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Janović A, Bracanović Đ, Antić S, Marković-Vasiljković B. Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study. BMC Oral Health 2024; 24:141. [PMID: 38287310 PMCID: PMC10823646 DOI: 10.1186/s12903-024-03869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/06/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis. METHODS We retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests. RESULTS The mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%. CONCLUSION Our findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis.
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Affiliation(s)
- Aleksa Janović
- School of Dental Medicine, Center of Diagnostic Radiology, University of Belgrade, 6 Rankeova, Belgrade, 11000, Republic of Serbia.
| | - Đurđa Bracanović
- School of Dental Medicine, Center of Diagnostic Radiology, University of Belgrade, 6 Rankeova, Belgrade, 11000, Republic of Serbia
| | - Svetlana Antić
- School of Dental Medicine, Center of Diagnostic Radiology, University of Belgrade, 6 Rankeova, Belgrade, 11000, Republic of Serbia
| | - Biljana Marković-Vasiljković
- School of Dental Medicine, Center of Diagnostic Radiology, University of Belgrade, 6 Rankeova, Belgrade, 11000, Republic of Serbia
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Kjems J, Elisabet Håkansson K, Andrup Kristensen C, Grau Eriksen J, Horsholt Kristensen M, Ivalu Sander Holm A, Overgaard J, Rønn Hansen C, Zukauskaite R, Johansen J, Richter Vogelius I, Friborg J. The influence of tumor volume on the risk of distant metastases in head and neck squamous cell carcinomas. Radiother Oncol 2023; 186:109771. [PMID: 37385382 DOI: 10.1016/j.radonc.2023.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Distant metastases (DM) in head and neck squamous cell carcinomas (HNSCC) are in most circumstances non-curable. The TNM staging system is insufficient to predict the risk of DM. This study investigates if the DM risk can be predicted using a multivariate model including pre-treatment total tumor volume for both p16-positive oropharyngeal squamous cell carcinoma (OPSCC) and all other sites (other HNSCC). MATERIALS AND METHODS The study includes patients with localized pharyngeal and laryngeal squamous cell carcinomas treated with primary radiotherapy from 2008-2017 from three head and neck cancer centers. Patients were identified in the Danish Head and Neck Cancer (DAHANCA) database. Total (nodal and primary) tumor volume (Gross Tumor Volume, GTV) was extracted from local treatment planning systems. The GTV was grouped by volume (cm3) in four intervals and included in a multivariate Cox proportional hazard regression controlled for pre-selected clinical values incl. stage. RESULTS The study includes 2,865 patients, of which 321 (11 %) had DM post-treatment. The risk of DM was assessed in a multivariate model based on 2,751 patients (p16-positive OPSCC: 1,032; and other HNSCC: 1,719). There was a significant association between GTV and the risk of DM, and in tumor volumes ≥ 50 cm3 hazard ratios of 7.6 (2.5-23.4) for p16-positive OPSCC and 4.1 (2.3-7.2) in other HNSCC were observed. CONCLUSION Tumor volume is an independent risk factor for DM. The addition of total tumor volume to a predictive model is important to identify subgroups of HNSCC patients at high risk of DM.
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Affiliation(s)
- Julie Kjems
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | | | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
| | | | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
| | - Christian Rønn Hansen
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense 5000, Denmark; Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark.
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark.
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark.
| | - Ivan Richter Vogelius
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
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Does Tumor Volume Have a Prognostic Role in Oropharyngeal Squamous Cell Carcinoma? A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14102465. [PMID: 35626068 PMCID: PMC9139846 DOI: 10.3390/cancers14102465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to assess the prognostic value of tumor volume in oropharyngeal squamous cell carcinoma (OPSCC). The study was performed according to the PRISMA guidelines. A total of 1417 patients with a median age of 59.3 years (IQR 57.5−60) were included. The combined Hazard Ratios (HRs) for overall survival (OS) were 1.02 (95% CI, 0.99−1.05; p = 0.21) for primary tumor volume (pTV) and 1.01 (95% CI, 1.00−1.02; p = 0.15) for nodal tumor volume (nTV). Regarding locoregional control (LRC), the pooled HRs were 1.07 (95% CI, 0.99−1.17; p = 0.10) for pTV and 1.02 (95% CI, 1.01−1.03; p < 0.05) for nTV. Finally, the pooled HRs for disease-free survival (DFS) were 1.01 (95% CI, 1.00−1.03; p < 0.05) for pTV and 1.02 (95% CI, 1.01−1.03; p < 0.05) for nTV. In conclusion, pTV and nTV seem not to behave as reliable prognostic factors in OPSCC.
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Kuznetsov S, Yu Q, Spieler B, Hartsough R, Zhu X, Murnan E, Hironaka M, Zaid W. Can Radiographic Tumor Volume of Oral Squamous Cell Carcinoma Help Predict Clinical and Pathological Tumor Features? J Oral Maxillofac Surg 2021; 79:2582-2592. [PMID: 34252366 DOI: 10.1016/j.joms.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Radiographic tumor volume (RTV) of oral squamous cell carcinoma (SCC) is seldom measured in practice. Aims of the study are to estimate RTV of SCC and to investigate its relationship with clinical and pathological stage, tumor margin status, recurrence, and need for chemo/radiation. METHODS The Design is a retrospective cohort study. The predictor variable is SCC RTV. The primary outcome variables are clinical and pathological tumor size. The secondary outcomes are margin status and postoperative chemo/radiation. Tumor dimensions were measured on preoperative maxillofacial or neck computer tomography images with contrast. Information on patient and tumor characteristics was obtained. Pearson correlation, t test, ANOVA and log rank test were used for statistical analysis. The significance level was set at .05. RESULTS Thirty-Six subjects aged 36 to 86 were included in the study. Positive association was found between clinical T stage and RTV (P = .0003) and between pathologic T stage and RTV (P = .002). Mean value of RTV was significantly higher in group with positive margins (P = .0004). RTV was significantly higher in cancers requiring adjuvant chemo/radiation (P = .033). Mean RTV for patients with recurrence was 1.86 cm3 as compared to 1.29 cm3 for patients with no recurrence. Higher tumor volumes were more likely to be associated with recurrence. CONCLUSIONS RTV is a variable that is readily available to head and neck surgeons. RTV is associated with clinical and pathological tumor sizes, margin status, need for adjuvant chemo/radiation and tumor recurrence.
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Affiliation(s)
- Sergei Kuznetsov
- Resident. Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Qingzhao Yu
- Professor. Department of Biostatistics, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Bradley Spieler
- Associate Professor of Diagnostic Radiology. Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Richard Hartsough
- Fellow. Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Xiaodan Zhu
- Research Assistant. Department of Biostatistics, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Eric Murnan
- Resident. Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Michael Hironaka
- Resident. Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Waleed Zaid
- Associate Professor. Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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Sinha S, Agarwal JP, Mahajan A, Chaturvedi P, Balaji A, Juvekar S, Gupta T, Budrukkar A, Murthy V, Mummudi N, Swain M, Jadhav R, Laskar SG. Implications of limited exolaryngeal disease and cricoarytenoid joint involvement in organ conservation protocols for laryngopharyngeal cancers: Results from a prospective study. Head Neck 2020; 43:1289-1299. [PMID: 33368793 DOI: 10.1002/hed.26593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To identify clinicoradiological factors that determine functional outcomes in laryngopharyngeal cancers treated with chemoradiotherapy. METHODS One hundred patients of locally advanced laryngopharyngeal cancers who were treated with chemoradiotherapy were accrued in this prospective study. The coprimary endpoint of the study was local control (LC) and functional larynx preservation survival (FLPS). RESULTS The median follow-up was 39 months. Thirty-nine patients had a local failure of which 17 underwent a salvage laryngectomy. A dysfunctional larynx with clinic-radiologically disease was seen in only 1 patient. Factors significant for LC were thyroid cartilage erosion/lysis and cricoarytenoid joint involvement. Within the T4a subset, patients with exolaryngeal disease through the soft tissue framework had significantly better LC and FLPS than those with cartilage erosion/lysis. CONCLUSIONS Patients with limited exolaryngeal disease through the soft-tissue framework can be considered for functional organ preservation, while those with thyroid cartilage involvement and cricoarytenoid joint involvement are not suitable.
