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Özkul Y, İşlek A, Bayrak AF, Akdağ E, Etit D. Tumor Volume Staging Provides a Comparable Stratifying for Laryngeal Squamous Cell Cancer According to T Stages. Indian J Otolaryngol Head Neck Surg 2023; 75:1344-1351. [PMID: 37636709 PMCID: PMC10447356 DOI: 10.1007/s12070-023-03522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/22/2023] [Indexed: 02/15/2023] Open
Abstract
The prognostic significance of tumor volume (TV) in laryngeal squamous cell cancer (LSCC) has been demonstrated previously. Still, its clinical use is uncertain, and a method for accurate staging for TV is lacking. This study aimed to develop an objective staging and determine the effect of tumor volume on disease outcome after surgical treatment for LSCC. This study was designed retrospectively. Patients with LSCC who underwent laryngectomy were identified. Discretization for optimal scaling level of Tumor Volume (TV) was performed by Catreg Version 3.0. The rate of cancer recurrence, disease-free survival (DFS), and overall survival (OS) rate were calculated and compared between T stage and TV staging. Kaplan-Meier survival analysis was performed for comparison. 206 LSCC patients enrolled in the study. TV was found significantly higher in patients with cartilage invasion, contralateral nodal metastasis, and extranodal extension (p = 0.004, 0.010, and 0.021, respectively). TV and lymph node density LND showed a low significant positive correlation (p = 0.015, r = 0.169). TV was 7.25 + 7.53 ml on average, and TV above the mean value was found to be an independent risk factor for OS and DFS (p = 0.043, HR = 1.8; CI95% for HR: 1.02-3.44 and p < 0.001, HR = 3.7; CI95% for HR: 1.8-7.3, respectively). The optimal scaling level of TV was found in three-level; group 1: TV ≤ 7.07, group 2: 7.07 < TV ≤ 14.09, and group 3: TV ≥ 14.10. This categorization of TV has obtained significant discretization between patients for DFS and OS (Long-Rank = 0.038 and < 0.001). This classification may provide better performance in addition to helping the T stage in determining prognosis, especially in patients with advanced laryngeal SCC.
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Affiliation(s)
- Yılmaz Özkul
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Akif İşlek
- Otolaryngology-Head & Neck Surgery Clinic, Acibadem Eskişehir Hospital, Hoşnudiye Mah, Acıbadem Sk. No: 19, Tepebaşı, Eskişehir, Turkey
| | - Asuman Feda Bayrak
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Ecem Akdağ
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Demet Etit
- Department of Otorhinolaryngology, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
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Rønn Hansen C, Price G, Field M, Sarup N, Zukauskaite R, Johansen J, Eriksen JG, Aly F, McPartlin A, Holloway L, Thwaites D, Brink C. Larynx cancer survival model developed through open-source federated learning. Radiother Oncol 2022; 176:179-186. [PMID: 36208652 DOI: 10.1016/j.radonc.2022.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Federated learning has the potential to perfrom analysis on decentralised data; however, there are some obstacles to survival analyses as there is a risk of data leakage. This study demonstrates how to perform a stratified Cox regression survival analysis specifically designed to avoid data leakage using federated learning on larynx cancer patients from centres in three different countries. METHODS Data were obtained from 1821 larynx cancer patients treated with radiotherapy in three centres. Tumour volume was available for all 786 of the included patients. Parameter selection among eleven clinical and radiotherapy parameters were performed using best subset selection and cross-validation through the federated learning system, AusCAT. After parameter selection, β regression coefficients were estimated using bootstrap. Calibration plots were generated at 2 and 5-years survival, and inner and outer risk groups' Kaplan-Meier curves were compared to the Cox model prediction. RESULTS The best performing Cox model included log(GTV), performance status, age, smoking, haemoglobin and N-classification; however, the simplest model with similar statistical prediction power included log(GTV) and performance status only. The Harrell C-indices for the simplest model were for Odense, Christie and Liverpool 0.75[0.71-0.78], 0.65[0.59-0.71], and 0.69[0.59-0.77], respectively. The values are slightly higher for the full model with C-index 0.77[0.74-0.80], 0.67[0.62-0.73] and 0.71[0.61-0.80], respectively. Smoking during treatment has the same hazard as a ten-years older nonsmoking patient. CONCLUSION Without any patient-specific data leaving the hospitals, a stratified Cox regression model based on data from centres in three countries was developed without data leakage risks. The overall survival model is primarily driven by tumour volume and performance status.
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Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia.
| | - Gareth Price
- Radiotherapy department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Field
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Nis Sarup
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Ruta Zukauskaite
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jesper Grau Eriksen
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark
| | - Farhannah Aly
- Ingham Institute for Applied Medical Research, Sydney, Australia; Southwest Sydney Clinical Campus, University of New South Wales, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Andrew McPartlin
- Radiotherapy department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia; Southwest Sydney Clinical Campus, University of New South Wales, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia
| | - Carsten Brink
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Smits HJG, Assili S, Kauw F, Philippens MEP, de Bree R, Dankbaar JW. Prognostic imaging variables for recurrent laryngeal and hypopharyngeal carcinoma treated with primary chemoradiotherapy: A systematic review and meta-analysis. Head Neck 2021; 43:2202-2215. [PMID: 33797818 PMCID: PMC8252607 DOI: 10.1002/hed.26698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy. Methods A systematic search was performed in PubMed and EMBASE (1990–2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated. Results Twenty‐two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut‐off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors. Conclusion Pretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
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Affiliation(s)
- Hilde J G Smits
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Sanam Assili
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Frans Kauw
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marielle E P Philippens
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Sharrett JM, Ward MC, Murray E, Scharpf J, Lamarre ED, Prendes BL, Lorenz RR, Burkey BB, Koyfman SA, Woody NM, Greskovich JF, Adelstein DJ, Geiger JL, Joshi NP. Tumor Volume Useful Beyond Classic Criteria in Selecting Larynx Cancers For Preservation Therapy. Laryngoscope 2019; 130:2372-2377. [PMID: 31721229 DOI: 10.1002/lary.28396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 09/07/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the association between tumor volume and locoregional failure (LRF) after concurrent chemoradiation (CCRT) for locally advanced larynx cancer (LC). METHODS This is a retrospective cohort study from 2009 to 2014 identified from an institutional review board-approved registry. Fifty-nine of 68 patients with locally advanced larynx cancer treated with definitive CCRT who had available imaging for review were identified. The main endpoint to be assessed was the association between gross tumor volumes (GTV; T = total, P = primary, N = nodal) and LRF. Receiver operative characteristic (ROC) curves were used to investigate diagnostic accuracy. RESULTS Twenty LRFs were observed, resulting in a 2-year LRF rate of 39% (95% CI, 23-52%). On UVA, the GTV-T (P = .01), GTV-P (P = .05), and GTV-N (P = .04) were statistically significant predictors of LRF. Furthermore, age, smoking status, N-stage, larynx subsite, and tracheostomy/feeding tube dependence were potentially associated with LRF (P < .3), whereas T-stage (T3-4 vs. T2) was not (HR 1.05, 95% CI, 0.38-2.91, P = .92). In the multivariable model, GTV-P (HR 1.022, 95% CI, 0.999-1.046, P = .07) and GTV-N (HR 1.053, 95% CI, 1.0004-1.108, P = .05) were the two most impactful covariates on the model's R2 . ROC analysis suggested an optimal cut point of 12 cc in the GTV-T. The 2-year LRF for GTV-T > 12 cc was 64.2% and ≤ 12 cc was 16.4%, P = .006. CONCLUSION GTV is associated with LRF after definitive CCRT for LC. Patients with bulky primary and/or nodal tumors may be better served with upfront surgical resection regardless of T-stage. Further investigation into the safety of larynx preservation for low-volume T4 tumors can be considered. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2372-2377, 2020.
