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Importance of tumor volume in supraglottic and glottic laryngeal carcinoma

Einfluss des Tumorvolumens beim glottischen und supraglottischen Larynxkarzinom

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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.

Zusammenfassung

Ziel

Ziel der Studie war es, die prognostischen Werte des Tumorvolumens und/oder des T-Stadiums hinsichtlich der Entwicklung eines Lokalrezidivs (LC), des krankheitsfreien Überlebens (DFS) und des Gesamtüberlebens (OS) für Patienten mit glottischen und supraglottischen Larynxkarzinomen vergleichend zu bewerten.

Patienten und Methodik

Das Volumen des primären Larynxkarzinoms wurde in 150 Patienten mittels Computertomographie bestimmt. Anschließend wurden die Zusammenhänge von Tumorvolumen, T-Stadium und die Kombination beider Kriterien mit dem DFS, OS und der Entwicklung eines Lokalrezidivs nach 5 Jahren mittels univariater und multivariater Cox-Regression analysiert. Die Annahme eines linearen Zusammenhangs zwischen Volumen und therapeutischem Ergebnis wurde mit Hilfe einer quadratischen Approximationsfunktion untersucht. Die Vorhersagekraft der Modelle für das Wiederauftreten von Tumorerkrankungen in der Nachsorgeperiode wurde durch die Auswertung der jeweiligen Grenzwertoptimierungskurve ermittelt.

Ergebnisse

Es wurde ein klarer Zusammenhang zwischen Tumorvolumen und DFS und OS gefunden. Allerdings ergab die Auswertung der quadratischen Approximation keine non-lineare Abhängigkeit des DFS und des LC vom Tumorvolumen. Der prognostische Wert der Untersuchung des Tumorvolumens bezüglich des DFS und OS erwies sich dabei derer des T-Stagings überlegen (jeweils 0,68 und 0,57 vs. 0,59 und 0,54). Bei der Entwicklung eines Lokalrezidivs resultierte für das T-Staging eine bessere Unterscheidung als für die Volumenbestimmung (0,63 vs. 0,61). Die Kombination beider Methoden ergab ebenfalls eine bessere Unterscheidungsfähigkeit (0,69).

Schlussfolgerung

Die Studie zeigt, dass die Voraussagekraft des primären Tumorvolumens bezüglich des DFS und OS bei Larynxkarzinomen derer des T-Stadiums überlegen ist. Eine Ergänzung des T-Staging mit der Untersuchung des Tumorvolumens könnte daher zu einer verbesserten Voraussage von DFS, OS und der Entwicklung eines Lokalrezidivs führen.

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References

  1. Cooper JS, Porter K, Mallin K et al (2009) National Cancer Database report on cancer of the head and neck: 10‐year update. Head Neck 31:748–758

    Article  PubMed  Google Scholar 

  2. Bourhis J, Dendale R, Hill C et al (1996) Potential doubling time and clinical outcome in head and neck squamous cell carcinoma treated with 70 Gy in 7 weeks. Int J Radiat Oncol Biol Phys 35:471–476

    Article  PubMed  CAS  Google Scholar 

  3. Barton MB, Morgan G, Smee R et al (1997) Does waiting time affect the outcome of larynx cancer treated by radiotherapy? Radiother Oncol 44:137–141

    Article  PubMed  CAS  Google Scholar 

  4. Begg AC, Haustermans K, Hart AAM et al (1999) The value of pretreatment cell kinetic parameters as predictors for radiotherapy outcome in head and neck cancer: a multicenter analysis. Radiother Oncol 50:13–23

    Article  PubMed  CAS  Google Scholar 

  5. Hoyer M, Jorgensen K, Bundgaard T et al (1998) Lack of predictive value of potential doubling time and iododeoxyuridine labelling index in radiotherapy of squamous cell carcinoma of the head and neck. Radiother Oncol 46:147–155

    Article  PubMed  CAS  Google Scholar 

  6. Mackillop WJ, Bates JHT, O’Sullivan B, Withers HR (1996) The effect of delay in treatment on local control by radiotherapy. Int J Radiat Oncol Biol Phys 34:243–250

    Article  PubMed  CAS  Google Scholar 

  7. Rades D, Seibold ND, Gebhard MP et al (2011) Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Strahlenther Onkol 187:626–632

    Article  PubMed  Google Scholar 

  8. Studer G, Lütolf UM, El-Bassiouni M et al (2007) Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol 46:386–394

    Article  PubMed  CAS  Google Scholar 

  9. Studer G, Seifert B, Glanzmann C (2008) Prediction of distant metastasis in head neck cancer patients: implications for induction chemotherapy and pre-treatment staging? Strahlenther Onkol 184:580–585

    Article  PubMed  Google Scholar 

  10. Pameijer FA, Balm AJM, Hilgers FJM, Muller SH (1997) Variability of tumor volumes in T3-staged head and neck tumors. Head Neck 19:6–13

    Article  PubMed  CAS  Google Scholar 

  11. Kurek R, Kalogera-Fountzila A, Muskalla K et al (2003) Usefulness of tumor volumetry as a prognostic factor of survival in head and neck cancer. Strahlenther Onkol 179:292–297

    Article  PubMed  Google Scholar 

  12. Johnson CR, Khandelwal SR, Schmidt-Ullrich RK et al (1995) The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation. Int J Radiat Oncol Biol Phys 32:635–641

    Article  PubMed  CAS  Google Scholar 

  13. Knegjens JL, Hauptmann M, Pameijer FA et al (2010) Tumor volume as prognostic factor in chemoradiation for advanced head and neck cancer. Head Neck 33:375–382