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Affiliation(s)
- Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arun Balaji
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shashikant Juvekar
- Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Jadhav
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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de Andrade NMM, Dedivitis RA, Ramos DM, Matos LL, Garcia MRT, Conti GG, Kowalski LP. Tumor volume as a prognostic factor of locally advanced laryngeal cancer. Eur Arch Otorhinolaryngol 2020; 278:1627-1635. [PMID: 33095433 DOI: 10.1007/s00405-020-06438-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The TNM tumor staging system is the most widely used for laryngeal cancer. However, in the same T stage, lesions with different primary tumor volumes (TV) can be found, impacting treatment outcomes. METHODS 145 patients with T3 and T4a laryngeal cancer, according to Union for International Cancer Control, who underwent surgical treatment from 2008 to 2017, were analyzed. TV measurements were collected and compared to different outcomes. RESULTS The mean TV was 23.0 ± 16.4 cm3. A cutoff point for TV of 14.2 cm3 was established. Cumulative sample 5-year overall survival (OS) was 62.1%, while 5-years disease-free survival (DFS) was 65.5%. In univariate analysis, TV ≥ 14.2 cm3 was associated with a higher risk of distant metastases (p = 0.045), and worse rates of OS (p = 0.009) and DFS (p = 0.035). In multivariate analysis, TV was not an independent risk factor of worse DFS (p = 0.569) or OS (p = 0.094). CONCLUSION Primary lesion TV showed significant association, in univariate analysis, with worse rates of recurrence and survival in advanced laryngeal cancer undergoing surgical treatment and can be a promising prognostic for these patients.
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Affiliation(s)
- Natália Martins Magacho de Andrade
- Department of Head and Neck Surgery, Instituto Central, University of Sao Paulo Medical School, 8° andar. Cerqueira César, São Paulo, 05403-000, Brazil.
| | - Rogério Aparecido Dedivitis
- Department of Head and Neck Surgery, Instituto Central, University of Sao Paulo Medical School, 8° andar. Cerqueira César, São Paulo, 05403-000, Brazil
| | | | - Leandro Luongo Matos
- Department of Head and Neck Surgery, Instituto Central, University of Sao Paulo Medical School, 8° andar. Cerqueira César, São Paulo, 05403-000, Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | | | - Gustavo Gonçalves Conti
- Department of Radiology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Mair M, Nair D, Nair S, Malik A, Mishra A, Kannan S, Bobdey S, Singhvi H, Chaturvedi P. Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue. Head Neck 2018; 40:1667-1675. [PMID: 29734474 DOI: 10.1002/hed.25161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 09/13/2017] [Accepted: 02/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. METHODS This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. RESULTS Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification. CONCLUSION Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.
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Affiliation(s)
- Manish Mair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Akshat Malik
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Aseem Mishra
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sadhana Kannan
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, India
| | - Hitesh Singhvi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
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Panje C, Riesterer O, Glanzmann C, Studer G. Neutrophil-lymphocyte ratio complements volumetric staging as prognostic factor in patients treated with definitive radiotherapy for oropharyngeal cancer. BMC Cancer 2017; 17:643. [PMID: 28893236 PMCID: PMC5594523 DOI: 10.1186/s12885-017-3590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 08/22/2017] [Indexed: 01/04/2023] Open
Abstract
Background Volumetric tumor staging has been shown as superior prognostic tool compared to the conventional TNM system in patients undergoing definitive intensity-modulated radiotherapy (IMRT) for head and neck cancer. Recently, clinical immunoscores such as the neutrophil-lymphocyte ratio (NLR) have been investigated as prognostic markers in several tumor entities. The aim of this study was to assess the combined prognostic value of NLR and tumor volume in patients treated with IMRT for oropharyngeal cancer (OC). Methods Data on all consecutive patients treated for locally advanced or inoperable OC with IMRT from 2002–2011 was prospectively collected. Tumor volume was assessed based on the total gross tumor volume (tGTV) calculated by the treatment planning system volume algorithm. The NLR was collected by a retrospective analysis of differential blood count before initiation of therapy. Results Overall, 187 eligible patients were treated with a median IMRT dose of 69.6 Gy. Three-year recurrence-free survival (RFS) for low, intermediate, high and very high tumor volume groups was 88%, 74%, 62% and 25%, respectively (p = 0.007). Patients with elevated NLR (>4.68) showed a significantly decreased 3-year RFS of 44% vs. 81% (p < 0.001) and 3-year OS of 56% vs. 84% (p < 0.001). The NLR remained a significant prognostic factor for RFS and OS when tested among tumor volume groups. Univariate and multivariate regression analysis confirmed both tumor volume and NLR as independent prognostic factors. The NLR offered further statistically significant prognostic differentiation of the small/intermediate/large tumor volume groups. Conclusion The NLR remains an independent prognostic factor for patients with OC undergoing radiotherapy independent of the tumor volume.
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Affiliation(s)
- Cédric Panje
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Christoph Glanzmann
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland. .,Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne, Switzerland.
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Tumour volumes: Predictors of early treatment response in locally advanced head and neck cancers treated with definitive chemoradiation. Rep Pract Oncol Radiother 2016; 21:419-26. [PMID: 27489511 DOI: 10.1016/j.rpor.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/08/2016] [Indexed: 11/22/2022] Open
Abstract
AIM To analyse and predict early response 3 months post definitive chemoradiation (CCRT) utilising tumour volume (TV) measurement in locally advanced head and neck cancers (LAHNC). BACKGROUND LAHNC are 3-dimentional lesions. The largest diameter of these tumours measured for T-classification may not necessarily reflect the true tumour dimensions. TV accurately reflects the tumour burden because it is a measurement of tumour burden in all three dimensions. MATERIALS AND METHODS It is a single institutional prospective study including 101 patients with LAHNC treated with definitive CCRT. TV data noted were primary tumour volume (PTV), total nodal volume (TNV) and total tumour volume (TTV). Response evaluation was done at 3 months after the completion of definitive CCRT and patients were categorised either having achieved complete response (CR) or residual disease. RESULTS Patients who had not achieved CR were found to have larger TV compared with those who had achieved CR. There were significant inverse correlations between PTV and response (median 16.37 cm(3) vs. 45.2 cm(3); p = 0.001), and between TTV and response (median 36.14 cm(3) vs. 66.06 cm(3); p < 0.001). Receiver operating characteristic (ROC) analysis identified an "optimal cut-off" value of 41 cm(3) for PTV and 42 cm(3) for TTV above and below which the magnitude of difference in response was the greatest. CONCLUSIONS If response evaluation 3 months post CCRT is to be predicted it is simply not enough to measure the largest single dimension of the tumour. TV seems to be a better and more accurate reflection of the true total tumour burden or extent of the disease.
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Issa MR, Samuels SE, Bellile E, Shalabi FL, Eisbruch A, Wolf G. Tumor Volumes and Prognosis in Laryngeal Cancer. Cancers (Basel) 2015; 7:2236-61. [PMID: 26569309 PMCID: PMC4695888 DOI: 10.3390/cancers7040888] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/19/2015] [Accepted: 10/27/2015] [Indexed: 01/22/2023] Open
Abstract
Tumor staging systems for laryngeal cancer (LC) have been developed to assist in estimating prognosis after treatment and comparing treatment results across institutions. While the laryngeal TNM system has been shown to have prognostic information, varying cure rates in the literature have suggested concern about the accuracy and effectiveness of the T-classification in particular. To test the hypothesis that tumor volumes are more useful than T classification, we conducted a retrospective review of 78 patients with laryngeal cancer treated with radiation therapy at our institution. Using multivariable analysis, we demonstrate the significant prognostic value of anatomic volumes in patients with previously untreated laryngeal cancer. In this cohort, primary tumor volume (GTVP), composite nodal volumes (GTVN) and composite total volume (GTVP + GTVN = GTVC) had prognostic value in both univariate and multivariate cox model analysis. Interestingly, when anatomic volumes were measured from CT scans after a single cycle of induction chemotherapy, all significant prognosticating value for measured anatomic volumes was lost. Given the literature findings and the results of this study, the authors advocate the use of tumor anatomic volumes calculated from pretreatment scans to supplement the TNM staging system in subjects with untreated laryngeal cancer. The study found that tumor volume assessment after induction chemotherapy is not of prognostic significance.
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Affiliation(s)
- Mohamad R Issa
- Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Stuart E Samuels
- Department of Radiation Oncology, The University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Emily Bellile
- Department of Biostatistics, The School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Firas L Shalabi
- Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Avraham Eisbruch
- Department of Radiation Oncology, The University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Gregory Wolf
- Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Rutkowski T. The role of tumor volume in radiotherapy of patients with head and neck cancer. Radiat Oncol 2014; 9:23. [PMID: 24423415 PMCID: PMC3903043 DOI: 10.1186/1748-717x-9-23] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/09/2014] [Indexed: 12/23/2022] Open
Abstract
The assumption that the larger tumor contains a higher number of clonogenic cells what may deteriorate prognosis of patients treated with RT has been confirmed in many clinical studies. Significant prognostic influence of tumor volume (TV) on radiotherapy (RT) outcome has been found for tumors of different localizations including patients with head and neck cancer (HNC). Although TV usually is a stronger prognostic factor than T stage, commonly used TNM classification system dose not incorporate TV data. The aim of the paper is to refresh clinical data regarding the role of TV in RT of patients with HNC. At present somehow new meaning of TV could be employed in the aspect of modern RT techniques and combined treatment strategies. For larger TV more aggressive treatment options may be considered. In modern RT techniques escalated dose could be provided highly conformal or RT can be combined with systemic treatment increasing therapeutic ratio. In the study several reports estimating prognostic value of TV for patients with HNC treated with RT has been reviewed.Due to substantially various reported groups of patients as to tumor site, stage of disease or treatment strategies, precise cut-off value could not be establish in general, but the significant association between TV and treatment outcome had been found in almost all studies. There is a strong suggestion that TV should supplement clinical decision in the choice of optimal treatment strategy for patients with HNC.