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Affiliation(s)
- Jonathan M Sharrett
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Matthew C Ward
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Eric Murray
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Joseph Scharpf
- Taussig Cancer Institute; and the Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Eric D Lamarre
- Taussig Cancer Institute; and the Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Brandon L Prendes
- Taussig Cancer Institute; and the Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Robert R Lorenz
- Taussig Cancer Institute; and the Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Brian B Burkey
- Taussig Cancer Institute; and the Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Neil M Woody
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - John F Greskovich
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - David J Adelstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Nikhil P Joshi
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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Kamal M, Ng SP, Eraj SA, Rock CD, Pham B, Messer JA, Garden AS, Morrison WH, Phan J, Frank SJ, El-Naggar AK, Johnson JM, Ginsberg LE, Ferrarotto R, Lewin JS, Hutcheson KA, Cardenas CE, Zafereo ME, Lai SY, Hessel AC, Weber RS, Gunn GB, Fuller CD, Mohamed ASR, Rosenthal DI. Three-dimensional imaging assessment of anatomic invasion and volumetric considerations for chemo/radiotherapy-based laryngeal preservation in T3 larynx cancer. Oral Oncol 2018; 79:1-8. [PMID: 29598944 PMCID: PMC5880303 DOI: 10.1016/j.oraloncology.2018.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/07/2018] [Accepted: 01/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate the impact of 3-Diminsional (3D) tumor volume (TV) and extent of involvement of primary tumor on treatment outcomes in a large uniform cohort of T3 laryngeal carcinoma patients treated with nonsurgical laryngeal preservation strategies. MATERIALS AND METHODS The pretreatment contrast-enhanced computed tomography images of 90 patients with T3 laryngeal carcinoma were reviewed. Primary gross tumor volume (GTVp) was delineated to calculate the 3D TV and define the extent of invasion. Cartilage and soft tissue involvement was coded. The extent of invasion was dichotomized into non/limited invasion versus multiple invasion extension (MIE), and was subsequently correlated with survival outcomes. RESULTS The median TV was 6.6 cm3. Sixty-five patients had non/limited invasion, and 25 had MIE. Median follow-up for surviving patients was 52 months. The 5-year local control and overall survival rates for the whole cohort were 88% and 68%, respectively. There was no correlation between TV and survival outcomes. However, patients with non/limited invasion had better 5-year local control (LC) than those with MIE (95% vs 72%, p = .009) but did not have a significantly higher rate of overall survival (OS) (74% vs 67%, p = .327). In multivariate correlates of LC, MIE maintained statistical significance whereas baseline airway status showed a statistically significance trend with poor LC (p = .0087 and 0.06, respectively). Baseline good performance status was an independent predictor of improved OS (p = .03) in multivariate analysis. CONCLUSION The extent of primary tumor invasion is an independent prognostic factor of LC of the disease after definitive radiotherapy in T3 larynx cancer.
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Affiliation(s)
- Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Salman A Eraj
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA
| | - Crosby D Rock
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; School of Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Brian Pham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay A Messer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adel K El-Naggar
- Department of Pathology, Division of Pathology/Lab Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jason M Johnson
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lawrence E Ginsberg
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Cancer Biology Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Cancer Biology Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Dziegielewski PT, Reschly WJ, Morris CG, DeJesus RD, Silver N, Boyce BJ, Santiago I, Amdur RJ, Mendenhall WM. Tumor volume as a predictor of survival in T3 glottic carcinoma: A novel approach to patient selection. Oral Oncol 2018; 79:47-54. [PMID: 29598950 DOI: 10.1016/j.oraloncology.2018.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optimal treatment for T3 glottic cancers continues to be debated. Organ preservation has become the standard of care, but not all tumors respond equally. The purpose of this was to investigate the long-term survival outcomes of organ preservation protocols based on tumor volume. METHODS A retrospective review of prospectively collected data from 1966 to 2016 was performed. Patients with T3 vocal cord cancer treated with radiation therapy (RT) at the University of Florida were included. Local control rates as well as survival rates were determined with a Kaplan Meier and Cox regression analysis. Survival was analyzed as a function of tumor volume and an optimal cut point was determined. RESULTS 107/234 patients were included. 79% received RT and 21% chemo-RT. 5-year local control was 61.5% and 5-year disease specific survival was 79.3%. Tumor volume was a significant predictor of survival (p = 0.007). An optimal cut point for tumor volume was 2.5 cc. Patients with tumor volumes ≥2.5 cc had significantly worse (p < 0.05) tumor control rates (100% vs. 70.4%). CONCLUSION Tumor volume is a significant predictor of survival outcomes in T3 vocal cord cancers, but will need external validation. Tumors <2.5 cc have favorable outcomes. Those with higher volume tumors should be counselled appropriately and be considered for primary surgical management.
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Affiliation(s)
- Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA; University of Florida Health Cancer Center, Gainesville, FL, USA.
| | - William J Reschly
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Chris G Morris
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | | | - Natalie Silver
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Brian J Boyce
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Inocente Santiago
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Robert J Amdur
- University of Florida Health Cancer Center, Gainesville, FL, USA; Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - William M Mendenhall
- University of Florida Health Cancer Center, Gainesville, FL, USA; Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
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7
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Dankbaar JW, Oosterbroek J, Jager EA, de Jong HW, Raaijmakers CP, Willems SM, Terhaard CH, Philippens ME, Pameijer FA. Detection of cartilage invasion in laryngeal carcinoma with dynamic contrast-enhanced CT. Laryngoscope Investig Otolaryngol 2017; 2:373-379. [PMID: 29299511 PMCID: PMC5743155 DOI: 10.1002/lio2.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/11/2017] [Accepted: 09/16/2017] [Indexed: 12/23/2022] Open
Abstract
Objective Staging of laryngeal cancer largely depends on cartilage invasion. Presence of cartilage invasion affects treatment choice and prognosis. On MRI and contrast‐enhanced CT (CECT) it may be challenging to differentiate cartilage invasion from inflammation. The purpose of this study is to compare the diagnostic properties of dynamic contrast‐enhanced CT (DCECT) and CECT for visual detection of cartilage invasion in laryngeal cancer. Study Design Prospective cohort study. Methods Patients with T3 or T4 laryngeal squamous cell carcinoma treated with total laryngectomy were evaluated using 0.625 mm slice CT. DCECT derived permeability and blood volume maps and CECT images were visually evaluated for the presence of invasion of the cartilaginous T‐stage subsites of laryngeal cancer, by detecting continuity with the tumor‐bulk of increased permeability, increased blood volume, and enhancement. Histological evaluation of the surgical total laryngectomy specimen served as the gold standard. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated and compared using the McNemar and Chi‐squared test. Results From 14 included patients, a total of 462 subsites were available for T‐stage analysis, of which 84 were cartilage. The median time between CT imaging and total laryngectomy was 1 day (range 1–34 days). There was no significant difference in the detection of cartilage invasion between DCECT and CECT. The sensitivity of CECT was better for all subsites combined (0.85 vs. 0.75; p < 0.01). Conclusion DCECT does not improve visual detection of cartilage invasion in T3 and T4 laryngeal cancer compared to CECT. Level of Evidence 2b, individual cohort study.
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Affiliation(s)
- Jan W Dankbaar
- Department of Radiology University Medical Center Utrecht the Netherlands.,Image Sciences Institute University Medical Center Utrecht the Netherlands
| | - Jaap Oosterbroek
- Department of Radiology University Medical Center Utrecht the Netherlands
| | - Elise A Jager
- Department of Radiotherapy University Medical Center Utrecht the Netherlands
| | - Hugo W de Jong
- Department of Radiology University Medical Center Utrecht the Netherlands.,Image Sciences Institute University Medical Center Utrecht the Netherlands
| | | | - Stefan M Willems
- Department of Pathology University Medical Center Utrecht the Netherlands
| | - Chris H Terhaard
- Department of Radiotherapy University Medical Center Utrecht the Netherlands
| | | | - Frank A Pameijer
- Department of Radiology University Medical Center Utrecht the Netherlands
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8
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Shiao JC, Mohamed ASR, Messer JA, Hutcheson KA, Johnson JM, Enderling H, Kamal M, Warren BW, Pham B, Morrison WH, Zafereo ME, Hessel AC, Lai SY, Kies MS, Ferrarotto R, Garden AS, Schomer DF, Gunn GB, Phan J, Frank SJ, Beadle BM, Weber RS, Lewin JS, Rosenthal DI, Fuller CD. Quantitative pretreatment CT volumetry: Association with oncologic outcomes in patients with T4a squamous carcinoma of the larynx. Head Neck 2017; 39:1609-1620. [PMID: 28464542 DOI: 10.1002/hed.24804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/26/2017] [Accepted: 02/28/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the impact of CT-determined pretreatment primary tumor volume on survival and disease control in T4a laryngeal squamous cell carcinoma (SCC). METHODS We retrospectively reviewed 124 patients with T4a laryngeal cancer from 2000-2011. Tumor volume measurements were collected and correlated with outcomes. RESULTS Five-year overall survival (OS) for patients with tumor volume ≥21 cm3 treated with larynx preservation (n = 26 of 41) was significantly inferior compared to <21 cm3 (42% vs 64%, respectively; P = .003). Five-year OS for patients with tumor volumes ≥21 cm3 in the cohort treated with total laryngectomy followed by radiotherapy (RT; n = 42 of 83) was not statistically significant when compared to <21 cm3 (50% vs 63%, respectively; P = .058). On multivariate analysis, tumor volume ≥21 cm3 was a significant independent correlate of worse disease-specific survival (DSS; P = .004), event-free survival (P = .005), recurrence-free survival (RFS; P = .04), noncancer cause-specific survival (P = .02), and OS (P = .0002). CONCLUSION Pretreatment CT-based tumor volume is an independent prognostic factor of outcomes in T4a laryngeal cancer.
