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. 2017 Aug;39(8):1609-1620.
doi: 10.1002/hed.24804. Epub 2017 May 2.

Quantitative pretreatment CT volumetry: Association with oncologic outcomes in patients with T4a squamous carcinoma of the larynx

Jay C Shiao  1   2 , Abdallah S R Mohamed  1   3 , Jay A Messer  1   4 , Katherine A Hutcheson  5 , Jason M Johnson  6 , Heiko Enderling  7 , Mona Kamal  1   8 , Benjamin W Warren  1 , Brian Pham  1 , William H Morrison  1 , Mark E Zafereo  5 , Amy C Hessel  5 , Stephen Y Lai  5 , Merril S Kies  9 , Renata Ferrarotto  9 , Adam S Garden  1 , Donald F Schomer  6 , G Brandon Gunn  1 , Jack Phan  1 , Steven J Frank  1 , Beth M Beadle  1 , Randal S Weber  5 , Jan S Lewin  5 , David I Rosenthal  1 , Clifton D Fuller  1   10
Affiliations

Quantitative pretreatment CT volumetry: Association with oncologic outcomes in patients with T4a squamous carcinoma of the larynx

Jay C Shiao et al. Head Neck. 2017 Aug.

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.

Keywords: T4a; outcomes; radiotherapy; survival; tumor; volume; volumetry.

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Conflict of interest statement

Conflict of interest statement:

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The top panel shows an example A) axial, B) sagittal, and C) coronal section of pretreatment contrast-enhanced CT scan of a patient with T4a supraglottic tumor. The primary tumor is delineated in red and extends through the thyrohyoid ligament into the strap musculature with tumor volume of 54.8 cm3. The lower panel shows an example D) axial, E) sagittal, and F) coronal section of pretreatment contrast-enhanced CT scan of another patient with the tumor delineated in orange, centered in the left subglottic area with destruction of the cricoid cartilage and thyroid cartilage and tumor volume of 17.1 cm3.
Figure 2
Figure 2
Kaplan-Meier curve plot of overall survival endpoint for tumor volume ≥21cm3 vs tumor volume< 21cm3.
Figure 3
Figure 3
Competing risk analysis for patients with T4a laryngeal cancer who underwent (a) larynx preservation with radiotherapy (LP-RT) or (b) total laryngectomy followed by post-operative radiotherapy (TL-PORT). Patterns of competing risk of demise by case are presented.
Figure 4
Figure 4
Kaplan-Meier curve showing the effect of tumor volume in patients treated with larynx preservation followed by radiotherapy.
Figure 5
Figure 5
Results of a multivariate analysis for all survival endpoints. The vertical white lines on the colored boxplots represent hazard ratios (HRs); the colored boxplots themselves represent 95% confidence intervals (CIs). Statistical significance is indicated if a boxplot does not encroach upon a risk ratio of 1.0 (indicated by vertical dashed lines); red boxplots represent increased risk of endpoint occurrence, green boxplots indicate increased reduced risk and grey boxplots indicate no statistically significant difference. Abbreviations: Local control (LC), locoregional control (LRC), relapse-free survival (RFS), disease-specific survival (DSS), cancer event–free survival (EFS), non–cancer cause–specific survival (NCCSS), and overall survival (OS).
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