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Affiliation(s)
- Tomasz Rutkowski
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Gliwice Branch, Poland.
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Mendenhall WM, Mancuso AA, Strojan P, Beitler JJ, Suarez C, Lee TF, Langendijk JA, Corry J, Eisbruch A, Rinaldo A, Ferlito A. Impact of primary tumor volume on local control after definitive radiotherapy for head and neck cancer. Head Neck 2013; 36:1363-7. [PMID: 23956049 DOI: 10.1002/hed.23454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/16/2013] [Accepted: 08/12/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The impact of primary tumor volume (pTV) on local control after definitive radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC) is unclear. METHODS Pertinent literature was reviewed to address the impact of pTV on local control after definitive RT for HNSCC. RESULTS Reproducibility of pTV calculations is probably influenced by interobserver variability and may be reduced by relying on experienced observers. The impact of pTV on local control after definitive RT is probably influenced by primary site. A relatively limited impact of pTV on local control after RT for oropharyngeal squamous cell carcinomas (SCCs) might be attributable to human papillomavirus (HPV) positivity. CONCLUSION pTV may be a useful parameter to select patients for treatment with definitive RT, particularly for those with laryngeal SCCs. Patients with high-volume primary cancers, in which the probability of local control with a functional larynx is low, are likely better treated with surgery.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
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13
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Relationships between Tumor Volume and Lymphatic Metastasis and Prognosis in Early Oral Tongue Cancer. Clin Exp Otorhinolaryngol 2013; 6:243-8. [PMID: 24353865 PMCID: PMC3863674 DOI: 10.3342/ceo.2013.6.4.243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/27/2012] [Accepted: 11/02/2012] [Indexed: 11/08/2022] Open
Abstract
Objectives Although T stage is an important prognostic tool for oral tongue cancer, it fails to define the depth of invasion and true three-dimensional volume of primary tumors. The purpose of this paper is to determine the relations between tumor volume and lymph node metastasis and survival in early oral tongue cancer. Methods Forty-seven patients with T1-2 tongue cancer were included. Tumor volumes were measured by the computerized segmentation of T2-weighted magnetic resonance imaging. Results The overall average tumor volume was 27.7 cm3 (range, 1.4 to 60.1 cm3). A significant positive correlation was found between tumor volume and pathological T stage, depth of invasion, and cervical lymph node metastasis (P<0.001, P<0.001, and P=0.002, respectively). When the tumor volume exceeded 20 cm3, the cervical metastasis rate increased to 69.2%. The overall 5-year disease specific survival rate was 80%. There was a statistically significant association between large tumor volume (≥20 cm3) and the 5-year disease-specific survival (P=0.046). Conclusion Tumor volume larger than 20 cm3 was associated with greater risk cervical lymph node metastasis and poor 5-year disease-specific survival rate in early oral tongue cancer patients.
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Importance of tumor volume in supraglottic and glottic laryngeal carcinoma. Strahlenther Onkol 2013; 189:1009-14. [PMID: 24196282 DOI: 10.1007/s00066-013-0467-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of our study was to assess the prognostic value of tumor volume compared to and in addition to T-stage on local control (LC), disease-free survival (DFS), and overall survival (OS) in glottic and supraglottic laryngeal carcinoma patients. PATIENTS AND METHODS In 150 patients, we determined tumor volume on diagnostic CT scans. We applied crude and multivariable Cox regression analysis to relate volume (continuous), T-stage and the combination to 5-year DFS, OS, and LC. Before, we examined the linearity assumption of the association between volume and outcome with restricted cubic spline functions. Prognostic performance of the models was examined by determination of the model's discrimination. Discriminative ability was determined with the C statistic referring to the ability to discriminate between patients who do and do not develop an event during follow-up. RESULTS A strong association between tumor volume and DFS and OS was found. The restricted cubic spline plot did not indicate a non-linear relationship between tumor volume and DFS and local control. Tumor volume demonstrated a better discriminative ability to predict DFS and OS compared to T-stage (0.68 and 0.57 vs. 0.59 and 0.54, respectively). For local control, T-stage showed a higher discriminative ability than tumor volume (0.63 vs. 0.61). The combined model increased discriminative power (0.69). CONCLUSION Volume seems to be more important than T-stage in prediction of DFS or OS in laryngeal squamous cell carcinoma patients. Perhaps prediction of DFS, OS, and LC could be improved by including tumor volume into the staging process.
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Rutkowski T, Wygoda A, Składowski K, Hejduk B, Rutkowski R, Kołosza Z, Maciejewski B. Prognostic role of tumor volume for radiotherapy outcome in patient with T2 laryngeal cancer. Strahlenther Onkol 2013; 189:861-6. [DOI: 10.1007/s00066-013-0411-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022]
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16
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Knegjens JL, Hauptmann M, Pameijer FA, Balm AJ, Hoebers FJ, de Bois JA, Kaanders JH, van Herpen CM, Verhoef CG, Wijers OB, Wiggenraad RG, Buter J, Rasch CR. Tumor volume as prognostic factor in chemoradiation for advanced head and neck cancer. Head Neck 2011; 33:375-82. [PMID: 20629076 DOI: 10.1002/hed.21459] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Tumor volume is an important predictor of outcome in radiotherapy alone. Its significance in concomitant chemoradiation (CCRT) is much less clear. We analyzed the prognostic value of primary tumor volume for advanced head and neck squamous cell carcinoma (HNSCC) treated with CCRT. METHODS Three hundred sixty patients treated with definitive CCRT for advanced HNSCC were selected. The pretreatment MRI or CT scan was used to calculate the primary tumor volume. Median follow-up was 19.8 months. RESULTS The average primary tumor volume was 37.0 cm³ (range, 2.1-182.7 cm³; median, 28.7 cm³). Multivariate analysis showed a significant effect of tumor volume on local control. The hazard ratio for a local recurrence increased by 14% per 10 cm³ volume increase (95% CI, 8% to 21%). There was no significant independent effect of T and N status on local control. CONCLUSION For advanced HNSCC, tumor volume is more powerful for predicting outcome after CCRT than TNM status.
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Affiliation(s)
- Joost L Knegjens
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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17
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Ho ACW, Lee VHF, To VSH, Kwong DLW, Wei WI. Natural course and tumor doubling time of nasopharyngeal carcinoma. A study of 15 patients. Oral Oncol 2011; 47:742-6. [PMID: 21708482 DOI: 10.1016/j.oraloncology.2011.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 05/30/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is a non-lymphomatous carcinoma that develops in the epithelial lining of the nasopharynx. The knowledge of natural course of tumor progression has been based on anatomical model without clinical correlation. This study is the first to describe and analyze the natural progression of NPC based on clinical information and calculate the tumor growth rate of NPC. Fifteen NPC patients who refused treatment after initial work-up and then subsequent re-presentation at a later time were recruited during the period from January 2003 to August 2009. Clinical data were analyzed and CT scans were used to calculate the tumor volumes. The time interval between the first planning CT image and the subsequent planning CT image was used to calculate the rate of tumor growth in this group of patients. The tumor volume doubling time can be calculated by using the formula DT=tln2/(lnV2-lnV1), where t is the time interval between measurements and V(2) and V(1) are the tumor volumes at the end and beginning of the time interval, respectively. Cranial nerves palsies such as diplopia and systemic upset were the most common reason for re-presentation and the consent for treatment. The median growth rate was 1.63mm(3) per day and the median tumor doubling time was 279days. This study is the first report in the literature looking at the natural progression of nasopharyngeal carcinoma (NPC) based on clinical information. The current study showed that NPC has a propensity to grow superiorly to involve the skull base rather than laterally or anteriorly. Although the tumor growth rate was very variable, the median natural NPC growth rate was 1.63mm(3)/day.
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Affiliation(s)
- Ambrose Chung-Wai Ho
- Division of Otorhinolaryngology, Head & Neck Surgery, Department of Surgery, Hong Kong.