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Affiliation(s)
- Jay C Shiao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Jay A Messer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason M Johnson
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heiko Enderling
- Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Ain Shams, Cairo, Egypt
| | - Benjamin W Warren
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian Pham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merril S Kies
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas
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9
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Relationship of medial versus superior vocal-cord location of T1 squamous cell carcinoma with tumor recurrence. Am J Otolaryngol 2017; 38:316-320. [PMID: 28169008 DOI: 10.1016/j.amjoto.2017.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if the clinical behavior of T1 glottic squamous cell carcinoma varies by its location on the medial free edge or upper aspect of the vocal cords. STUDY DESIGN Retrospective cohort. SETTING Single tertiary university-affiliated medical center. SUBJECTS AND METHODS Clinical, treatment, and outcome data were collected for 104 patients with T1N0M0 glottic squamous cell carcinoma who were treated and followed at our center in 1995-2013. Findings were compared between those with a tumor on the medial (n=60, 57.7%) or superior (n=44, 42.3%) aspect of the cords. RESULTS Mean follow-up time was 4.15years. No between-group differences were found in demographic or risk factors. There was a significant association of anterior commissure involvement with disease recurrence (P=0.0012) and of superior (vs medial) location with higher rates of anterior commissure involvement (P<0.001) and recurrence (P=0.01) and shorter time to recurrence (P<0.001). CONCLUSIONS T1 squamous cell carcinomas on the superior aspect of the vocal cords have a poorer prognosis than medial tumors and should be closely monitored for recurrence.
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Eskiizmir G, Baskın Y, Yalçın F, Ellidokuz H, Ferris RL. Risk factors for radiation failure in early-stage glottic carcinoma: A systematic review and meta-analysis. Oral Oncol 2016; 62:90-100. [PMID: 27865377 DOI: 10.1016/j.oraloncology.2016.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/08/2016] [Accepted: 10/16/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiotherapy is one of the main treatment modalities for early-stage glottic carcinoma. Unfortunately, local failure may occur in a group of cases with T1-T2 glottic carcinoma. This meta-analysis sought to determine risk factors for radiation failure in patients with early-stage glottic carcinoma. METHODS A systematic and comprehensive search was performed for related studies published between 1995 and 2014. The primary end-point was 5-year local control. Data extraction and analysis were performed using the software STATA/SE 13.1 for Windows. RESULTS Twenty-seven studies were eligible. A higher risk of radiation failure was demonstrated in male patients [relative risk (RR): 0.927, p<0.001] and those with low hemoglobin level (RR: 0.891, p<0.001) with a high agreement between studies (I-squared=0.0%). Moreover, T2 tumors (RR: 0.795, p<0.001), tumors with anterior commissure involvement (RR: 0.904, p<0.001), tobacco use during/after therapy (RR: 0.824, p<0.001), and "bulky" tumors (RR: 1.270, p<0.001] or tumors bigger in size (RR: 1.332, p<0.001]. Poorly differentiated tumors had a questionable risk of local failure, although a moderate to high interstudy heterogeneity was determined. A statistically significant contribution was not detected for age, presence of comorbidity, alcohol use or subglottic extension. CONCLUSION This is the first meta-analysis which assessed the potential risk factors for radiation failure in patients with early-stage glottic carcinoma. Gender and pretreatment hemoglobin level are major influential factors associated with radiation failure in patients with early-stage glottic carcinoma. However, prospective, randomized clinical trials may permit better stratification of their relative contributions, and those who may benefit more from upfront surgery.
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Affiliation(s)
- Görkem Eskiizmir
- Celal Bayar University, Department of Otolaryngology-Head and Neck Surgery, Manisa, Turkey.
| | - Yasemin Baskın
- Dokuz Eylül University, Institute of Oncology, Izmir, Turkey
| | - Femin Yalçın
- Katip Celebi University, Department of Engineering Sciences, Izmir, Turkey
| | - Hülya Ellidokuz
- Dokuz Eylül University, Institute of Oncology, Izmir, Turkey
| | - Robert L Ferris
- University of Pittsburgh, Division of Head Neck Surgery, Pittsburgh, PA, United States
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11
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Mendenhall WM, Dagan R, Bryant CM, Amdur RJ, Mancuso AA. Definitive Radiotherapy for Squamous Cell Carcinoma of the Glottic Larynx. Cancer Control 2016; 23:208-12. [DOI: 10.1177/107327481602300303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Depending on the extent of disease, squamous cell carcinoma (SCC) of the glottis is managed with surgery, radiotherapy (RT), or a combination of these modalities. Patients with advanced disease may receive concomitant chemotherapy in conjunction with definitive or postoperative RT. Methods The treatment policies of the University of Florida and patient outcomes are reviewed. Results The likelihood of cure after RT for carcinoma in situ (Tis) to T2 glottic SCC varies from 70% to 94% depending on tumor stage. Consideration should be given to adding weekly cisplatin for patients with T2b SCC because of the high local recurrence rate after RT alone. The probability of cure is about 65% to 80% for select low-volume (≤ 3.5 cc) T3 to T4 glottic SCC after RT. These patients should be considered for concomitant weekly cisplatin. Higher-volume tumors, particularly those with airway compromise, should be treated with laryngectomy and postoperative RT. Conclusion Definitive RT is an excellent treatment for select patients with laryngeal cancer.
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Affiliation(s)
| | - Roi Dagan
- Proton Therapy Institute, Jacksonville, Florida
| | | | | | - Anthony A. Mancuso
- Diagnostic Radiology, Gainesville, Florida University of Florida College of Medicine, Gainesville, Florida
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12
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Hoorweg JJ, Kruijt RH, Heijboer RJJ, Eijkemans MJC, Kerrebijn JDF. Reliability of Interpretation of CT Examination of the Larynx in Patients with Glottic Laryngeal Carcinoma. Otolaryngol Head Neck Surg 2016; 135:129-34. [PMID: 16815197 DOI: 10.1016/j.otohns.2006.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 01/30/2006] [Indexed: 11/18/2022]
Abstract
INTRODUCTION: Reports in literature suggest that tumor volume, cartilage invasion, and cartilage sclerosis are independent prognostic factors for tumor control in radiotherapy as primary treatment of laryngeal carcinomas. OBJECTIVE: Assessment of the interobserver variability and prognostic value in the measurement of tumor volume, cartilage invasion, and sclerosis. MATERIALS AND METHODS: Retrospective analysis of 55 CT scans by three independent observers. Volume measurements and determination of cartilage invasion, cartilage sclerosis, and tumor localization were calculated. Correlation between the prognostic factors and radiotherapy was calculated for each observer. RESULTS: Values for interobserver agreement varied substantially; cartilage invasion (κ value: −0.02 to 0.66), cartilage sclerosis (κ value: 0.13 to 0.57), tumor localization of subsites (κ value: 0.03 to 0.60), and tumor volume (correlation: 0.34 to 0.73). The found interobserver variation makes it impossible to establish accurate prognostic factors. CONCLUSION: Determination of tumor volume, cartilage invasion, and cartilage sclerosis on the basis of CT imaging shows considerable interobserver variation; clinical significance appears to be limited. EBM rating: B-3a
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Affiliation(s)
- J J Hoorweg
- Department of Otorhinolaryngology and Head and Neck Surgery, Flevoziekenhuis Almere, Hospitaalweg 1, 1315 Almere, the Netherlands.