    Google Scholar 

  14. Pameijer FA, Mancuso AA, Mendenhall WM et al (1997) Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy? Int J Radiat Oncol Biol Phys 37:1011–1021

    Article  PubMed  CAS  Google Scholar 

  15. Mancuso AA, Mukherji SK, Schmalfuss I et al (1999) Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma. J Clin Oncol 17:631–637

    PubMed  CAS  Google Scholar 

  16. Dubben HH, Thames HD, Beck-Bornholdt HP (1998) Tumor volume: a basic and specific response predictor in radiotherapy. Radiother Oncol 47:167–174

    Article  PubMed  CAS  Google Scholar 

  17. Johnson CR, Khandelwal SR, Schmidt-Ullrich RK et al (1995) The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation. Int J Radiat Oncol Biol Phys 32:635–641

    Article  PubMed  CAS  Google Scholar 

  18. Terhaard CHJ, Kal HB, Hordijk GJ (2005) Why to start the concomitant boost in accelerated radiotherapy for advanced laryngeal cancer in week 3. Int J Radiat Oncol Biol Phys 62:62–69

    Article  PubMed  Google Scholar 

  19. Janssens GO, Rademakers SE, Terhaard CH et al (2012) Accelerated radiotherapy with carbogen and nicotinamide for laryngeal cancer: results of a phase III randomized trial. J Clin Oncol 30:1777–1783

    Article  PubMed  CAS  Google Scholar 

  20. Bol GH, Kotte A, Lagendijk JJW (2003) Volumetool: an image evaluation, registration, and delineation system for radiotherapy. Phys Med 19:80

    Google Scholar 

  21. Wang CC (1986) Factors influencing the success of radiation therapy for T2 and T3 glottic carcinomas importance of cord mobility and sex. Am J Clin Oncol 9:517–520

    Article  PubMed  CAS  Google Scholar 

  22. Wiggenraad RG, Terhaard CH, Hordijk GJ, Ravasz LA (1990) The importance of vocal cord mobility in T2 laryngeal cancer. Radiother Oncol 18:321–327

    Article  PubMed  CAS  Google Scholar 

  23. Royston P, Moons KGM, Altman DG, Vergouwe Y (2009) Prognosis and prognostic research: developing a prognostic model. BMJ 338:b604

    Article  PubMed  Google Scholar 

  24. De Stefani E, Boffetta P, Deneo‐Pellegrini H et al (2004) Supraglottic and glottic carcinomas: epidemiologically distinct entities? Int J Cancer 112:1065–1071

    Article  Google Scholar 

  25. Cooper JS, Mukherji SK, Toledano AY et al (2007) An evaluation of the variability of tumor-shape definition derived by experienced observers from CT-images of supraglottic carcinomas (ACRIN protocol 6658). Int J Radiat Oncol Biol Phys 67:972–975

    Article  PubMed  Google Scholar 

  26. Mukherji SK, Toledano AY, Beldon C et al (2005) Interobserver reliability of computed tomography‐derived primary tumor volume measurement in patients with supraglottic carcinoma. Cancer 103:2616–2622

    Article  PubMed  Google Scholar 

  27. Ljumanovic R, Langendijk JA, van Wattingen M et al (2007) MR imaging predictors of local control of glottic squamous cell carcinoma treated with radiation alone. Radiology 244:205–212

    Article  PubMed  Google Scholar 

  28. Ljumanović R, Langendijk JA, Schenk B et al (2004) Supraglottic carcinoma treated with curative radiation therapy: identification of prognostic groups with MR imaging. Radiology 232:440–448

    Article  PubMed  Google Scholar 

  29. Murakami R, Furusawa M, Baba Y et al (2000) Dynamic helical CT of T1 and T2 glottic carcinomas: predictive value for local control with radiation therapy. Am J Neuroradiol 21:1320–1326

    PubMed  CAS  Google Scholar 

  30. Lo SM, Venkatesan V, Matthews TW, Rogers J (1998) Tumour volume: implications in T2/T3 glottic/supraglottic squamous cell carcinoma. J Otolaryngol 27:247–251

    PubMed  CAS  Google Scholar 

  31. Freeman DE, Mancuso AA, Parsons JT et al (1990) Irradiation alone for supraglottic larynx carcinoma: can CT findings predict treatment results? Int J Radiat Oncol Biol Phys 19:485–489

    Article  PubMed  CAS  Google Scholar 

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Compliance with ethical guidelines

Conflict of interest. L.W. van Bockel, E.M. Monninkhof, F.A. Pameijer, and C.H.J. Terhaard 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, University Medical Centre Utrecht, HP Q00.118, Postbus 85500, 3508 GA, Utrecht, The Netherlands

    L.W. van Bockel MD. & C.H.J. Terhaard MD PhD.

  2. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

    E.M. Monninkhof PhD.

  3. Radiology, University Medical Centre Utrecht, Utrecht, Netherlands

    F.A. Pameijer MD PhD.

Authors
  1. L.W. van Bockel MD.
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  2. E.M. Monninkhof PhD.
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  3. F.A. Pameijer MD PhD.
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  4. C.H.J. Terhaard MD PhD.
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Correspondence to L.W. van Bockel MD..

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van Bockel, L., Monninkhof, E., Pameijer, F. et al. Importance of tumor volume in supraglottic and glottic laryngeal carcinoma. Strahlenther Onkol 189, 1009–1014 (2013). https://doi.org/10.1007/s00066-013-0467-2

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  • DOI: https://doi.org/10.1007/s00066-013-0467-2

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