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18
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Ohnishi K, Shioyama Y, Hatakenaka M, Nakamura K, Abe K, Yoshiura T, Ohga S, Nonoshita T, Yoshitake T, Nakashima T, Honda H. Prediction of local failures with a combination of pretreatment tumor volume and apparent diffusion coefficient in patients treated with definitive radiotherapy for hypopharyngeal or oropharyngeal squamous cell carcinoma. JOURNAL OF RADIATION RESEARCH 2011; 52:522-530. [PMID: 21905311 DOI: 10.1269/jrr.10178] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kayoko Ohnishi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi, Higashi-ku, Fukuoka city, Japan
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Rebol J. Volume determination of oral cavity tumors by 3-dimensional ultrasonography. J Oral Maxillofac Surg 2008; 66:2296-301. [PMID: 18940495 DOI: 10.1016/j.joms.2008.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Accepted: 01/11/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE With the help of 3-dimensional (3D) ultrasound, the ultrasonographic determination of tumor volumes offers a new view of tumors in the oral cavity. These are classified according to their maximal diameter in TNM classification whereby the possibility exists in the high T category of overestimating small tumors that have spread into surrounding structures, and in the low T of underestimating large volume tumors that do not extend into surrounding structures. MATERIALS AND METHODS We analyzed a group of 49 patients with tumors of the oral cavity, all of whom underwent surgery. Tumor volumes were determined before surgery with 3D ultrasound aided by 3D View program software. After excision, the tumors were classified in pT categories based on pathologic findings. N stage was determined after neck dissection and correlation to tumor volume were performed. RESULTS The average volume of T1 tumors was 1.74 cm(3); T2 was 5.21 cm(3); T3 was 23.36 cm(3), and T4 was 13.53 cm(3). There were significant differences in tumor volumes between all T categories except T3 and T4. Tumor volumes in our patients did not correlate with N stage. CONCLUSION Volume determination of tumors with the help of 3D View software may categorize small tumors better and perhaps become a new refinement in TNM tumor classification. Results show that although T category in oral cavity tumors is determined by diameter in T1 to T3, the volumes match with T category. By using this method, a successful follow-up can be performed and the effects of radiotherapy or chemotherapy can be evaluated.
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Affiliation(s)
- Janez Rebol
- Department of Otolaryngology, Maribor University Hospital, Maribor, Slovenia.
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20
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Chu ST, Wu PH, Hou YY, Chang KP, Chi CC, Lee CC. Primary tumor volume of nasopharyngeal carcinoma: significance for recurrence and survival. J Chin Med Assoc 2008; 71:461-6. [PMID: 18818139 DOI: 10.1016/s1726-4901(08)70149-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary tumor volume (PTV) is known to be a significant prognostic factor in malignant tumor. There have been several studies of nasopharyngeal carcinoma (NPC) relating tumor volume to treatment outcome. Our study was designed to evaluate the effect of PTV on treatment outcomes in NPC treated with radiotherapy (RT)/concurrent chemoradiotherapy (CCRT) or CCRT with adjuvant chemotherapy. METHODS We retrospectively reviewed 100 cases with newly diagnosed NPC who were treated with RT/CCRT or CCRT with adjuvant chemotherapy from 2002 to 2006. Magnetic resonance imaging-derived PTV was calculated using the summation-of-area technique. Kaplan-Meier plots and the log-rank test were used to estimate tumor recurrence (locoregional, distant, or both) and overall survival. Cox proportional hazards regression analysis was used to assess the prognostic impact of PTV. RESULTS The median PTV was 12.94 mL. PTV remained an independent prognostic factor for distant metastasis (hazard ratio [HR], 1.04; p=0.03), for any relapse (HR, 1.04; p=0.02), and for overall survival (HR, 1.09; p<0.001) in multivariate analysis. In the large tumor volume group (PTV>15 mL), patients' metastasis-free survival rates, with and without adjuvant chemotherapy, were 100% and 68.3%, respectively (p=0.002). Their 3-year recurrence-free survival rates, with and without adjuvant chemotherapy, were 94.1% and 69.6%, respectively (p=0.006). In the small tumor volume group (PTV <or= 15 mL), this phenomenon was not observed. CONCLUSION PTV had a close relationship with survival rates and recurrence rates in patients with NPC. The large tumor volume group (PTV>15 mL) was associated with more recurrence and poor survival rate, and it was suggested that these high-risk patients should benefit from CCRT followed by adjuvant chemotherapy.
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Affiliation(s)
- Sau-Tung Chu
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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21
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Tumor Volume as a Prognostic Factor in Oropharyngeal Squamous Cell Carcinoma Treated With Primary Radiotherapy. Laryngoscope 2008; 118:1377-82. [DOI: 10.1097/mlg.0b013e318172c82c] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Chu PY, Li WY, Chang SY. Clinical and pathologic predictors of survival in patients with squamous cell carcinoma of the hypopharynx after surgical treatment. Ann Otol Rhinol Laryngol 2008; 117:201-6. [PMID: 18444480 DOI: 10.1177/000348940811700307] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Hypopharyngeal squamous cell carcinoma (HPSCC) usually presents at an advanced stage. Although chemoradiotherapy has become more popular in treating HPSCC in recent years, surgery with postoperative adjuvant therapy still plays an important role. The purpose of this study was to identify the clinicopathologic factors that predict survival in patients with HPSCC who underwent surgical treatment. METHODS Between 1986 and 1995, 94 previously untreated HPSCC patients who underwent surgery with or without postoperative radiotherapy were enrolled. The surgical specimens were reexamined by a single pathologist. The clinicopathologic parameters and prognostic data were analyzed. RESULTS With a median follow-up of 50 months, the 5-year overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS) were 47%, 60%, and 58%, respectively. Thirty-seven patients (39%) had tumor recurrence. The level of lymph node metastasis was an independent factor in OS, DSS, and RFS. Neck biopsy before surgery, tumor involvement of more than 1 subsite, and extracapsular spread were independent factors in DSS, as was lymphovascular permeation in RFS. CONCLUSIONS The level of cervical lymph node metastasis is the only independent prognostic factor in OS, DSS, and RFS. The addition of postoperative chemoradiotherapy may benefit high-risk cases.
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Affiliation(s)
- Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, Taipei 112, Taiwan
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23
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Pre- and post-radiotherapy MRI results as a predictive model for response in laryngeal carcinoma. Eur Radiol 2008; 18:2231-40. [DOI: 10.1007/s00330-008-0986-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 02/16/2008] [Accepted: 03/22/2008] [Indexed: 10/22/2022]
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24
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Primary tumor volume of nasopharyngeal carcinoma: prognostic significance for recurrence and survival rate. Eur Arch Otorhinolaryngol 2008; 265 Suppl 1:S115-20. [DOI: 10.1007/s00405-008-0590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
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25
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Lee CC, Ho HC, Lee MS, Hsiao SH, Hwang JH, Hung SK, Chou P. Primary tumor volume of nasopharyngeal carcinoma: significance for survival. Auris Nasus Larynx 2008; 35:376-80. [PMID: 18249078 DOI: 10.1016/j.anl.2007.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Revised: 07/20/2007] [Accepted: 10/22/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To elucidate the effect of primary tumor volume (PTV) on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy or concurrent chemoradiotherapy. The TNM staging system developed by American Joint Committee of Cancer (AJCC) is universally used and accepted but its prediction of prognosis in NPC receives a lot of challenge. Primary tumor volume had been reported to have close relationship with prognosis of head and neck cancer. We may predict prognosis of NPC with PTV. METHODS From 1999 to 2006, 91 patients with newly diagnosed NPC who were treated with radiotherapy or CCRT were enrolled in the study. Computed tomography-derived or magnetic resonance-derived primary tumor volume was calculated. The correlation between AJCC disease stage, primary tumor volume and disease-specific survival were analyzed. Multivariate analyses using the Cox proportional hazard model was performed. RESULTS The median primary tumor volume for the whole series was 11.39 ml (range 1.25-166.58 ml). The median primary tumor volume was 2.69 ml in T1 disease, 10.14 ml in T2 disease, 15.41 ml in T3 disease, and 26.69 ml in T4 disease. Hazard ratio increased with tumor volume, ranging from 5.91 (95% confidence interval (95% CI) 1.13-26.43) for tumor volumes between 20 ml and 40 ml, and 15.72 (95% CI, 3.82-61.05) for tumor volumes >40 ml. With both tumor volume and T classification in the same Cox regression model, only tumor volume remained statistically significant in the prognosis of NPC. CONCLUSION Primary tumor volume has closer relationship with survival rates of patients with NPC. Calculation of primary tumor volume may be further considered to improve the current staging system.
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Affiliation(s)
- Ching-Chih Lee
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC.
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26
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Silva P, Homer JJ, Slevin NJ, Musgrove BT, Sloan P, Price P, West CML. Clinical and biological factors affecting response to radiotherapy in patients with head and neck cancer: a review. Clin Otolaryngol 2008; 32:337-45. [PMID: 17883552 DOI: 10.1111/j.1749-4486.2007.01544.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The main aim of this article was to review the clinical and biological factors that have been shown to influence the response of the head and neck squamous cell carcinoma (HNSCC) to primary radiotherapy and briefly discuss how some of these factors could be exploited to improve outcome. DESIGN Medline based search covering 1982-2006 to identify the HNSCC literature where the effect of clinical and biological factors on locoregional control and overall survival were investigated. RESULTS Clinical factors are routinely used in management decisions. Nevertheless, identically staged tumours receiving the same treatment may have different outcomes. Biological factors such as hypoxia, proliferation and radio-sensitivity play an important role in radiation response. However, these are not currently used in practise because tests that are clinically reliable and feasible are not available. CONCLUSION High-quality translational research will allow us to develop biological tests that can be used in routine clinical practise to tailor individual treatment, with the ability to improve patient outcome further by modifying the underlying tumour biology.