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13
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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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14
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Bingol F, Yoruk O, Bingol BO, Erdemci B, Ozkan O, Mazlumoglu MR. Estimation of the efficacy of chemo-radiotherapy on tumor regression in the patients with laryngeal cancer via computerized tomography using the Cavalieri method. Acta Otolaryngol 2015; 136:164-7. [PMID: 26472267 DOI: 10.3109/00016489.2015.1096958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Calculating tumor volume using the Cavalieri method in laryngeal tumors before and after treatment may be useful to optimize the treatment and to minimize the side-effects of radiotherapy. PURPOSE This study aimed to estimate the pre-treatment and post-treatment tumor volumes of the patients to whom radiotherapy or radio-chemotherapy was applied as a treatment using Cavalieri's Principle as a stereological method and to assess tumor regression rates in the patients with Laryngeal Squamous Cell Carcinoma (LSCC) statistically. MATERIALS AND METHOD Sixteen patients (eight patients with stage T3 and eight patients with stage T4) diagnosed with LCCC bearing the appropriate characteristics to criteria in the otorhinolaryngology clinic were included. Patients had computerized tomography (CT) scans in the axial plane before treatment and 2 months after the treatment. Pre-treatment and post-treatment tumor volumes on CT images were calculated using Cavalieri's principle as a stereological method and then compared. FINDINGS Average tumor volumes in patients with stage T3 before and after treatment were 10.12 ± 3.58 cm(3) and 1.33 ± 1.74 cm(3), respectively (p = 0.008). These volumes were 11.92 ± 4.61 cm(3) and 2.17 ± 2.34 cm(3) (p = 0.008) for patients with stage T4, respectively. Post-treatment tumor volumes were statistically reduced compared to pre-treatment volumes in all stages.
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Affiliation(s)
- Fatih Bingol
- a Department of Otorhinolaryngology , Ataturk University, School of Medicine , Erzurum , Turkey
| | - Ozgur Yoruk
- a Department of Otorhinolaryngology , Ataturk University, School of Medicine , Erzurum , Turkey
| | - Buket Ozel Bingol
- a Department of Otorhinolaryngology , Ataturk University, School of Medicine , Erzurum , Turkey
| | - Burak Erdemci
- b Department of Radiation Oncology , Ataturk University, School of Medicine , Erzurum , Turkey
| | - Ozalkan Ozkan
- a Department of Otorhinolaryngology , Ataturk University, School of Medicine , Erzurum , Turkey
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15
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Timmermans AJ, Lange CAH, de Bois JA, van Werkhoven E, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer. Laryngoscope 2015; 126:E60-7. [DOI: 10.1002/lary.25567] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/02/2015] [Accepted: 07/20/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Adriana J. Timmermans
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam the Netherlands
| | | | - Josien A. de Bois
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Erik van Werkhoven
- Biometrics Department; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Frans J. M. Hilgers
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam the Netherlands
- Institute of Phonetic Sciences/Amsterdam Center for Language and Communication, University of Amsterdam; Amsterdam the Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam the Netherlands
- Institute of Phonetic Sciences/Amsterdam Center for Language and Communication, University of Amsterdam; Amsterdam the Netherlands
- Department of Oral and Maxillofacial Surgery; Academic Medical Center; Amsterdam the Netherlands
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16
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Doornaert P, Terhaard CHJ, Kaanders JH. Treatment of T3 laryngeal cancer in the Netherlands: a national survey. Radiat Oncol 2015; 10:134. [PMID: 26112272 PMCID: PMC4480981 DOI: 10.1186/s13014-015-0440-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/16/2015] [Indexed: 11/22/2022] Open
Abstract
Background Treatment strategies for T3 laryngeal carcinoma include radiotherapy (RT) with or without chemotherapy (CT) and sometimes surgery. We conducted a national survey to determine how T3 laryngeal carcinoma is currently being managed in the Netherlands. Methods A questionnaire on general treatment policy, also inquiring details on RT and CT, was sent to all 13 radiotherapy departments accredited for treatment of head and neck cancer (HNC) in the Netherlands. Results Twelve centers completed the questionnaire. All centers reported using RT with or without CT. Upfront laryngectomy is rarely performed. At 9/12 centers, CT is added to RT in cases with large tumors in T3N0 disease. Three centers use a volume criterion (3–6 cc); 6 centers don’t specify “large” with such criteria. CT consists of cisplatin 3-weekly (7 centers) or weekly (2 centers), unless contra-indicated or age; 6 centers use an age limit of 70 years. RT is given concomitantly with CT 5×/week except at the 2 centers where cisplatin weekly is combined with 6 fractions/week. In case of RT only, treatment is accelerated. Lymph node levels II-IV are treated electively. In T3N+ disease, 11/12 centers treat non-bulky T3N1 with RT only. Volume criteria for combined CT-RT are the same as above. Two centers perform an upfront neck dissection in case of (resectable) N3 disease; 10 centers treat T3N2-3 cancer with primary CT-RT, 2 centers don’t use the N-stage criterion. Total RT dose is 68–70 Gy, the elective dose varies between 46 and 57.75 Gy. Eight centers use a simultaneous integrated boost technique. Conclusions Treatment of T3 laryngeal cancer in the Netherlands is generally comparable, with CT-RT for voluminous T3N0 and most T3N+ tumors, but there are some differences between the centers in the use of chemotherapy and the dose-fractionation schemes. Therefore, the aim of the National Platform RT HNC is further standardization of RT dose, fractionation and delivery techniques.
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Affiliation(s)
- Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Chris H J Terhaard
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Johannes H Kaanders
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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17
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Cartilage invasion patterns in laryngeal cancer. Eur Arch Otorhinolaryngol 2015; 273:1863-9. [PMID: 26100029 DOI: 10.1007/s00405-015-3687-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
The cartilaginous invasion determines the T and is one of the most common sources of mistake in tumor staging. Also it is of great importance when planning any therapeutic alternative. In the latest revision of the TNM classification a clear distinction is made between infiltration of cartilage without going through it, considered a T3 recently and that would be a T4 according to the previous classification, and those going through the cartilage, classified as T4a. While this classification makes the difference in depth of infiltration, it does not emphasize the extent of invasion. This paper provides a detailed description of the laryngeal cartilage tumor infiltration by whole organ serial section in which the invasion is considered both horizontal (transcartilaginous) and vertical (extent of invasion) and establishing patterns of three-dimensional infiltration of the cartilage. This is a cross-sectional study of prevalence. 275 records of patients treated for laryngeal squamous cell carcinoma between 1995 and 2000 were reviewed. The pathological processing of laryngectomy surgical specimens was performed following the method of whole organ serial section described by G. F. Tucker. The following patterns of cartilaginous infiltration were defined: (1) transcartilaginous infiltration; (2a) partial focal infiltration of the cartilage: infiltration not going through the cartilage but occupying one third or less of its extent; (2b) partial extensive infiltration of the cartilage: infiltration occupying two thirds or more of its length and (3) no cartilage infiltration: tumor in contact with the cartilage (paraglottic space) but without affecting it. 161 patients met the inclusion criteria. The most frequent tumor location was supraglottic (58 cases) followed by glottic (47). 109 patients (67.7 %) were treated with total laryngectomy. Partial surgical techniques were performed in the remaining cases. TNM tumor staging was performed according to the results of pathological study (pTNM). 72.06 % (116) were classified as advanced laryngeal tumors (pT3 and pT4). 46 % of patients showed some extent of laryngeal cartilage infiltration (thyroid, cricoid, arytenoids, epiglottis). The cartilage most frequently infiltrated was the thyroid in 48 patients (29.8 %) and when it is affected, in most cases (66.7 %), the infiltration is transcartilaginous. The next most common pattern is partial focal infiltration (27 %). In the cricoid cartilage, the most common pattern of infiltration is focal partial infiltration (52.6 %). Of the 19 cases with infiltration of the cricoid, there are 12 cases with extra laryngeal invasion through a cricothyroid membrane perforation. The study of laryngeal cancer by laryngeal whole serial section has been proved to be very useful in offering a high precision pTNM staging and a detailed description of the infiltration of cartilage. We have seen that when the thyroid cartilage is infiltrated the tumor often passes through the cartilage. However, there are cases where the tumor is extremely aggressive, being very widespread in cartilage thickness without actually crossing it. The isolated infiltration of the cricoid cartilage is exceptional.
