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Prognostic role of tumor volume for radiotherapy outcome in patient with T2 laryngeal cancer

Prognostische Bedeutung des Tumorvolumens für das Ergebnis der Strahlentherapie in Patienten mit T2-Kehlkopfkrebs

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Abstract

Background and purpose

Tumor volume (TV) is recognized as a prognostic factor of treatment outcome for head and neck tumors but is not routinely included in the treatment decision-making process. The purpose of the study was to define its prognostic role for patients with T2 laryngeal cancer.

Material and methods

TV of 160 patients who underwent RT between 2002 and 2006 for T2 laryngeal squamous cell carcinoma were reviewed. The tumor was located in the glottis and epiglottis in 82 (51 %) and 78 (49 %) patients, respectively. TV was manually contoured on pretreatment, planning, contrast-enhanced CT scans and the volumetric measurement (cm3) was calculated by the volume algorithm.

Results

The median TV value was 2.01 cm3 (range 0.15–21.68 cm3). The median TV was significantly lower in patients with glottic tumors (p < 0.0001), N0 (p < 0.001), or well histopatologically differentiated tumors (p = 0.01). A significant correlation between TV, hemoglobin concentration (p < 0.01), and total dose (TD; p < 0.001) was observed. On univariate analyses, TV influenced local control (LC; p = 0.02) and overall survival (OS, p < 0.001). On multivariate analysis, both age (HR 1.038, p = 0.03) and TV (HR = 1.075, p = 0.01) remained significantly related to LC and OS (age: HR 1.038, p = 0.005; TV: HR 1.097, p = 0.0001).

Conclusion

Large TV worsen prognosis of patients with T2 laryngeal cancer. A large TV is more common for supraglottic, poorly differentiated tumors and may suggest higher risk of nodal spread. The routine estimation of TV prior to therapy may be essential in order to select the best treatment option for patients with T2 laryngeal cancer.

Zusammenfassung

Hintergrund

Das Tumorvolumen (TV) ist ein prognostischer Faktor des Behandlungsergebnisses von Kopf- und Halstumoren. Es wird jedoch nicht routinemäßig bei dem Entscheidungsprozess der Therapie angewandt. Das Ziel dieser Studie war, die prognostische Rolle des TV für Patienten mit Kehlkopfkrebs im Stadium T2 festzulegen.

Methoden

Im Zeitraum von 2002 bis 2006 wurden TV von 160 mit Strahlentherapie (RT) behandelten Patienten mit einem T2-Plattenepithelkarzinom des Kehlkopfs analysiert. Der Tumor war in 82 (51 %) Fällen in der Glottis und in 78 (49 %) Fällen in der Epiglottis lokalisiert. Das TV wurde jeweils vor Behandlung manuell anhand von Kontrastmittel-Computertomographieaufnahmen umrissen. Die volumetrischen Berechnungen (cm3) erfolgten mittels eines zweckbestimmten Algorithmus.

Ergebnisse

Der TV-Medianwert betrug 2,01 cm3 (0,15–21,68). Der TV-Median war deutlich niedriger in Patienten mit Glottistumoren (p < 0,0001), im Stadium N0 (p < 0,001) und histopatologisch differenzierten Tumoren (p = 0,01). Eine statistisch signifikante Korrelation wurde zwischen TV und Hämoglobinkonzentration (p < 0,01) und der Gesamtdosis (TD; p < 0,001) beobachtet. In der univariaten Analyse beeinflusste TV signifikant die lokale Kontrollrate (LC; p = 0,02) und das Gesamtüberleben (OS; p < 0,001). Im multivariaten Modell hingen sowohl Alter (HR = 1,038; p = 0,03) als auch TV (HR = 1,075; p = 0,01) signifikant mit LC und OS (Alter: HR = 1,038; p = 0,005; TV: HR = 1,097; p = 0,0001) zusammen.

Schlussfolgerung

Große TV verschlechtern die Prognose der Patienten mit T2-Kehlkopfkrebs. Ein großes TV liegt häufiger bei schlecht differenzierten supraglottischen Tumoren vor und stellt ein höheres Risiko der lymphogenen Metastasierung dar. Die vor der Therapie routinemäßig durchgeführten TV-Schätzungen könnten wesentlich dafür sein, die beste Behandlung für T2-Kehlkopfkrebspatienten auszuwählen.

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Compliance with ethical guidelines

Conflict of interest. T. Rutkowski, A. Wygoda, K. Składowski, B. Hejduk, R. Rutkowski. Z. Kołosza, and B. Maciejewski state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Branch in Gliwice, Wybrzeże Armii Krajowej 15, 44–101, Gliwice, Poland

    T. Rutkowski, A. Wygoda, K. Składowski, R. Rutkowski & B. Maciejewski

  2. Department of Radiodiagnostic, Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Branch in Gliwice, Gliwice, Poland

    B. Hejduk

  3. Department of Epidemiology, Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Branch in Gliwice, Gliwice, Poland

    Z. Kołosza

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  1. T. Rutkowski
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Correspondence to T. Rutkowski.

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Rutkowski, T., Wygoda, A., Składowski, K. et al. Prognostic role of tumor volume for radiotherapy outcome in patient with T2 laryngeal cancer. Strahlenther Onkol 189, 861–866 (2013). https://doi.org/10.1007/s00066-013-0411-5

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  • DOI: https://doi.org/10.1007/s00066-013-0411-5

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