Importance of tumor volume in supraglottic and glottic laryngeal carcinoma
- PDF / 494,400 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 22 Downloads / 206 Views
Bockel1 · E.M. Monninkhof2 · F.A. Pameijer3 · C.H.J. Terhaard1 1 Department of radiation oncology, University Medical Centre Utrecht 2 Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht 3 Radiology, University Medical Centre Utrecht
Importance of tumor volume in supraglottic and glottic laryngeal carcinoma At present about 50% of laryngeal carcinoma patients are primarily treated with (chemo-)radiotherapy [1]. In our hospital, this number is even higher (≈70–80%; unpublished data). Knowledge of pretreatment factors, which are predictors of outcome, is important. It is commonly known that prognosis declines with more advanced tumor stage (T-stage) [2, 3, 4, 5, 6, 7]. Another important predictor in head and neck squamous cell carcinoma is tumor volume (TV). It is suggested that TV is even more important for outcome than T-stage [8, 9, 10, 11, 12, 13]. For example, in T3 glottic carcinoma local control was achieved in 85% of patients for tumors measuring 3.5 cm3 local control was achieved in only 25%.[14]. Mancuso et al. [15] found a local control of 89% vs. 52% with a TV threshold of 6 cm3 in supraglottic carcinoma. Within the AJCC and UICC staging system, volume is not taken into account. Since there is a large variation in volume within T-stages [10, 15, 16, 17], volume might have additional prognostic value besides T-stage in patients with laryngeal squamous cell carcinoma (SCC). The aim of our study was to assess the prognostic value of TV compared to and in addition to T-stage in glottic and supraglottic laryngeal carcinoma on local control (LC), disease-free survival (DFS), and overall survival (OS).
Material and methods Patients Between 1996 and 2009, 689 patients were treated for laryngeal SCC at the radiation oncology department of our hospital. To improve group homogeneity, we included patients with supraglottic and glottic laryngeal SCC, who were primarily treated with accelerated radiotherapy according to the ASO schedule [18] or who were included in the ARCON study [19]. No chemotherapy was given. A diagnostic CT scan had to be available, on which the tumor had to be clearly visible without artifacts. Finally, 150 patients were eligible for this study.
Measurements Volume
Visible tumor mass was delineated manually on the transversal slices of the contrast-enhanced diagnostic CT. In the majority of the CT scans, a single-slice technique was used. Most diagnostic CT scans had a slice thickness of 1.5–2 mm. Delineations were performed by the first author in consensus with an experienced radiation oncologist (CHJT). In difficult cases, an experienced head and neck radiologist (FAP) was consulted. Criteria for tumor involvement were abnormal contrast enhancement, soft tissue thickening, presence of a mass lesion, infiltration of fatty tissue, or a combination of these. Delineation was performed using 3D delineation software (developed in-house) [20].
T-stage
In a previous study, division of T-stage 2 in 2a and 2b based on the mobility of the vocal cord was suggested, i.e
Data Loading...