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18
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Swartz JE, Pothen AJ, Stegeman I, Willems SM, Grolman W. Clinical implications of hypoxia biomarker expression in head and neck squamous cell carcinoma: a systematic review. Cancer Med 2015; 4:1101-16. [PMID: 25919147 PMCID: PMC4529348 DOI: 10.1002/cam4.460] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/05/2015] [Accepted: 03/10/2015] [Indexed: 02/06/2023] Open
Abstract
Awareness increases that the tumor biology influences treatment outcome and prognosis in cancer. Tumor hypoxia is thought to decrease sensitivity to radiotherapy and some forms of chemotherapy. Presence of hypoxia may be assessed by investigating expression of endogenous markers of hypoxia (EMH) using immunohistochemistry (IHC). In this systematic review we investigated the effect of EMH expression on local control and survival according to treatment modality in head and neck cancer (head and neck squamous cell carcinoma [HNSCC]). A search was performed in MEDLINE and EMBASE. Studies were eligible for inclusion that described EMH expression in relation to outcome in HNSCC patients. Quality was assessed using the Quality in Prognosis Studies (QUIPS) tool. Hazard ratios for locoregional control and survival were extracted. Forty studies of adequate quality were included. HIF-1a, HIF-2a, CA-IX, GLUT-1, and OPN were identified as the best described EMHs. With exception of HIF-2a, all EMHs were significantly related to adverse outcome in multiple studies, especially in studies where patients underwent single-modality treatment. Positive expression was often correlated with adverse clinical characteristics, including disease stage and differentiation grade. In summary, EMH expression was common in HNSCC patients and negatively influenced their prognosis. Future studies should investigate the effect of hypoxia-modified treatment schedules in patients with high In summary, EMH expression. These may include ARCON, treatment with nimorazole, or novel targeted therapies directed at hypoxic tissue. Also, the feasibility of surgical removal of the hypoxic tumor volume prior to radiotherapy should be investigated.
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Affiliation(s)
- Justin E Swartz
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ajit J Pothen
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Glottic and supraglottic pT3 squamous cell carcinoma: outcomes with transoral laser microsurgery. Eur Arch Otorhinolaryngol 2015; 272:1983-90. [DOI: 10.1007/s00405-015-3611-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/23/2015] [Indexed: 11/25/2022]
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20
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Adolphs APJ, Boersma NA, Diemel BDM, Eding JEC, Flokstra FE, Wegner I, Grolman W, Braunius W. A systematic review of computed tomography detection of cartilage invasion in laryngeal carcinoma. Laryngoscope 2015; 125:1650-5. [DOI: 10.1002/lary.25145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anda P. J. Adolphs
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
| | - Nienke A. Boersma
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
| | - Babette D. M. Diemel
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
| | - Joep E. C. Eding
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
| | - Francien E. Flokstra
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | - Weibel Braunius
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
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Computed tomography-based tumour volume as a predictor of outcome in laryngeal cancer: Results of the phase 3 ARCON trial. Eur J Cancer 2014; 50:1112-9. [DOI: 10.1016/j.ejca.2013.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/10/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
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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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Park G, Jung J, Roh JL, Lee J, Cho KJ, Choi SH, Nam S, Kim S. Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor. Oncology 2014; 86:170-6. [DOI: 10.1159/000358177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
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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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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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Yang CJ, Kim DY, Lee JH, Roh JL, Choi SH, Nam SY, Kim SY. Prognostic value of total tumor volume in advanced-stage laryngeal and hypopharyngeal carcinoma. J Surg Oncol 2013; 108:509-15. [DOI: 10.1002/jso.23444] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/27/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Chan-Joo Yang
- Department of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Dae-Yoon Kim
- Department of Radiology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology; Asan Medical Center, University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Republic of Korea
- Biomedical Research Institute; Korea Institute of Science and Technology; Seoul Republic of Korea
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Studer G, Glanzmann C. Volumetric stratification of cT4 stage head and neck cancer. Strahlenther Onkol 2013; 189:867-73. [PMID: 24002381 PMCID: PMC3825283 DOI: 10.1007/s00066-013-0413-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/17/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Locoregionally advanced stage head and neck cancer (HNC) is known for unfavorable outcome with only ~ 40-50% 3-year overall survival (OS). Clinical T4 stage includes a wide range of tumor burden. The lack of further nonsurgical subgrouping of cT4 stage makes intercenter outcome of irradiated cohorts difficult. Aim of this analysis was to further stratify cT4 stage HNC using volumetric staging. MATERIAL AND METHODS Between January 2002 and January 2013, a total of 201 cT4 stage squamous cell cancer (SCC) HNC patients referred to our center for curative definitive radiation were consecutively irradiated. Radiation was performed using modulated techniques. Total gross tumor volumes (tGTV: primary+nodal tumor volume) of all patients have retrospectively been stratified using a prospectively evaluated volumetric staging system which bases on 3 cut-offs (15/70/130 ml), translating into 4 prognostic subgroups [V1: 1-15 ml (n=15), V2: 16-70 ml (108), V3: 71-130 ml (62), V4: >130 ml (16)]. OS, disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) rates were calculated. RESULTS The mean/median follow-up was 31/23 months (range 1-116 months). The 3-year OS, DFS, LRC, and DMFS rates of the entire cohort were 63, 44, 48, and 77%, respectively. Volumetric staging revealed its potential to prognostically statistically significantly divide the cT4 cohort into 4 volume subgroups (V1/2/3/4): OS: 90%/72%/58%/18%; DFS: 83%/50%/39%/10%; LRC: 81%/53%/47%/15%; DMFS: 93%/90%/70%/41%, all p<0.0001. CONCLUSION Volumetric staging allowed a highly statistically significant stratification of cT4 HNC stages into prognostic subgroups, which offers the chance of better intercenter comparability of irradiated advanced stage HNC cohorts.
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Affiliation(s)
- G Studer
- Department of Radiation Oncology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland,
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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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Definitive radiation therapy for treatment of laryngeal carcinoma. Strahlenther Onkol 2013; 189:834-41. [DOI: 10.1007/s00066-013-0414-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
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30
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Lodder WL, Gilhuijs KGA, Lange CAH, Pameijer FA, Balm AJM, van den Brekel MWM. Semi-automated primary tumor volume measurements by dynamic contrast-enhanced MRI in patients with head and neck cancer. Head Neck 2012; 35:521-6. [DOI: 10.1002/hed.22988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2012] [Indexed: 11/09/2022] Open
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Kats SS, Muller S, Aiken A, Hudgins PA, Wadsworth JT, Shin DM, Khuri F, Beitler JJ. Laryngeal tumor volume as a predictor for thyroid cartilage penetration. Head Neck 2012; 35:426-30. [PMID: 22488941 DOI: 10.1002/hed.22995] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Review of laryngectomy specimens demonstrated that preoperative CT scanning is suboptimal in predicting both thyroid cartilage penetration and extralaryngeal spread. We investigated the association between the CT-based gross tumor volume (GTV) with pathologic evidence of thyroid cartilage penetration among patients undergoing laryngectomy for squamous cell carcinoma (SCC) of the larynx. METHODS Ninety-four patients were identified who underwent total laryngectomy for SCC of the larynx. GTV, as defined by preoperative diagnostic CT scan, was contoured and analyzed using treatment-planning software. RESULTS Among the 49 nonirradiated patients, the mean GTVs of patients with (n = 15) and without (n = 34) thyroid cartilage penetration was 60.1 and 28.0 cm(3) (p = .004). When the nonirradiated patients were divided into 3 GTV groups (≤25 cm(3), 25-50 cm(3), >50 cm(3)), the rates of thyroid cartilage penetration were 23%, 17%, and 78%, respectively (p = .003). CONCLUSIONS Laryngeal tumor volume is associated with pathologic evidence of thyroid cartilage penetration in nonirradiated patients.
