang Drexler
3,
Mengyang Liu
3 and
Cora Waldstein
1
1
Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, 1090 Vienna, Austria
2
PolitoBIOMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
3
Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
4
Department of Dermatology, Medical University Vienna, 1090 Vienna, Austria
*
Authors to whom correspondence should be addressed.
Diagnostics 2025, 15(21), 2698; https://doi.org/10.3390/diagnostics15212698 (registering DOI)
Submission received: 18 September 2025 / Revised: 20 October 2025 / Accepted: 22 October 2025 / Published: 24 October 2025
(This article belongs to the Collection Biomedical Optics: From Technologies to Applications)
Review Reports Versions Notes

Abstract

Background/Objectives: This proof-of-concept study evaluated whether optical coherence tomography angiography (OCTA) can non-invasively capture micro-vascular alterations in non-melanoma skin cancer (NMSC) lesions during and after superficial orthovoltage radiotherapy (RT) using radiomics and vascular features analysis. Methods: Eight patients (13 NMSC lesions) received 36–50 Gy in 6–20 fractions. High-resolution swept-source OCTA volumes (1.1 × 10 × 10 mm3) were acquired from each lesion at three time points: pre-RT, immediately post-RT, and three months post-RT. Additionally, healthy skin baseline was scanned. After artifact suppression and region-of-interest cropping, (i) first-order and texture radiomics and (ii) skeleton-based vascular features were extracted. Selected features after LASSO (least absolute shrinkage and selection operator) were explored with principal-component analysis. An XGBoost model was trained to classify time points with 100 bootstrap out-of-bag validations. Kruskal–Wallis tests with Benjamini–Hochberg correction assessed longitudinal changes in the 20 most influential features. Results: Sixty-one OCTA volumes were analyzable. LASSO retained 47 of 103 features. The first two principal components explained 63% of the variance, revealing a visible drift of lesions from pre- to three-month post-RT clusters. XGBoost achieved a macro-averaged AUC of 0.68 ± 0.07. Six features (3 texture, 2 first order, 1 vascular) changed significantly across time points (adjusted p < 0.05), indicating dose-dependent reductions in signal heterogeneity and micro-vascular complexity as early as treatment completion, which deepened by three months. Conclusions: OCTA-derived radiomic and vascular signatures tracked RT-induced micro-vascular remodeling in NMSC. The approach is entirely non-invasive, label-free, and feasible at the point of care. As an exploratory proof-of-concept, this study helps to refine scanning and analysis protocols and generates knowledge to support future integration of OCTA into adaptive skin-cancer radiotherapy workflows.
Keywords: optical coherence tomography angiography; vascularization; radiotherapy; radiomics; non-melanoma skin cancer optical coherence tomography angiography; vascularization; radiotherapy; radiomics; non-melanoma skin cancer

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MDPI and ACS Style

Heilemann, G.; Rotunno, G.; Krainz, L.; Gili, F.; Müller, C.; Meiburger, K.M.; Georg, D.; Widder, J.; Drexler, W.; Liu, M.; et al. Optical Coherence Tomography Angiography (OCTA) Captures Early Micro-Vascular Remodeling in Non-Melanoma Skin Cancer During Superficial Radiotherapy: A Proof-of-Concept Study. Diagnostics 2025, 15, 2698. https://doi.org/10.3390/diagnostics15212698

AMA Style

Heilemann G, Rotunno G, Krainz L, Gili F, Müller C, Meiburger KM, Georg D, Widder J, Drexler W, Liu M, et al. Optical Coherence Tomography Angiography (OCTA) Captures Early Micro-Vascular Remodeling in Non-Melanoma Skin Cancer During Superficial Radiotherapy: A Proof-of-Concept Study. Diagnostics. 2025; 15(21):2698. https://doi.org/10.3390/diagnostics15212698

Chicago/Turabian Style

Heilemann, Gerd, Giulia Rotunno, Lisa Krainz, Francesco Gili, Christoph Müller, Kristen M. Meiburger, Dietmar Georg, Joachim Widder, Wolfgang Drexler, Mengyang Liu, and et al. 2025. "Optical Coherence Tomography Angiography (OCTA) Captures Early Micro-Vascular Remodeling in Non-Melanoma Skin Cancer During Superficial Radiotherapy: A Proof-of-Concept Study" Diagnostics 15, no. 21: 2698. https://doi.org/10.3390/diagnostics15212698

APA Style

Heilemann, G., Rotunno, G., Krainz, L., Gili, F., Müller, C., Meiburger, K. M., Georg, D., Widder, J., Drexler, W., Liu, M., & Waldstein, C. (2025). Optical Coherence Tomography Angiography (OCTA) Captures Early Micro-Vascular Remodeling in Non-Melanoma Skin Cancer During Superficial Radiotherapy: A Proof-of-Concept Study. Diagnostics, 15(21), 2698. https://doi.org/10.3390/diagnostics15212698

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