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Affiliation(s)
- P Silva
- Academic Department of Radiation Oncology, The University of Manchester, Manchester, UK.
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27
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Lee CC, Chu ST, Ho HC, Lee CC, Hung SK. Primary tumor volume calculation as a predictive factor of prognosis in nasopharyngeal carcinoma. Acta Otolaryngol 2008; 128:93-7. [PMID: 17851945 DOI: 10.1080/00016480701361921] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS Primary tumor volume (PTV) has a close relationship with survival rates of patients with nasopharyngeal carcinoma (NPC) who were treated with concurrent chemoradiotherapy (CCRT) or radiotherapy. Besides the current AJCC staging system, measurement of PTV may be needed to predict prognosis of NPC and adjust treatment strategy. OBJECTIVES We conducted a retrospective study to elucidate the effect of PTV on treatment outcomes in patients with NPC who were treated with CCRT or radiotherapy. PATIENTS AND METHODS A total of 66 patients with newly diagnosed NPC were enrolled in this study. Computed tomography (CT)-derived or magnetic resonance imaging (MRI)-derived PTV was calculated. The correlation between AJCC disease stage, PTV, and disease-specific survival was analyzed. Correlations between different prognostic factors were assessed using a Cox regression model. RESULTS The median PTV for the whole series was 12.01 ml (range 1.25-166.58 ml). The median PTV was 3.45 ml in T1 disease, 7.96 ml in T2 disease, 17.95 ml in T3 disease, and 64.73 ml in T4 disease. Disease stage and T stage carried no prognostic significance (p=0.25 and p =0.30, respectively). Four categories of PTV (<12.5 ml, 12.5-25 ml, 25-50 ml and >50 ml) had prognostic significance (p=0.02). Survival analysis demonstrated a significant difference in overall survival with larger tumor volume (risk ratio 5.447; p=0.044).
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Affiliation(s)
- Ching-Chih Lee
- Department of Otolaryngology, Buddhist Tzu Chi Dalin General Hospital, Dalin, Chiayi, Taiwan.
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Abstract
Tumour volume is a significant prognostic factor in the treatment of malignant head and neck tumours. Studies of laryngeal and pharyngeal tumours have shown tumour volume to be an important predictor for tumour recurrence. Some studies (for instance nasopharyngeal carcinoma) have shown through multivariate modelling that tumour volume is a dominant covariate that overwhelms T stage, N stage and stage group. The results of these studies have prompted several investigators to suggest the inclusion of tumour volume as an additional prognostic factor in future revisions of the TNM staging system. This paper briefly reviews the TNM system as a staging tool, the measurement of tumour volume and how tumour volume could possibly be incorporated in the system or used as an additional prognostic factor.
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Affiliation(s)
- Vincent F H Chong
- Department of Diagnostic Radiology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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29
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Zhou JY, Chong VFH, Khoo JBK, Chan KL, Huang J. The relationship between nasopharyngeal carcinoma tumor volume and TNM T-classification: a quantitative analysis. Eur Arch Otorhinolaryngol 2006; 264:169-74. [PMID: 17021779 DOI: 10.1007/s00405-006-0163-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Accepted: 08/17/2006] [Indexed: 11/26/2022]
Abstract
Recent findings show that tumor volume is a significant prognostic factor for the treatment of nasopharyngeal carcinoma (NPC). The inclusion of tumor volume as an additional prognostic factor in the UICC TNM classification system was suggested; however, how tumor volume could possibly be incorporated is still unexplored. In this paper, we report a quantitative analysis on the relationship between NPC tumor volume and T-classification, using the data from 206 NPC patients. By T-classification and semi-automatic tumor volume measurement, the difference in tumor volumes among the various TNM T-classification groups was examined. In addition, a statistics-based analysis scheme, which used the T-classification as the "gold standard", was proposed to classify NPC tumors into volume-based groups to explore the possible links. The results show that NPC tumor volume has positive correlation with advancing T-classification groups and significant difference existed in the distribution of T-classification among various volume-based groups (P < 0.001). By the proposed statistical scheme, tumor volume could be included as an additional prognostic factor in the TNM framework, following validation studies.
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Affiliation(s)
- Jia-Yin Zhou
- Biomedical Engineering Research Centre, School of Chemical and Biomedical Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, Singapore.
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Kuhnt T, Mueller AC, Pelz T, Haensgen G, Bloching M, Koesling S, Schubert J, Dunst J. Impact of tumor control and presence of visible necrosis in head and neck cancer patients treated with radiotherapy or radiochemotherapy. J Cancer Res Clin Oncol 2005; 131:758-64. [PMID: 16088405 DOI: 10.1007/s00432-005-0018-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 06/07/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Tumor volume after the lymph node involvement is one of the most important single prognostic factor in patients of head and neck cancers treated with radiotherapy. We have recently demonstrated that the hypoxic subvolume is more important than the total tumor volume. We therefore propose the hypothesis that the presence of visible necrosis might be an important factor for cure by radiotherapy in squamous cell cancers of the head and neck. METHODS A total of 51 patients with locally advanced inoperable (T3-4 or N2-3) squamous cell cancers of the head and neck (mean age 57 years, range 41-75 years) were prospectively investigated with regard to a possible impact of tumor volume. All patients received CT examination of the head and neck according to a standardized protocol (spiral CT, contrast enhancement after automatic injection), and the total tumor volume was calculated as the sum of volumes of all visible macroscopic tumor sites. Poorly perfused and necrotic areas (no contrast enhancement) within macroscopic tumor sites were also calculated. Patients were then treated with accelerated-hyperfractionated radiotherapy in about 6 weeks. Seventeen patients were treated with only radiation. Patients without contraindications to cisplatin chemotherapy received cisplatin chemotherapy or a combination of cisplatin and paclitaxel (N=34). The allocation of patients to certain treatment regimens was based on individual decisions in each case and not randomized. RESULTS In patients treated with radiation alone, 12/17 (71%) got recurrence whereas in patients treated with radiation plus cisplatin, only 14/34 (41%) recurred (P=0.05). The 2-year overall survival was for radiation alone versus radiation plus cisplatin 0% vs. 62% (P<0.0008). Tumors with smaller amount of necrosis (necrosis volume<4 cm3) had a good prognosis irrespective of type of treatment (radiation alone or radiation plus cisplatin). However, patients with tumors with a larger amount of necrosis (necrosis volume> or =4 cm3) had a significantly better outcome if they were treated with radiation plus cisplatin as compared to patients treated with radiation alone. In a multi-variate analysis using a Cox-regression model the type of treatment (radiotherapy plus versus without cisplatin) was the only independent prognostic factor for event-free survival (P<0.03) in the whole group. CONCLUSIONS In this non-randomized retrospective investigation with limited sample size, radiation plus cisplatin was superior to radiation alone. This resulted mainly from a higher efficacy of the radiochemotherapy regimen in patients with large and especially necrotic tumors. The prognostic and predictive impact of visible necrosis should be further evaluated.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Dose Fractionation, Radiation
- Female
- Head and Neck Neoplasms/diagnostic imaging
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/therapy
- Humans
- Male
- Multivariate Analysis
- Necrosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Paclitaxel/administration & dosage
- Proportional Hazards Models
- Prospective Studies
- Radiotherapy, Adjuvant
- Retrospective Studies
- Survival Analysis
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Thomas Kuhnt
- Clinic of Radiotherapy, Martin Luther University Halle Wittenberg, Dryanderstrasse 4, 06097, Halle/Saale, Germany.
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Cavalcanti MGP, Santos DTD, Perrella A, Vannier MW. CT-based analysis of malignant tumor volume and localization: a preliminary study. Braz Oral Res 2004; 18:338-44. [PMID: 16089267 DOI: 10.1590/s1806-83242004000400012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
The purpose of this study was to correlate 3D-CT (3D computed tomography) volume measurements of malignant tumors with the response to treatment, and to observe bone invasion in these lesions applying a specific imaging protocol. We analyzed 17 individuals with maxillofacial malignant lesions who were submitted to spiral CT (2D-CT). The original data were transferred to an independent workstation using a 3D volume rendering package software, which was used by two examiners to obtain area and volume measurements of the lesions, independently, three times each, prior to and after treatment. The segmentation protocol was applied for the assessment of bone involvement. The difference between imaging and gold standard values was not considered significant (p > 0.05). Regarding bone invasion, three false-negatives were obtained using MPR-CT (multiplanar reconstruction) and no false-negatives were obtained using the 3D segmentation protocol. The use of 3D-CT may be a differential and important factor for expanding options regarding the localization, dimension, and clarification of lesion components.