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Affiliation(s)
- Svetlana S Kats
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322-1013, USA
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Moubayed SP, Bélair M, Saliba J, Bibeau-Poirier J, Christopoulos A, Nguyen-Tan PF, Guertin L, Lambert L, Olivier MJ, Ayad T. Prognostic Value of Cartilage Sclerosis in Laryngeal Cancer Treated with Primary Radiation Therapy. Otolaryngol Head Neck Surg 2012; 147:57-62. [DOI: 10.1177/0194599812438181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective In patients with laryngeal cancer, pretreatment diagnosis of cartilage invasion often warrants a surgical or a bimodal treatment. Controversy exists on whether laryngeal cartilage sclerosis on computed tomography (CT) scan is a sign of tumor invasion. Our objective is to evaluate locoregional, laryngectomy-free, disease-specific, and overall survival in patients with laryngeal cancer with or without laryngeal cartilage sclerosis treated with primary radiation therapy. Study Design Historical cohort study. Setting Tertiary referral university center. Subjects and Methods All laryngeal cancer patients treated with primary radiation therapy between 2002 and 2007 were included. Patients with and without laryngeal cartilage sclerosis on CT scan were identified. Patient, tumor, and treatment data were collected. Univariate and multivariate analyses were conducted using Kaplan-Meier survival analyses and Cox proportional-hazards regression. Results One hundred eleven patients were included for analysis. Seventy-nine patients were classified as T1 or T2, and 32 patients were classified as T3 or T4. Twenty-three percent of patients had any laryngeal cartilage sclerosis, and 77% of patients had no sclerosis. On univariate and multivariate analyses, there was no statistically significant difference between patients with or without sclerosis. Results did not vary when studying each cartilage separately. Conclusion Laryngeal cancer patients with cartilage sclerosis on CT scan do not have significantly different survival than patients without sclerosis. Validation of these results prospectively is warranted.
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Affiliation(s)
- Sami P. Moubayed
- Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Canada
| | | | - Joe Saliba
- Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Canada
| | - Jackie Bibeau-Poirier
- Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Canada
| | | | | | - Louis Guertin
- Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Canada
| | - Louise Lambert
- Department of Radiation Oncology, CHUM, Montreal, Canada
| | - Marie-Jo Olivier
- Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Canada
| | - Tareck Ayad
- Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Canada
- Department of Surgery, Maisonneuve-Rosemont Hospital, Montreal, Canada
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Lodder WL, Pameijer FA, Rasch CRN, van den Brekel MWM, Balm AJM. Prognostic significance of radiologically determined neck node volume in head and neck cancer: a systematic review. Oral Oncol 2011; 48:298-302. [PMID: 22112442 DOI: 10.1016/j.oraloncology.2011.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022]
Abstract
This systematic review addresses the prognostic significance of neck node volume in head and neck cancer. Primary tumor volume evolved as an independent significant factor for survival in head and neck cancer patients. Besides primary tumor volume, multiple prognostic features related to the regional lymph nodes were studied in literature. In literature, some authors showed the significance of total tumor volume/nodal volume for survival and loco-regional control. Articles reporting prognosis and survival in nodal tumor volumes were collected by systematically reviewing publications listed in the Pubmed and Embase databases. Publications were included when they at least reported on total tumor volume (TTV) or nodal volume and survival. In this systematic review we studied 21 articles. For measurement of nodal volume different formulas were used. Until now, there's no clear statistical evidence for the use of either TTV or nodal volume versus primary tumor volume to predict the individual loco-regional control or survival after treatment. There is wide variety of tumor measuring systems in the literature. The cut-off value for local tumor response also shows large variation. Firstly consensus should be accomplished on standardization of volume measurements, preferably automatic, and secondly large study groups are needed with identical treatment modalities to further unravel the role of neck node volume as separate staging tool.
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Affiliation(s)
- W L Lodder
- Department of Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Sarisahin M, Cila A, Ozyar E, Yıldız F, Turen S. Prognostic significance of tumor volume in nasopharyngeal carcinoma. Auris Nasus Larynx 2011; 38:250-4. [PMID: 20970934 DOI: 10.1016/j.anl.2010.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 09/18/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the prognostic significance of primary and residual tumor volume in nasopharyngeal carcinoma. METHODS 56 patients were included in the study. Diameters of tumors were measured from CT and MR film hardcopies. Diameter-based measurements were computed as an ellipsoid (V=4/3·π·d1·d2·d3) to calculate diameter-based volume. It was investigated whether primary tumor volume provided prognostic information about local regional recurrence free survival (LRRFS), disease free survival (DFS), distant metastasis free survival (DMFS) and overall survival (OS) by monovariant and multivariant analysis. Kaplan-Meier survival analysis method and log-rank test were used to estimate survival analysis (95% confidence interval). Cox regression test was used for two variant and multivariant survival analysis. Statistical Package for Social Sciences (SSSP) 10.0 for Windows programme was used for data analysis. RESULTS In the multivariate analysis, in the patients with tumor volume more than 60ml, local regional recurrence more frequently developed. The relationship between tumor volume and local regional recurrence was found significant (p=0.053). In the monovariate analysis, primary tumor volume was found to be a significant predictive value on DFS and DMFS. In the patients with tumor volume below 20ml, DFS was 60%, whereas in the patients with tumor volume above 60ml, DFS was 0% (p=0.007). The prevalence were 68% and 0% in the patients group that had tumor volume below 30ml and above 60ml respectively. DMSF ratios in the patients with primary tumor volume below 20ml and above 60ml were 86.67% and 33.3% respectively. The residual tumor volume (RTV) at first control after treatment was found to be a significant prognostic factor on LRRFS (p=0.03). CONCLUSION The foundation of new T staging systems that consists of PTV that was found as an independent prognostic factor alone in multivariate statistical analysis may precede better prediction of prognosis and more appropriate treatment of patients having different prognostic factors. RTV in the first control after treatment was a significant prognostic factor on LRRFS.
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Chen SA, Muller S, Chen AY, Hudgins PA, Shin DM, Khuri F, Saba NF, Beitler JJ. Patterns of extralaryngeal spread of laryngeal cancer. Cancer 2011; 117:5047-51. [DOI: 10.1002/cncr.26130] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 02/11/2011] [Accepted: 02/23/2011] [Indexed: 11/11/2022]
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Robertson SM, Yeo JCL, Dunnet C, Young D, Mackenzie K. Voice, swallowing, and quality of life after total laryngectomy: results of the west of Scotland laryngectomy audit. Head Neck 2011; 34:59-65. [PMID: 21416548 DOI: 10.1002/hed.21692] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the effects of radiotherapy and surgical voice restoration on functional outcome after total laryngectomy. METHODS Questionnaire packs were posted to all 258 laryngectomy patients in the West of Scotland Managed Clinical Network. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW-QOL). RESULTS Significantly better VoiSS and MDADI scores were reported by patients undergoing laryngectomy alone in comparison with patients receiving adjuvant radiotherapy and patients undergoing salvage laryngectomy (p < .02). Patients using tracheoesophageal voice reported significantly better VoiSS scores than patients using other communication methods (p < .005). CONCLUSION Radiotherapy has a highly significant and detrimental effect on voice and swallowing outcome after total laryngectomy. Surgical voice restoration confers significant benefit in terms of self-reported voice outcome. These findings have implications for patients with advanced laryngeal cancer considering laryngectomy and organ preservation.
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Affiliation(s)
- Stuart M Robertson
- Department of Otolaryngology, Head and Neck Surgery, Glasgow Royal Infirmary, United Kingdom.
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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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Chen MK, Chen CM, Lee MC, Chen LS, Chen HC. Primary tumor volume is an independent predictor of outcome within pT4a-staged tongue carcinoma. Ann Surg Oncol 2010; 18:1447-52. [PMID: 21174152 PMCID: PMC3078304 DOI: 10.1245/s10434-010-1489-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Indexed: 11/18/2022]
Abstract
Background We evaluated the heterogeneity of primary tumor volume (PTV) within tumors of the same pT4a-staged tongue carcinoma and to elucidate the effects of PTV on treatment outcomes in patients with pT4a-staged tongue carcinoma. Methods Fifty-eight patients with newly diagnosed pT4a-staged tongue carcinoma who received surgery were enrolled onto this study. Magnetic resonance imaging–derived PTV was measured by the summation-of-area technique. Results The mean PTV was 24.55 ml, with a range of 5.32 to 119.64 ml. The receiver operating characteristic curve was applied, and the optimal cutoff volume was 23 ml. Large PTV was associated with a significantly poor disease-specific survival (P = 0.010) by the log rank test. The Cox regression model also revealed that large PTV (P = 0.026) and positive lymphatic node metastasis (P = 0.004) were statistically significant in the prognosis of T4a-staged tongue carcinoma. Conclusions A substantial variation of PTV was present within the same pT4a-staged tongue carcinoma, and PTV represented an important prognostic factor. In the light of these findings, we suggest that taking the PTV into account in pT4a-staged tongue carcinoma would better refine the newest revised T classification, and the treatment strategies may be different.
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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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Hadjiiski L, Mukherji SK, Gujar SK, Sahiner B, Ibrahim M, Street E, Moyer J, Worden FP, Chan HP. Treatment response assessment of head and neck cancers on CT using computerized volume analysis. AJNR Am J Neuroradiol 2010; 31:1744-51. [PMID: 20595363 DOI: 10.3174/ajnr.a2177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Head and neck cancer can cause substantial morbidity and mortality. Our aim was to evaluate the potential usefulness of a computerized system for segmenting lesions in head and neck CT scans and for estimation of volume change of head and neck malignant tumors in response to treatment. MATERIALS AND METHODS CT scans from a pretreatment examination and a post 1-cycle chemotherapy examination of 34 patients with 34 head and neck primary-site cancers were collected. The computerized system was developed in our laboratory. It performs 3D segmentation on the basis of a level-set model and uses as input an approximate bounding box for the lesion of interest. The 34 tumors included tongue, tonsil, vallecula, supraglottic, epiglottic, and hard palate carcinomas. As a reference standard, 1 radiologist outlined full 3D contours for each of the 34 primary tumors for both the pre- and posttreatment scans and a second radiologist verified the contours. RESULTS The correlation between the automatic and manual estimates for both the pre- to post-treatment volume change and the percentage volume change for the 34 primary-site tumors was 0.95, with an average error of -2.4 ± 8.5% by automatic segmentation. There was no substantial difference and specific trend in the automatic segmentation accuracy for the different types of primary head and neck tumors, indicating that the computerized segmentation performs relatively robustly for this application. CONCLUSIONS The tumor size change in response to treatment can be accurately estimated by the computerized segmentation system relative to radiologists' manual estimations for different types of head and neck tumors.
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Affiliation(s)
- L Hadjiiski
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5842, USA.
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Pretreatment prognostic factors of survival in patients with locally advanced nonmetastatic squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent chemotherapy. Am J Clin Oncol 2009; 32:163-8. [PMID: 19307954 DOI: 10.1097/coc.0b013e31818254cc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identification of pretreatment prognostic factors influencing overall survival (OS) in locally advanced squamous cell carcinoma of the head and neck is an important issue in head and neck oncology. METHODS A total of 289 patients were treated with standard fraction or hyperfractionated radiation therapy with or without concurrent low-dose daily chemotherapy. RESULTS Gender (P = 0.43) and age (P = 0.26) did not influence OS whereas Karnofsky Performance Status (KPS) (P < 0.0001), T stage (P < 0.0001), and N stage (P < 0.0001) did. Stage grouping was another factor that influenced OS (P < 0.001). Patients with larynx and nasopharynx fared better than those with other primaries (P = 0.0153). Finally, treatment significantly influenced OS. Multivariate analysis showed that KPS, T and N stage, and treatment were independent prognosticators of OS. CONCLUSIONS KPS, T and N stage, and treatment are independent prognosticators of OS in patients with locally advanced squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent low-dose daily chemotherapy.
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Cagli S, Oztürk M, Yüce I, Deniz K, Güney E. The value of routine clinical and radiologic studies in predicting neoplastic invasion of cricoarytenoid units. AJNR Am J Neuroradiol 2009; 30:1936-40. [PMID: 19643918 DOI: 10.3174/ajnr.a1692] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Evaluation of the laryngeal cartilages is essential for the treatment strategy of patients with laryngeal carcinoma. Our aim was to assess the accuracy of preoperative clinical examinations and CT for preoperative evaluation. MATERIALS AND METHODS A prospective comparative study was performed at a university department on 30 patients with advanced laryngeal carcinomas. All patients were men and underwent total laryngectomy. The preoperative mobility of vocal folds was evaluated and classified as mobile, impaired, or fixed. CT was performed by using multidetector row CT. Cricoarytenoid units (CAUs) from the laryngectomy specimens were cut into sections. Histologic findings were compared with the clinical and radiologic findings. RESULTS The accuracy of combined clinical and CT staging in CAUs with normal mobility, impaired mobility, and absent mobility and negative CT findings was 96.5%, 50%, and 80%, respectively. These scores were 40%, 54.5%, and 83.3% for CAUs with normal mobility, impaired mobility, and absent mobility and positive CT findings, respectively. CONCLUSIONS Arytenoid mobility and >1 cartilage abnormality on CT were found to be reliable indicators of neoplastic cartilage invasion in patients with laryngeal carcinoma.
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Affiliation(s)
- S Cagli
- Department of Otorhinolaryngology, Erciyes University, Kayseri, Turkey.
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Haugen H, Johansson KA, Ejnell H, Edström S, Mercke C. Accelerated radiotherapy for advanced laryngeal cancer. Acta Oncol 2009; 44:481-9. [PMID: 16118082 DOI: 10.1080/02841860510029950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate a single institution's outcome for patients with advanced laryngeal cancer treated with accelerated radiotherapy (RT). Fifty-eight patients with advanced laryngeal cancer (T3/T4N0/N + M0) were treated with curative intent with accelerated RT during the period 1990-1998. Patients received radiotherapy alone or with induction chemotherapy. The 5-year local control (LC) and loco-regional control (LRC) probabilities were both 49% for T3 and 75% for T4 tumors. The 5-year disease-free survival probability was 46% and 68% and overall survival probability was 30% and 39% for T3 and T4 tumors respectively. No significant statistical difference in outcome was found, either between T3 and T4 tumors, or between patients who received induction chemotherapy and those who did not. The treatment results for advanced laryngeal cancer at this institution were comparable to those reported in the literature. The results for T3 and T4 were similar. T4 classification alone should not be an exclusion criterion for larynx preservation. Overall survival was poor, partly because of a high incidence of deaths from intercurrent diseases.
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Affiliation(s)
- Hedda Haugen
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
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Studer G, Lütolf UM, El-Bassiouni M, Rousson V, Glanzmann C. Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol 2009; 46:386-94. [PMID: 17450476 DOI: 10.1080/02841860600815407] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The UICC classification (TNM) represents the validated standard tool to describe tumor extent and includes prognostic information on the probability of disease control. The American Joint Committee on Cancer (AJCC) stage grouping is based on the evaluation of treatment and outcome. Gross tumor volume (GTV) might be more relevant than pure description (TNM) or stage grouping as prognostic factor for local control in head and neck cancer (HNC). Based on the observation of GTV-correlated outcome in our initial HNC patient cohort treated with IMRT, we tested the hypothesis that the GTV is the most reliable predictive tool in HNC outcome. A GTV based volumetric staging system (VS) was introduced, using two volumetric cut-off values (15 and 70 cm3). VS, TNM, and AJCC stages were assessed and correlated with outcome following primary radiation in 172 HNC patients. Analyses were based on Kaplan-Meier survival curves. VS proved to be superior to the TNM/AJCC in predicting outcome. In addition, VS enabled to stratify high- and low-risk patients in advanced TN stages. GTV represented the most important prognostic indicator in HNC treated with IMRT and is recommended to be considered for therapeutic decisions and estimation of outcome.
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Affiliation(s)
- G Studer
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland.
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Bisdas S, Rumboldt Z, Wagenblast J, Baghi M, Koh TS, Hambek M, Vogl TJ, Mack MG. Response and progression-free survival in oropharynx squamous cell carcinoma assessed by pretreatment perfusion CT: comparison with tumor volume measurements. AJNR Am J Neuroradiol 2009; 30:793-9. [PMID: 19351906 PMCID: PMC7051758 DOI: 10.3174/ajnr.a1449] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 11/10/2008] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Perfusion CT (PCT) provides a rapid, reliable, and non-invasive technique for assessing tumor vascularity. The purpose of this study was to assess whether pretreatment dynamic perfusion CT (PCT) may predict response to induction chemotherapy and midterm progression-free survival (PFS) in advanced oropharynx squamous cell carcinoma (SCCA) and to compare the results with those derived by tumor volume measurements. MATERIALS AND METHODS Nineteen patients underwent routine contrast-enhanced CT (CECT), pretreatment PCT, and conventional endoscopy. Tumor response was determined according to radiologic (RECIST) criteria. The PCT parameters, tumor volume, radiologic response, and PFS were analyzed with use of Cox-proportional hazards model, receiver operating characteristic (ROC), and Kaplan-Meier analysis. RESULTS The baseline blood flow (BF), blood volume (BV), and permeability surface area product (PS) were significantly higher, whereas mean transit time (MTT) was significantly lower in the responders than in the nonresponders (P < or = .002). BV showed 100% sensitivity, MTT and PS had the highest specificity (100%), and BF showed 84.2% sensitivity and 66.7% specificity for prediction of tumor response after induction chemotherapy. The pretreatment tumor volume correlated with PFS in the pooled patients group (r = 0.4; P < .0001), whereas postinduction tumor volume correlated significantly with PFS in the responders and nonresponders (r = 0.22-0.64; P < or = .006). Pretreatment tumor volume (P = .0001) and BF (P = .001) were significant predictors for PFS. CONCLUSIONS Pretreatment PCT parameters may predict response after induction chemotherapy. Tumor volume and BF values may predict PFS in patients with advanced oropharyngeal SCCA.