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32
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Ljumanović R, Langendijk JA, Schenk B, Van Wattingen M, Knol DL, Leemans CR, Castelijns JA. Supraglottic carcinoma treated with curative radiation therapy: identification of prognostic groups with MR imaging. Radiology 2004; 232:440-8. [PMID: 15286316 DOI: 10.1148/radiol.2322031001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess the prognostic meaning of tumor characteristics depicted on pretreatment magnetic resonance (MR) images for local outcome in supraglottic squamous cell carcinoma treated with definitive radiation therapy. MATERIALS AND METHODS Pretreatment MR images acquired in 84 patients with supraglottic carcinoma treated with curative radiation therapy were reviewed for tumor involvement of laryngeal sites including glottis, subglottis, pre-epiglottic space, laryngeal cartilages, and hypopharynx, and for extralaryngeal extension. The volume of each tumor was estimated, and mean tumor volume was calculated for the group of tumors in each T staging category. RESULTS Results of univariate analysis showed MR imaging-determined primary tumor volume (P =.03), involvement of pre-epiglottic space (P =.008), abnormal signal intensity in thyroid cartilage (P =.04), and extralaryngeal extension beyond thyroid and/or cricoid cartilage (P =.02) to be significant predictors of local control rate. Results of multivariate analysis with the Cox regression model confirmed statistical significance for invasion of pre-epiglottic space (P =.004) and for abnormal signal intensities in thyroid cartilage adjacent to the anterior commissure (P =.04) and in cricoid cartilage (P =.01). Five-year local control rates were calculated from the regression coefficients of three independent MR imaging prognostic factors, and three prognostic groups were identified on the basis of these control rates. The 5-year local control rate in the high-risk group was 35%, significantly lower than the rates in the intermediate- and low-risk groups (60% and 89%, respectively; P =.002). CONCLUSION MR imaging-determined pre-epiglottic space involvement and abnormal signal intensities in the thyroid cartilage adjacent to the anterior commissure and/or the cricoid cartilage are strong predictors of local outcome in supraglottic carcinoma treated with definitive radiation therapy.
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Affiliation(s)
- Redina Ljumanović
- Department of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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33
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Plataniotis GA, Theofanopoulou ME, Kalogera-Fountzila A, Haritanti A, Ciuleanou E, Ghilezan N, Zamboglou N, Dimitriadis A, Sofroniadis I, Fountzilas G. Prognostic impact of tumor volumetry in patients with locally advanced head-and-neck carcinoma (non-nasopharyngeal) treated by radiotherapy alone or combined radiochemotherapy in a randomized trial. Int J Radiat Oncol Biol Phys 2004; 59:1018-26. [PMID: 15234035 DOI: 10.1016/j.ijrobp.2004.01.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Revised: 01/06/2004] [Accepted: 01/07/2004] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor volume (TV) is one of the main reported factors determining the outcome of treatment in head-and-neck carcinomas. In this study, the prognostic impact of TV was explored in the context of a randomized trial with the patients assigned to receive standard radiotherapy (RT) alone or RT plus platinum compounds (RT alone, RT plus cisplatin, or RT plus carboplatin). METHODS AND MATERIALS The tumor outlines were traced and digitized on each pretreatment CT slice for each of the 101 patients studied. Taking into account the magnification factor of the scan and CT slice thickness, a computer with specifically designed software calculated the TV in cubic centimeters. RESULTS The median overall survival for the whole group of patients was 21.6 months (95% confidence interval, 13.0-30.2) and the 3-year survival rate was 40%. The addition of platinum compounds to RT (Groups 2 and 3) significantly improved the survival rate (RT alone vs. RT plus cisplatin, hazard ratio 0.36, p = 0.002; RT alone vs. RT plus carboplatin, hazard ratio 0.53, p = 0.029). In univariate analysis, the most significant parameters for survival were treatment group, total gross tumor volume (TGTV), complete response, nodal GTV, primary GTV, and performance status. In multivariate analysis, treatment group, TGTV, gender, and primary site were independent prognostic factors for survival. A prognostic threshold of 22.8 cm(3) was detected for TGTV. Patients with a TGTV of <22.8 cm(3) were more likely to achieve a complete response and had a median survival of 45.3 months, and those with a TGTV >22.8 cm(3) had a median survival of 12.3 months (log-rank test, p = 0.0102). CONCLUSION The prognostic significance of the TGTV was confirmed and a cutoff value of 22.8 cm(3) derived. Our data indicated that locally advanced head-and-neck carcinomas should not be treated by standard (once-daily) RT alone. Tumor size and disease subsite should be taken into account in future randomized trials to increase their statistical power.
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Abstract
Tumor volume was measured in 69 patients with nasopharyngeal carcinoma. On transverse nonenhanced T1-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images, segmentation was performed by means of seed growing and knowledge-based fuzzy clustering methods. Data were compared with those collected with the manual tracing method and analyzed for interoperator variance and interobserver reliability. There was no significant difference between the volumes determined with manual tracing or semiautomated segmentation (P >.05). On the volume level, Pearson correction coefficients were close for both the manual tracing and semiautomated methods. Significant differences in interoperator variance existed between the two methods on the pixel level (P <.05). Compared with manual tracing, the semiautomated method helped reduce interoperator variance and obtain higher interobserver reliability. Findings in the current study validate the use of semiautomated volume measurement methods for nasopharyngeal carcinoma.
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Affiliation(s)
- Vincent F H Chong
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Republic of Singapore.
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35
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Chen MK, Chen THH, Liu JP, Chang CC, Chie WC. Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume. Cancer 2004; 100:2160-6. [PMID: 15139059 DOI: 10.1002/cncr.20210] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Heterogeneity of primary tumor volume within tumors of the same classification indicates a need to elucidate the effects of primary tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC). METHODS From 1994 through 1996, 129 patients with newly diagnosed NPC who were treated with high-dose radiotherapy were enrolled in the study. Computed tomography-derived primary tumor volume was measured using the summation-of-area technique. Correlations between American Joint Committee on Cancer (AJCC) disease stage, primary tumor volume, and disease-specific survival were assessed using a Cox regression model. Cross-validation based on receiver operating characteristic (ROC) curve also was examined. RESULTS Compared with the AJCC staging system and the TNM classification system, primary tumor volume was better at determining cumulative survival for patients with NPC. Hazard ratios increased with tumor volume, ranging from 6.68 (95% confidence interval [95% CI], 1.89-23.67) for tumor volumes between 20-40 mL, 18.03 (95% CI, 4.80-67.75) for tumor volumes between 40-60 mL, and 26.06 (95% CI, 7.70-88.20) for tumor volumes > 60 mL. With both tumor volume and T classification in the same Cox regression model, only tumor volume remained statistically significant in the prognosis of NPC. The validation results with ROC curves also revealed that, in predicting patient outcome, primary tumor volume (area under the ROC = 83.33%) was superior to disease stage (area under the ROC = 66.53%) and TNM classification (area under the ROC = 58.61%). CONCLUSIONS The incorporation of primary tumor volume may lead to a further refinement of the current AJCC staging system, particularly for patients with large primary tumor volumes (> 60 mL), who require more aggressive treatment. Cancer 2004.
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Affiliation(s)
- Mu-Kuan Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
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36
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Zhou J, Lim TK, Chong V, Huang J. Segmentation and visualization of nasopharyngeal carcinoma using MRI. Comput Biol Med 2003; 33:407-24. [PMID: 12860465 DOI: 10.1016/s0010-4825(03)00018-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, a semi-automatic system was developed for nasopharyngeal carcinoma (NPC) tumor segmentation, volume measurement and visualization using magnetic resonance imaging (MRI). Some novel algorithms for tumor segmentation from MRI and inter-slice interpolation were integrated in this medical diagnosis system. This system was applied to 10 MR image data sets of NPC patients and satisfactory results were achieved. This system can be used as a clinical image analysis tool for doctors or radiologists to obtain tumor location from MRI, tumor volume estimation, and 3D information.
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Affiliation(s)
- Jiayin Zhou
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore.
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37
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Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Mancuso AA. Parameters that predict local control after definitive radiotherapy for squamous cell carcinoma of the head and neck. Head Neck 2003; 25:535-42. [PMID: 12808656 DOI: 10.1002/hed.10253] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To analyze parameters that may influence the likelihood of local control after definitive radiotherapy for head and neck cancer. METHODS Between April 1980 and January 2000, 404 patients were treated with definitive RT alone (358 patients) or combined with adjuvant chemotherapy (46 patients) at our institution and were followed up for 0.25 to 20.25 years (median, 3.5 years.) All living patients were followed up for at least 2 years. All patients had the primary tumor volume calculated on pretreatment CT. End points were local control after RT and local control after RT without a severe late complication. Parameters evaluated in multivariate analyses of these end points included primary site, T stage, primary tumor volume, N stage, histologic differentiation, fractionation schedule, adjuvant chemotherapy, and gender. RESULTS The rates of local control and local control without a severe late complication after RT were significantly influenced by primary tumor volume for patients with cancer of the supraglottic larynx and true vocal cord. In contrast, the rates of local control and local control without severe complications for patients with tumors of the oropharynx and hypopharynx were less influenced by tumor volume. Multivariate analysis of the overall population revealed that the only parameter that was significantly related to the probability of local control after RT was T stage. Multivariate analyses stratified by primary site revealed that tumor volume significantly influenced local control for patients with cancers of the supraglottis (p =.0220) and glottis (p =.0042) but not for those with lesions of the tonsillar fossa/posterior tonsillar pillar (p =.0892), base of tongue (p =.9493), anterior tonsillar pillar/soft palate (p =.5909), and hypopharynx (p =.2282). CONCLUSIONS The most important parameter that has an impact on local control after RT is T stage. Primary tumor volume also significantly influences the probability of local control in cancers of the supraglottis and glottis.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida Health Science Center, P. O. Box 100385, Gainesville, Florida 32610-0385, USA.