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Affiliation(s)
- S Bisdas
- Department of Radiology, Johann Wolfgang Goethe University, Frankfurt, Germany.
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Hoebers FJP, Pameijer FA, de Bois J, Heemsbergen W, Balm AJM, Schornagel JH, Rasch CRN. Prognostic value of primary tumor volume after concurrent chemoradiation with daily low-dose cisplatin for advanced-stage head and neck carcinoma. Head Neck 2008; 30:1216-23. [DOI: 10.1002/hed.20865] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mendenhall WM, Mancuso AA, Hinerman RW, Malyapa RS, Werning JW, Amdur RJ, Villaret DB. Multidisciplinary Management of Laryngeal Carcinoma. Int J Radiat Oncol Biol Phys 2007; 69:S12-4. [PMID: 17848278 DOI: 10.1016/j.ijrobp.2007.05.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 04/24/2007] [Indexed: 11/21/2022]
Abstract
The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.
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Ljumanovic R, Langendijk JA, van Wattingen M, Schenk B, Knol DL, Leemans CR, Castelijns JA. MR Imaging Predictors of Local Control of Glottic Squamous Cell Carcinoma Treated with Radiation Alone. Radiology 2007; 244:205-12. [PMID: 17581903 DOI: 10.1148/radiol.2441060593] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the prognostic significance of magnetic resonance (MR) imaging-determined tumor parameters, especially the presence of cartilage invasion, regarding local control of glottic squamous cell carcinoma treated with radiation therapy (RT) alone. MATERIALS AND METHODS The study was performed with the approval of our institutional review board; direct patient consent was waived. Pretreatment MR images of 118 patients aged 41-86 years (110 men, eight women) with glottic carcinoma treated with RT alone were reviewed for tumor involvement of specific laryngeal anatomic subsites (including laryngeal cartilage), tumor volume, and extralaryngeal tumor spread; these findings were compared with local control. Local control was defined as absence of a recurrence at the primary site for 2 years. Statistical significance of differences between curves for local control estimated with the Kaplan-Meier method was tested with log-rank test. RESULTS Results of univariate analysis showed all MR imaging-determined parameters to be significant predictors of local control rate, compared with clinical parameters where T classification and vocal cord mobility were the only significant parameters associated with local control. Multivariate analysis (Cox regression model) of clinical and radiologic parameters revealed that hypopharyngeal extension (P=.04) and intermediate T2 signal intensity (SI) in cartilage similar to tumor SI (P<.001) were independent prognostic factors with regard to local control. CONCLUSION Intermediate T2 SI in cartilage, which may suggest cartilage invasion, and hypopharyngeal extension of tumor, predict greater likelihood of local failure, whereas high T2 SI, which may suggest inflammatory tissue in cartilage, predicts lower likelihood of local failure.
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Affiliation(s)
- Redina Ljumanovic
- Department of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
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Hinerman RW, Mendenhall WM, Morris CG, Amdur RJ, Werning JW, Villaret DB. T3 and T4 true vocal cord squamous carcinomas treated with external beam irradiation: a single institution's 35-year experience. Am J Clin Oncol 2007; 30:181-5. [PMID: 17414468 DOI: 10.1097/01.coc.0000251368.57302.cc] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the outcomes after external-beam radiotherapy (RT) for selected T3 and T4 vocal cord squamous cell carcinomas. METHODS AND MATERIALS One hundred nine patients with previously untreated T3 and T4 squamous cell carcinomas of the glottic larynx were treated with curative intent in this Institutional Review Board-approved outcome study using continuous-course RT alone (106 patients) or followed by a planned neck dissection (3 patients) between September 1966 and June 2002. Patients selected for such treatment had relatively low-volume, unilateral disease. Patients were staged according to the recommendations of the American Joint Committee on Cancer (AJCC) as follows: T3N0, 68 patients (62%); T3N1, 14 patients (13%); T3N2B, 5 patients (5%); T4N0, 17 patients (16%); T4N1, 4 patients (4%); and T4N2B, 1 patient. RESULTS The 5-year outcomes after treatment were: local control for stage T3 and T4, 78% and 81%; locoregional control for AJCC stage III and IVa, 62% and 78%; distant metastasis-free survival for AJCC stage III and IVa, 97% and 100%; cause-specific survival for AJCC stage III and IVa, 84% and 87%; and overall survival for AJCC stage III and IVa, 52% and 67%, respectively. Severe complications occurred in 13 patients (12%). CONCLUSIONS The results of this retrospective study compare favorably with those published elsewhere in the literature for T3 and T4 vocal cord carcinomas. Local control and ultimate cure probabilities will hopefully improve further with the addition of concomitant chemotherapy to RT for larger tumors.
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Affiliation(s)
- Russell W Hinerman
- Department of Radiation Oncology at the University of Florida, Gainesville, Florida, USA.
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Dagan R, Morris CG, Bennett JA, Mancuso AA, Amdur RJ, Hinerman RW, Mendenhall WM. Prognostic Significance of Paraglottic Space Invasion in T2N0 Glottic Carcinoma. Am J Clin Oncol 2007; 30:186-90. [PMID: 17414469 DOI: 10.1097/01.coc.0000251403.54180.df] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the prognostic significance of paraglottic space invasion determined with pretreatment computed tomography (CT) for patients with T2N0 glottic carcinoma treated with radiotherapy (RT). METHODS Eighty patients with T2N0 glottic squamous cell carcinomas treated with definitive RT between 1983 and 2002 who had pretreatment CT information available regarding paraglottic space invasion were analyzed. Follow up ranged from 0.14 to 18 years (median, 7.1 years). No patient was lost to follow up. RESULTS Five-year outcomes were: local control, 78%; local control with larynx preservation, 80%; relapse-free survival, 71%; and cause-specific survival, 91%. Multivariate analyses of various parameters (including vocal cord mobility, paraglottic space invasion, supraglottic invasion, and subglottic extension) showed that only subglottic extension significantly influenced the probability of cure. CONCLUSION Paraglottic space invasion is likely associated with increased tumor volume and, by itself, is not necessarily associated with poorer outcome after definitive RT.
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Affiliation(s)
- Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
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Volpato R, Souza RPD, Rapoport A, Carvalho Neto PBD, Beserra Júnior IM. O papel da tomografia computadorizada no estadiamento e tratamento cirúrgico do carcinoma epidermóide do seio piriforme. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Determinar a real extensão das neoplasias do seio piriforme através da tomografia computadorizada após estadiamento clínico/endoscópico (seio piriforme, prega ariepiglótica, espaço paraglótico, glote, subglote, orofaringe, cartilagem tireóide, cartilagem cricóide, cartilagem aritenóide, esôfago cervical, extensão para tecidos moles extralaríngeos e musculatura pré-vertebral) e sua repercussão no planejamento cirúrgico. MÉTODO: O estudo incluiu pacientes portadores de carcinoma epidermóide de seio piriforme, atendidos no Departamento de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis, Hosphel, São Paulo de 1988 e 2003. Foram avaliados os prontuários de 31 pacientes, sendo 29 (93,5%) do sexo masculino e dois (6,5%) do sexo feminino. A análise das tomografias foi realizada por três radiologistas individualmente e para o estudo da concordância interobservadores, foi utilizado o índice Kappa. RESULTADOS: A TC apresentou: forte concordância na avaliação de seio piriforme, prega ariepiglótica, espaço paraglótico e subglote; boa concordância para a orofaringe, glote, cartilagem cricóide, esôfago cervical e tecidos moles extralaríngeos; moderada para as cartilagens tireóide e aritenóide; fraca no estudo da musculatura pré-vertebral. CONCLUSÃO: A avaliação interobservadores das imagens do CEC do seio priforme determina o re-estadiamento TNM e conseqüente mudanças do paradigma cirúrgico.
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