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38
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Chang CC, Chen MK, Liu MT, Wu HK. The effect of primary tumor volumes in advanced T-staged nasopharyngeal tumors. Head Neck 2002; 24:940-6. [PMID: 12369073 DOI: 10.1002/hed.10151] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Tumor volume is an important prognostic factor in patients with malignancy treated with primary radiotherapy. It is necessary to have a clear understanding of the nasopharyngeal primary tumor volume and the treatment outcome, especially in the advanced T-staged tumors. METHODS From 1994-1996, 76 newly diagnosed patients with advanced T-staged nasopharyngeal carcinomas who were treated with high-dose radiotherapy with or without chemotherapy were included in this study. CT-derived primary tumor volume was obtained after the summation of area technique. RESULTS The median primary tumor volume was 29.6 mL in T3 disease and 54.1 mL in T4 disease, with a range of 8.0-131.8 in T3 disease, and 6.7-223.1 ml in T4 disease. Large primary tumor volume was associated with a significantly poor disease-specific survival (p <.0001), whereas the T stage carried no prognostic significance (p =.43). CONCLUSIONS In advanced T-staged (T3 and T4) nasopharyngeal tumors, a substantial variation of primary tumor volume was present within the same T stage, and primary tumor volume represented a more important prognostic factor for treatment outcome. Volumetric measurements of primary tumors in advanced nasopharyngeal tumors would refine the TNM staging system. Patients with large primary tumor volume should be treated more aggressively.
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Affiliation(s)
- Cheng-Chuan Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, 135 Nan Siau Street Changhua, 500, Taiwan
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39
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Keberle M, Tschammler A, Hahn D. Single-bolus technique for spiral CT of laryngopharyngeal squamous cell carcinoma: comparison of different contrast material volumes, flow rates, and start delays. Radiology 2002; 224:171-6. [PMID: 12091679 DOI: 10.1148/radiol.2241010894] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate different contrast material volumes, flow rates, and start delays for contrast material enhancement of neck structures and squamous cell carcinoma to determine the most effective examination protocol. MATERIALS AND METHODS Seventy patients with squamous cell carcinoma were prospectively randomized into four groups for examination with different protocols (125 mL of contrast material administered at a flow rate of 2.5 mL/sec, 100 mL at 2.0 mL/sec, 90 mL at 1.5 mL/sec, or 70 mL at 1.0 mL/sec). Dynamic series were performed on the tumors and relevant anatomic structures to obtain time-attenuation curves. The protocols were compared (analysis of variance and Tukey-Kramer tests) with regard to time and level of maximum tumor enhancement and carotid arterial enhancement of more than 150 HU. One selected protocol was tested in 30 additional routine examinations with start delays of 40 seconds (for laryngeal and/or hypopharyngeal tumors, 3-mm collimation) and 45 seconds (for oropharyngeal tumors, 5-mm collimation). RESULTS Except for the 70-mL bolus administered at 1.0 mL/sec, the other protocols performed similarly well, yielding comparable maximum tumor enhancement at 52 seconds and later. In spite of a smaller volume of 90 mL, due to the prolonged flow time at 1.5 mL/sec, carotid arterial enhancement of more than 150 HU was prolonged (when compared with that in 100- or 125-mL protocols). As a result of these circumstances, injection of 90 mL at 1.5 mL/sec was considered more effective, providing no significant differences in tumor (P =.39) or carotid arterial (P =.52) enhancement between routine examinations and dynamic series. CONCLUSION A single bolus of 90 mL administered at 1.5 mL/sec appears to be the most desirable protocol for contrast enhancement.
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Affiliation(s)
- Marc Keberle
- Department of Radiology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
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40
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Ferlito A, Rinaldo A, Buckley JG, Mondin V. General considerations on distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001; 63:189-91. [PMID: 11408810 DOI: 10.1159/000055738] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mortality in head and neck cancer is due to locoregional disease, distant metastases or intercurrent disease. As treatment of the primary tumor and cervical metastases has improved, the proportion of deaths from co-morbidity and from distant metastases has increased. Distant metastases almost invariably herald a poor prognosis in head and neck cancer with an average survival of 4.3-7.3 months and treatment is usually palliative. Reliable detection is important to prevent inappropriate treatment. The risk is related to the site, stage and histology of the primary tumor and the presence of cervical metastases. Early detection and treatment of cervical metastases may prevent distant metastases. Accurate staging of tumors helps to identify high-risk tumors that should be specifically investigated for distant metastases.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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Kuriakose MA, Loree TR, Hicks WL, Welch JJ, Wang H, DeLacure MD. Tumour volume estimated by computed tomography as a predictive factor in carcinoma of the tongue. Br J Oral Maxillofac Surg 2000; 38:460-5. [PMID: 11010774 DOI: 10.1054/bjom.2000.0316] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This retrospective study evaluated tumour volume, estimated by computed tomography (CT), as a predictive factor in carcinoma of the tongue. Tumour volume was measured from pretreatment CT scans of 20 consecutive patients, followed up for at least 3 years, and this measurement was compared with tumour volume estimated from pathological specimens. T-stage and CT-derived tumour volume were compared with the clinical and pathological status of the nodes, and with the outcome of treatment. The measurement of tumour volume derived from CT correlated well with measurements derived from pathological examination, and tumour volume also predicted overall treatment failure. The disease-specific survival rate was 100% for patients with low-volume tumours (<13 cc) compared with 79% for those with stage T1 and T2 tumours.CT is a reliable way of measuring the volume of tumours in carcinoma of the tongue, and tumour volume is useful adjunct to the clinical tumour-node-metastases staging system.
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Affiliation(s)
- M A Kuriakose
- Division of Head and Neck Surgery and Oncology, Department of Otolaryngology, New York University School of Medicine, New York, NY 10016, USA.
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42
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Cavalcanti MG, Ruprecht A, Bonomie JM, Vannier MW. The validation of 3D spiral CT-based measurements of simulated maxillofacial neoplasms. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:753-8. [PMID: 10846133 DOI: 10.1067/moe.2000.101617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the precision and accuracy of 3-dimensional spiral computed tomography-based linear measurements of neoplasms associated with the mandible. STUDY DESIGN Four cadaver heads, each with 2 simulated tumors made of clay, containing contrast medium, and positioned medial to the mandible, were examined by means of a subsecond spiral computed tomography unit. The computed tomography data were transferred to a computer workstation and analyzed through use of 3-dimensional reconstructed images. Linear measurements of the length, width, and depth of the simulated tumors were made by 2 observers, twice each. The soft tissues were then removed and the same measurements made by means of calipers. RESULTS There were no statistically significant differences between the 3-dimensional computed tomography and physical measurements (P >.05). The mean difference was found to be less than 0.4 mm. CONCLUSIONS Spiral computed tomography imaging allows for precise and accurate 3-dimensional computed tomography-based measurements for neoplastic lesions in the mandible.
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Affiliation(s)
- M G Cavalcanti
- Department of Radiology, Faculty of Odontology, University of São Paulo, São Paulo, Brazil
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43
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Abstract
Neoplastic disease of the nose, paranasal sinuses, the nasopharynx and the parapharyngeal space requires thorough assessment of location and extent in order to plan appropriate treatment. CT allows the deep soft tissue planes to be evaluated and provides a complement to the physical examination. It is especially helpful in regions involving thin bony structures (paranasal sinuses, orbita); here CT performs better than MRI. MRI possesses many advantages over other imaging modalities caused by its excellent tissue contrast. In evaluating regions involving predominantly soft tissue structures (ec nasopharynx and parapharyngeal space) MRI is superior to CT. The possibility to obtain strictly consecutive volume data sets with spiral CT or 3D MRI offer excellent perspectives to visualize the data via 2D or 3D postprocessing. Because head and neck tumors reside in a complex area, having a 3D model of the anatomical features may assist in the delineation of pathology. Data sets may be transferred directly into computer systems and thus be used in computer assisted surgery.
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Affiliation(s)
- K W Sievers
- Radiology Associates Dortmund, Brüderweg 13, 44135, Dortmund, Germany
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44
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Sánchez Fernández JM, Anta Escuredo JA, Sánchez Del Rey A, Santaolalla Montoya F. Morphometric study of the paranasal sinuses in normal and pathological conditions. Acta Otolaryngol 2000; 120:273-8. [PMID: 11603789 DOI: 10.1080/000164800750001080] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Prospective and retrospective morphometric CT (axial and coronal) research was performed with 100 healthy persons and 163 patients (145 males, 118 females, mean age 50 years, range 1-88 years). The patients were classified into the following groups: chronic sinusitis (n = 85), polyposis (n = 25), mucoceles (n = 13), benign tumors (n = 20) and malignant tumors (n = 20). After initial calibration with the scale (in cm) displayed on the CT image, each paranasal sinus was outlined following its bone inner surface. The data were processed with a high-resolution analysis system, and volumes were calculated using an integration areas rule. The ethmoid, maxillary and sphenoid sinuses exhibited an increase in volume for a period of up to 15 years, afterwards maintaining similar values. The frontal sinus grows in a monomodal pattern (peak at 30 years). The volumetric results (mean and standard deviation) in the normal adult group were as follows: maxillary sinus 13.07 cm3 (6.8), ethmoid 5.5 cm3 (2.0), sphenoid 3.5 cm3 (2.6) and frontal 3.7 cm3 (3.6). Primary frontal and maxillary sinus hypoplasia appeared in 3.9% and 1.3% of cases, respectively. The anatomic variations were as follows: concha bullosa 8.3%, Haller cells 3.2% and Onodi cells 8.3%. The sinusitis values (adults) were greater than those in the normal group: 14.4 cm3 (7.3), 6.8 cm3 (2.9), 2.9 cm3 (1.9) and 4.2 cm3 (5.2), with the exception of the sphenoid, but the difference was not statistically significant. Finally, we propose a new classification for paranasal sinus tumors (benign and malignant), volumetric T (vT), taking into account the morphometric tumoral volume and the mean volumetric value of normal sinuses.
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Affiliation(s)
- J M Sánchez Fernández
- Department of Otolaryngology, Basurto Hospital, School of Medicine, University of the Basque Country, Bilbao, Spain
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45
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Greenman J, Homer JJ, Stafford ND. Markers in cancer of the larynx and pharynx. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2000; 25:9-18. [PMID: 10764231 DOI: 10.1046/j.1365-2273.2000.00339.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J Greenman
- Academic Surgical Unit, University of Hull, Hull Royal Infirmary, UK
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46
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Cavalcanti MG, Ruprecht A, Bonomie JM, Vannier MW. Accuracy and precision of spiral CT in the assessment of neoplastic lesions associated with the mandible. Acad Radiol 2000; 7:94-9. [PMID: 10730164 DOI: 10.1016/s1076-6332(00)80456-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to determine the accuracy (validity) and precision (reliability) of spiral computed tomographic (CT) images by using film- and computer graphics-based measurements of simulated neoplastic lesions associated with the mandible. MATERIALS AND METHODS Four cadaver heads, each with two simulated tumors containing contrast medium positioned medial to the mandibles, were examined by using a subsecond spiral CT scanner. Data were transferred to film and to a computer workstation. With computer graphics, data were analyzed by using multiplanar reconstructed images. Linear measurements of the length, width, and depth of simulated tumors were made by two observers, twice each, on the film scans by using manual calipers and on the multiplanar reconstructed images by using computerized measurements. The soft tissues were then removed from the cadavers and the same measurements made by using the same calipers. RESULTS No statistically significant differences between computer graphics- or film-based measurements and physical measurements (P > .05) or between inter- and intraobserver measurements (P > .05) were found. CONCLUSION The authors found high reproducibility of measurements for all dimensions. Spiral CT allows accurate computer graphics- and film-based measurements of neoplastic lesions associated with the mandible.
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Affiliation(s)
- M G Cavalcanti
- Department of Radiology, Faculty of Odontology, University of São Paulo, Brazil
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47
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Nathu RM, Mancuso AA, Zhu TC, Mendenhall WM. The impact of primary tumor volume on local control for oropharyngeal squamous cell carcinoma treated with radiotherapy. Head Neck 2000; 22:1-5. [PMID: 10585598 DOI: 10.1002/(sici)1097-0347(200001)22:1<1::aid-hed1>3.0.co;2-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A study was needed to determine the effect of primary tumor volume on local control of oropharyngeal carcinoma treated with radiation therapy, with or without induction chemotherapy. METHODS Between July 1983 and April 1995, 114 patients with T2-T4 squamous cell carcinoma of the oropharynx were treated for cure with radiation therapy, with or without induction chemotherapy, and had a pretreatment CT scan available for retrospective review. All scans were reviewed by a single radiologist (A. A. M.) to determine the tumor volume of the primary lesion. Volume was measured with a computer digitizer for each CT slice showing the primary lesion. RESULTS A large variation in tumor volume within a given T stage was found. Multivariate analysis demonstrated T stage to be the most significant factor affecting local control. Tumor volume marginally influenced local control (p =.10). CONCLUSIONS Primary tumor volume varies significantly within a given T stage and has a marginal impact on the likelihood of local control after radiotherapy.
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Affiliation(s)
- R M Nathu
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA
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Rasch C, Keus R, Pameijer FA, Koops W, de Ru V, Muller S, Touw A, Bartelink H, van Herk M, Lebesque JV. The potential impact of CT-MRI matching on tumor volume delineation in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 1997; 39:841-8. [PMID: 9369132 DOI: 10.1016/s0360-3016(97)00465-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To study the potential impact of the combined use of CT and MRI scans on the Gross Tumor Volume (GTV) estimation and interobserver variation. METHODS AND MATERIALS Four observers outlined the GTV in six patients with advanced head and neck cancer on CT, axial MRI, and coronal or sagittal MRI. The MRI scans were subsequently matched to the CT scan. The interobserver and interscan set variation were assessed in three dimensions. RESULTS The mean CT derived volume was a factor of 1.3 larger than the mean axial MRI volume. The range in volumes was larger for the CT than for the axial MRI volumes in five of the six cases. The ratio of the scan set common (i.e., the volume common to all GTVs) and the scan set encompassing volume (i.e., the smallest volume encompassing all GTVs) was closer to one in MRI (0.3-0.6) than in CT (0.1-0.5). The rest volumes (i.e., the volume defined by one observer as GTV in one data set but not in the other data set) were never zero for CT vs. MRI nor for MRI vs. CT. In two cases the craniocaudal border was poorly recognized on the axial MRI but could be delineated with a good agreement between the observers in the coronal/sagittal MRI. CONCLUSIONS MRI-derived GTVs are smaller and have less interobserver variation than CT-derived GTVs. CT and MRI are complementary in delineating the GTV. A coronal or sagittal MRI adds to a better GTV definition in the craniocaudal direction.
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Affiliation(s)
- C Rasch
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam
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Chua DT, Sham JS, Kwong DL, Tai KS, Wu PM, Lo M, Yung A, Choy D, Leong L. Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome. Int J Radiat Oncol Biol Phys 1997; 39:711-9. [PMID: 9336154 DOI: 10.1016/s0360-3016(97)00374-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the variability of tumor volume in nasopharyngeal carcinoma using quantitative measurements of tumor bulk derived from computed tomography, and to study the prognostic value of tumor volume in comparison with other variables. METHODS AND MATERIALS Two hundred ninety patients with newly diagnosed nasopharyngeal carcinoma were included in the study. The primary tumor volume (PTV) and nodal tumor volume (NTV) were obtained by outlining the tumor contour followed by summation of areas in sequential pretreatment computed tomography axial scans. Total tumor volume (TTV) was obtained by adding the PTV and NTV. All patients had radiotherapy as the primary treatment, 67 patients also received cisplatin-based neoadjuvant chemotheraphy. RESULTS A large variation in tumor volume was observed, especially in advanced stage disease. The median PTV (cc) in Ho's T1, T2, and T3 disease were: 6.9 (range: 0.9-42.7), 18.8 (1.6-127.9), and 52.4 (3.3-166.8). The median TTV (cc) in Ho's stage I to IV disease were: 7.6 (range: 1.3-42.7), 19.8 (3.2-55.7), 40.7 (4.1-222.7), and 51.1 (3.1-274.7). Patients with a large PTV (>60 cc) were associated with significantly poorer local control (5-year local control rate: 56%) and disease-specific survival (5-year survival rate: 53%). In patients with a small PTV (< or =20 cc), there were no significant differences in local control among different T stages. Large NTV (>30 cc) was associated with significantly higher distant failure rate (5-year distant relapse-free survival rate: 54%) and lower disease-specific survival (5-year survival rate: 40%). In multivariate analysis, only PTV was found to be an independent factor in predicting local control. CONCLUSION A large variation of tumor volume was present in different T stage disease of nasopharyngeal carcinoma, and PTV represents an independent prognostic factor of local control that appears to be more predictive than Ho's T stage classification.
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Affiliation(s)
- D T Chua
- Department of Radiotherapy and Oncology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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